Professor Mike Pringle presented on the impact of the Quality and Outcomes Framework (QoF) in the UK. He addressed whether QoF improved health outcomes, reduced inequality gaps, and was cost-effective. While some metrics like blood pressure monitoring rates increased after QoF, improvements were already occurring before 2004. QoF initially widened inequality gaps but practices in deprived areas were exempted, and gaps have since narrowed. Potential downsides include reduced professionalism and displaced activities, but exemption code use has declined. Whether QoF is cost-effective is debated as effects of socioeconomics on health are greater than QoF incentives.
The experience of survival following Blood and Marrow Transplant in NSW, Aust...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many experience significant late morbidity and mortality.
Anti-cancer therapy is big business. In Australia alone between 2000 and 2009, cancer-related pharmaceutical expenditure has risen over 200% to over half a billion dollars per annum.
Valuing the EQ-5D-Y Using a Discrete Choice Experiment: Do Adult and Adolesce...Office of Health Economics
Slides from a presentation OHE's Koonal Shah gave at the PROMs research conference on June 20th, 2018. The subject of the presentation was valuing the EQ-5D-Y using a discrete choice experiment: do adult and adolescent preferences differ?
Implementing a shared care model to prevent liver cancer and improve chronic ...Cancer Institute NSW
Hepatocellular cancer (HCC) is among the top 10 causes of cancer death in Australia, with ~80% of cases attributable to chronic viral hepatitis. Although 60-80% of HCCs are preventable by antiviral therapies, multiple barriers exist in the diagnostic and treatment continuum. Chronic hepatitis B (CHB) is the main cause for rising HCC rates in Western Sydney, where the greatest burden of disease is among people born in hepatitis B endemic countries.
A Long-term Evaluation of Interventions on Preventing Preschool Children’s Injury in a Safe Community in Shanghai from 2009 to 2014
By Shuangxiao Qu, CHINA
The experience of survival following Blood and Marrow Transplant in NSW, Aust...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many experience significant late morbidity and mortality.
Anti-cancer therapy is big business. In Australia alone between 2000 and 2009, cancer-related pharmaceutical expenditure has risen over 200% to over half a billion dollars per annum.
Valuing the EQ-5D-Y Using a Discrete Choice Experiment: Do Adult and Adolesce...Office of Health Economics
Slides from a presentation OHE's Koonal Shah gave at the PROMs research conference on June 20th, 2018. The subject of the presentation was valuing the EQ-5D-Y using a discrete choice experiment: do adult and adolescent preferences differ?
Implementing a shared care model to prevent liver cancer and improve chronic ...Cancer Institute NSW
Hepatocellular cancer (HCC) is among the top 10 causes of cancer death in Australia, with ~80% of cases attributable to chronic viral hepatitis. Although 60-80% of HCCs are preventable by antiviral therapies, multiple barriers exist in the diagnostic and treatment continuum. Chronic hepatitis B (CHB) is the main cause for rising HCC rates in Western Sydney, where the greatest burden of disease is among people born in hepatitis B endemic countries.
A Long-term Evaluation of Interventions on Preventing Preschool Children’s Injury in a Safe Community in Shanghai from 2009 to 2014
By Shuangxiao Qu, CHINA
Defining and assessing a delineation uncertainty margin for modern radiotherapyCancer Institute NSW
The implementation of image-guided technology and progressively conformal techniques in modern radiotherapy for the treatment of cancer, ensure the planned distribution of dose is well matched to the clinician-defined target volume. However, this precision relies on the target volume including all malignant tissue, with delineation uncertainty resulting in potential normal tissue toxicities and insufficient dose to the cancer. Methods need to be implemented to minimise delineation uncertainty, and subsequently improve local control and patient outcomes.
SM2015 is an ambitious project with the Ministry of Health and local support. This presentation outlines the design and activities around the data collection and analysis of the evaluation, as well as the results, conclusions, and future activities.
Secondary Cancers, Health Behaviour and Cancer Screening Adherence in survivo...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many survivors experience an increased risk of secondary cancers, infections and chronic diseases.
