I am always interested to see new and innovative research on the data from QOF and some of the best stuff at the moment is coming from the National Primary Care Research and Development Centre and in particular the team of Dr Tim Doran.
Two papers from this team have been published within a month of each other in two big hitting journals. The first was published in the New England Journal and dealt with the effects of exception reporting (sorry, you or your institution need a subscription to read the whole thing). In one of the more thorough analyses of exception reporting so far there is no association found between exception rates and the points offered in each indicator. Indeed the main association is with the type of indicator with low rates for offering treatment and higher rates for achieving outcomes. No evidence of systematic gaming was found in the QOF data.
In the second paper, this time in the Lancet there is a look at socioeconomic factors on QOF performance (again cash required to read the whole paper). In the early years of QOF practices located in more deprived wards tended to have more problems with attaining higher levels of achievement than those in more affluent areas. There were, however, areas of high achievement in every type of area but low achievement was concentrated in more deprived areas. Things tended to become a lot more even by year three.
There are a couple of interesting points about this second paper. Firstly there appears to be some meaningful outcome despite the fairly poor results that you get with practice based social profiling rather than patient based profiling (no cash required to read - hooray!). i.e. where patients live is more important than where the practice is located.
The second interesting factor is that points are not used for the analysis. Overall mean achievement by each practice is used. This tends to give undue prominence to lithium prescribing and patient referrals and it seems likely that most of the variation between practices is concentrated in a small number of highly variable indicators. It is still, however, much the best method of analysis so far seen in any QOF study. Clearly a team to watch!
