Health inequalities. Volume II, Written evidence / House of Commons, Health Committee.

  • Great Britain. Parliament. House of Commons. Health Committee
Date:
c2008
Catalogue details

Licence: Open Government Licence

Credit: Health inequalities. Volume II, Written evidence / House of Commons, Health Committee. Source: Wellcome Collection.

    19/370 (page 11)
    4. Research on QOF and inequalities can be divided into studies that have used: (1) national QOF data from QMAS and (2) existing primary care datasets containing patient level information. STUDIES USING NATIONAL QOF DATA 5. National QOF data is only available on general practices, PCTs, SHAs, and for England (ie individual patient data is unavailable).Studies using national QOF data have generally found that practices situated in less deprived areas achieve higher QOF scores.**+5° However, the gaps between practices in prosperous and poor areas have tended to be fairly small and more recent analyses suggest that these differences may have diminished further in year 2 of the new contract.’ 6. The scope for assessing the impact of QOF on known inequalities in chronic disease management using QMAS data is limited for several reasons. Firstly, the data lacks crucial patient level information on variables such as age, sex, ethnicity and deprivation. As such these studies are restricted to undertaking ecological analyses using practice assigned, area-based measures of socio-economic status. Secondly, the ability of practices to “exception report” patients means that the quality of care delivered in different areas and to different patient groups may be much more variable than this data indicate. At least one study has found that practices with more deprived patient populations are more likely to report “exceptions” for QOF indicators. Finally, no baseline data is available to assess the extent of inequalities before the introduction of QOF. STUDIES USING DATASETS WITH PATIENT LEVEL INFORMATION 7. Findings from a smaller number of published studies which have used individual patient level information suggest that the impact of QOF on inequalities has been mixed. The findings suggest that while care was largely equitable between ethnic groups when assessed using process of care measures,”!° inequities in prescribing and intermediate clinical outcomes between ethnic groups evident before the implementation of QOF have persisted after its implementation. |! 8. These studies examined trends in the quality of care for Coronary Heart Disease (CHD), hypertension and diabetes before (April 2003) and after (December 2005) the introduction of QOF in Wandsworth, south London. This work is part of a wider programme of research which has been evaluating the impact chronic disease management initiatives for cardiovascular disease and diabetes since 1998. 2 Ashworth, M., Armstrong, D. (2006). The relationship between general practice characteristics and quality of care: a national survey of indicators used in the UK “Quality and Outcomes Framework”, 2004-5. BMC Family Practice,7,68. http://www. ingentaconnect.com/content/regp/bjgp/2007/39283057/00000539/ art00005?token = 004b1950f38ac52a12f653b2a2d3a7c4e7247704f7e4 | 225f406a535747465476783b6f4455 3 McLean G, Sutton M, Guthrie B. Deprivation and quality of primary care services: evidence for persistence of the inverse care law from the UK Quality and Outcomes Framework J Epidemiol Community Health. 2006 Nov;60(11):917-22. http://jech.bmj.com/cgi/content/full/60/1 1/917 4 C Millett, J Car, D Eldred, K Khunti, A Mainous, A Majeed. Diabetes prevalence, process of care and outcomes in relation to practice size, caseload and socio-economic status: national cross-sectional study in primary care. JRSM 2007;100: 275-283. http://www. jrsm.org/cgi/content/full/100/6/275?maxtoshow = &HITS = 10&hits = 1|O&RESULTFORMAT = &author! = millett&searchid = 1|&FIRSTINDEX = 0&resourcetype = HWCIT > Saxena S, Car J, Eldred D, Soljak M, Majeed A. Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study. BMC Health Serv Res. 2007 Jun 27;7:96. http://www.biomedcentral.com/1472-6963/7/96 6 Doran, T., Fullwood, C., Gravelle, H., Reeves, D., Kontopantelis, E., Hiroeh, U., Roland, M. (2006). Pay-for-performance programs in family practices in the United Kingdom. N Engl J Med, 355, 375-384. http://content.nejm.org/cgi/content/full/355/4/375 7 Ashworth, M., Armstrong, D., Seed, P., Durbaba, S., Jones, R. The relationship between social deprivation and the quality of primary care: a national survey using indicators from the UK Quality and Outcomes Framework. Br J Gen Pract 2007;57, 441-448. http://www. biomedcentral.com/1471—2296/7/68 8 L.A. Sigfrid, C. Turner, D. Crook, S. Ray. Using the UK primary care Quality and Outcomes Framework to audit health care equity: preliminary data on diabetes management. Journal of Public Health 2006; Vol. 28, No. 3, pp. 221-225. http://jpubhealth.oxfordjournals.org/cgi/content/full/28/3/221 ® Gray, J., Millett, C., Saxena, S., Netuveli,G., Khunti, K., Majeed, A. Ethnicity and quality of diabetes care in a health system with universal coverage: population-based cross sectional survey in primary care. J Gen Intern Med 2007;, 22, 1317-20. http://www.springerlink.com/content/m734751641272703/ Millett C, Gray J, Saxena S, Netuveli G, Majeed A. Impact of a pay for performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes. CMAJ 2007; 176(12):1705-10. http://www.cmaj.ca/cgi/content/full/1 76/12/1705 Millett C, Gray J, Saxena S, Netuveli G, Khunti K, Majeed A. Ethnic Disparities in Diabetes Management and Pay-for-Performance in the UK: The Wandsworth Prospective Diabetes Study. PLoS Medicine 2007; 4(6): e191. doi:10.1371/journal.pmed.0040191. http://medicine. plosjournals.org/perlserv/?request = get-document&doi = 10.1371/journal.pmed.0040191 1¢