The Flu-FIT Program : An Effective Colorectal Cancer Screening Intervention
Présentation de Michael B. Potter au colloque "Recherche interventionnelle contre le cancer : Réunir chercheurs, décideurs et acteurs de terrain » - 17 et 18 novembre 2014, BnF, Paris
Don't miss our upcoming webinars! Subscribe today!
In April, CCSN virtually met with MPPs throughout Ontario to discuss our COVID-19 and Cancer Care - Wave 2 Survey. During these meetings, we discussed the difficulty cancer patients and pre-diagnosis patients have had with accessing cancer services during the pandemic and the importance of ensuring the cancer patients receive their 1st and 2nd vaccine doses in a timely manner.
In this webinar, CCSN's Public Policy Analyst Conrad will begin by sharing some of the highlights from our meetings with Ontario MPPs. He will then turn things over to our patient advocates and they will share some of their reflections from our meetings as well as their own experiences with accessing cancer care during the pandemic. Lastly, Conrad will take a closer look at the Ontario data from our survey.
View the YouTube video: https://youtu.be/05u4i89WFfQ
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Rationale and Procedure for Oncology Pricing and Reimbursement in England Tow...Office of Health Economics
The Biotherapy Development Association convened a two-day workshop in January 2014 to assess access to innovative cancer medicines in Europe. This presentation by OHE's Adrian Towse covers the situation in England, examining challenges that are peculiar to England as well as the English experience with issues common across countries.
Defining and assessing a delineation uncertainty margin for modern radiotherapyCancer Institute NSW
The implementation of image-guided technology and progressively conformal techniques in modern radiotherapy for the treatment of cancer, ensure the planned distribution of dose is well matched to the clinician-defined target volume. However, this precision relies on the target volume including all malignant tissue, with delineation uncertainty resulting in potential normal tissue toxicities and insufficient dose to the cancer. Methods need to be implemented to minimise delineation uncertainty, and subsequently improve local control and patient outcomes.
SM2015 is an ambitious project with the Ministry of Health and local support. This presentation outlines the design and activities around the data collection and analysis of the evaluation, as well as the results, conclusions, and future activities.
Secondary Cancers, Health Behaviour and Cancer Screening Adherence in survivo...Cancer Institute NSW
Over 50% of patients undergoing allogeneic BMT can now be expected to become long-term survivors. Unfortunately many survivors experience an increased risk of secondary cancers, infections and chronic diseases.
The Flu-FIT Program : An Effective Colorectal Cancer Screening Intervention
Présentation de Michael B. Potter au colloque "Recherche interventionnelle contre le cancer : Réunir chercheurs, décideurs et acteurs de terrain » - 17 et 18 novembre 2014, BnF, Paris
Don't miss our upcoming webinars! Subscribe today!
In April, CCSN virtually met with MPPs throughout Ontario to discuss our COVID-19 and Cancer Care - Wave 2 Survey. During these meetings, we discussed the difficulty cancer patients and pre-diagnosis patients have had with accessing cancer services during the pandemic and the importance of ensuring the cancer patients receive their 1st and 2nd vaccine doses in a timely manner.
In this webinar, CCSN's Public Policy Analyst Conrad will begin by sharing some of the highlights from our meetings with Ontario MPPs. He will then turn things over to our patient advocates and they will share some of their reflections from our meetings as well as their own experiences with accessing cancer care during the pandemic. Lastly, Conrad will take a closer look at the Ontario data from our survey.
View the YouTube video: https://youtu.be/05u4i89WFfQ
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
Rationale and Procedure for Oncology Pricing and Reimbursement in England Tow...Office of Health Economics
The Biotherapy Development Association convened a two-day workshop in January 2014 to assess access to innovative cancer medicines in Europe. This presentation by OHE's Adrian Towse covers the situation in England, examining challenges that are peculiar to England as well as the English experience with issues common across countries.
Nursing Evidence Based Practice PPT for BSN Nurses.
This ppt assess effectiveness of using NPWT for DFUs with providing highest level of evidence. DFUs are a prevalent issue in many countries and is treated via dressings which take a long time to heal but utilizing this method will certainly make the recovery faster.
Helping chronically ill or disabled people into work: what can we learn from ...StephenClayton11
This project has added to knowledge in five main areas:
It has mapped the range and types of policies and interventions that have been
implemented in Canada, Denmark, Norway, Sweden and the UK that may influence
employment chances for chronically ill and disabled people. By doing so it has added
to understanding about what has actually been tried in each country and what might be
considered in others.
It has refined a typology of the focussed interventions that have been identified, based
on the underlying programme logic of the intervention, which aids strategic thinking
about national efforts to help chronically ill and disabled people into work.
It has produced systematic reviews of the impact of the focussed interventions on the
employment chances of chronically ill and disabled people and demonstrated the use of
the typology in helping to interpret the results of the evaluations.
The project’s empirical analyses of individual-level data have identified how
chronically ill people from different socio-economic groups have fared in the labour
markets of the five countries over the past two decades. It has then tested these findings
against hypotheses about the impact of macro-level labour market policies on
chronically ill people to provide insights into the influence of the policy context.
The project has contributed to methodological development in evidence synthesis and
the evaluation of natural policy experiments. By studying a small number of countries
in great depth, we gained greater understanding of the policies and interventions that
have been tried in these countries to help chronically ill and disabled people into work,
against the backdrop of the wider labour market and macro-economic trends in those
countries. We then integrated evidence from the wider policy context into the findings
of systematic reviews of effectiveness of interventions, to advance interpretation of the
natural policy experiments that have been implemented in these countries.
Project ECHO (Extension for Community Health Outcomes)icornpresentations
Sanjeev Arora MD, Distinguished Professor of Medicine (Gastroenterology/Hepatology); Director of Project ECHO®
Department of Medicine, University of New Mexico Health Sciences Center
MicroGuide app, pop up uni, 1pm, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
The revised OECD Health Systems Performance Framework: methodological issues ...Sax Institute
The OECD is a leading organization in the international measurement of health system performance. The OECD Expert Group on Health Care Quality Indicators (HCQI) has recently revised its performance framework, identifying core indicators and highlighting new directions. Although improving, the capacity of countries to deliver more accurate standardized indicators still needs to be fostered. A particular aspect that deserves attention is the design, planning and implementation of public performance reporting. Such activity, strictly interrelated to the capacity of the information infrastructure, also depends from cultural, organizational and political conditions that can be differently present at the international level. The applicability of standardized principles and the evidence of improved outcomes due to public reporting systems is still questioned to a large extent. A first international conference on the topic of hospital performance reporting has been organized in Rome, Italy in 2014, followed by a second event held in Seoul, South Korea, in 2015. In his talk, Fabrizio Carinci will present recent developments of OECD projects, including:
• state of the art in the definition of OECD performance indicators
• challenges emerging from OECD R&D studies
• transferability and use of definitions at sub-national and provider level
• applicability for hospital performance benchmarking and geographical variation
• limitations imposed by the legislation on privacy and data protection
• an overarching vision of “essential levels of health information”
Through practical examples drawn from his direct experience as Member of the Bureau of the HCQI and other relevant Boards, Prof. Fabrizio Carinci will discuss the state of the art, the role played by national governments (including Australia), and potential avenues for mutual collaboration.
Advancing Nursing Research to Address Global Health ChallengesRyan Michael Oducado
I this presentation, I will delve into the significance
of nursing research, some of the global health challenges that demand our attention,
the current state of nursing research, the vital role of studies conducted by nurses in
addressing these challenges, and how we can collectively advance the cause of
nursing research. We will also explore the challenges and the hurdles that often
accompany our research journey. Furthermore, we will discuss the power of
research, the strengths of collaboration, the availability of resources, and the
dissemination of research findings to create a positive, lasting impact.
1. Professor Mike Pringle, Valencia, 24th June 2010
THE IMPACT OF THE QUALITY AND
OUTCOMES FRAMEWORK
Professor Mike Pringle
Professor of General Practice
University of Nottingham
2. Professor Mike Pringle, Valencia, 24th June 2010
Questions to address
• What was the overall effect of the
introduction of QoF?
• What effects on inequalities?
• Any other unintended disbenefits?
• Is QoF cost-effective?
3. Professor Mike Pringle, Valencia, 24th June 2010
What was the overall effect of the
introduction of QoF?
• Qresearch1 analysis shows higher
prevalence of key conditions
• And improvement in between pre- and
post-QoF
5. Professor Mike Pringle, Valencia, 24th June 2010
What was the overall effect of the
introduction of QoF?
• And.... % of adults with up to date BP
monitoring up from 82.3% in 2005 to
88.3% in 20072
6. Professor Mike Pringle, Valencia, 24th June 2010
What was the overall effect of the
introduction of QoF?
• But.... QoF metrics were improving
before 2004 in diabetes3 and other
QoF conditions4.
• In CHD, the percentage of patients
with BP controlled rose from 47% in
1998 to 72% in 2003; and cholesterol
controlled from 18% in 1998 to 61% in
20035
7. Professor Mike Pringle, Valencia, 24th June 2010
What was the overall effect of the
introduction of QoF?
8. Professor Mike Pringle, Valencia, 24th June 2010
What was the overall effect of the
introduction of QoF?
• Improvements in diabetes QoF
indicators after 2004 were not great6
9. Professor Mike Pringle, Valencia, 24th June 2010
What effects on inequalities?
• There were fears that the better
practices in the least deprived areas
would perform best, increasing the
inequality gap (and disparity in GP
income)
10. Professor Mike Pringle, Valencia, 24th June 2010
What effects on inequalities?
• There were lower QoF scores in more
deprived areas7 and initially there was
evidence for a widening of
inequalities8,9
11. Professor Mike Pringle, Valencia, 24th June 2010
What effects on inequalities?
• But... Due to exemption codes,
practices in deprived areas have not
been penalised10
12. Professor Mike Pringle, Valencia, 24th June 2010
What effects on inequalities?
• And average levels of achievement
have increased over the first three
years of QoF, and the variation has
diminished 11:
Year Quintile 1 (least) Quintile 5 (most)
2004/5 86.8% 82.8%
2006/7 91.2% 90.4%
Difference +4.4% +7.6%
13. Professor Mike Pringle, Valencia, 24th June 2010
What effects on inequalities?
Average score (% ) against deprivation
100%
95% 2004-5
90% 2008-9
85%
Q1 - areas with Q2 - areas with Q3 - areas with Q4 - areas with
lowest middle lowest middle highest highest
deprivation deprivation deprivation deprivation
Quartiles
15. Professor Mike Pringle, Valencia, 24th June 2010
Any other unintended disbenefits?
Proposed disbenefits include:
• Reduction in professionalism (box
ticking)12,13
• Gaming12,14
• Patient coersion12
• Displacement of other, more useful,
activities12
16. Professor Mike Pringle, Valencia, 24th June 2010
Any other unintended disbenefits?
But.... Use of exemption codes
decreased markedly in the second
year and remains low14
17. Professor Mike Pringle, Valencia, 24th June 2010
Is QoF cost-effective?
• £1bn per year (20% of general
practice income)15 but most would
have been paid anyway
• Could be argued that good care
should have been core, not requiring
incentives
• Effects of socio-economics is much
greater than any effects of QoF16
18. Professor Mike Pringle, Valencia, 24th June 2010
Is QoF cost-effective?
It is your decision!
19. Professor Mike Pringle, Valencia, 24th June 2010
References:
1. Time series analysis for selected clinical indicators from the Quality and
Outcomes Framework 2001-2006. Hippis;ey-Cox J, Vinogradova V,
Coupland C. Qresearch, 2006
http://www.qresearch.org/Public_Documents/Time%20Series%20Analysis
%20for%20selected%20clinical.pdf
2. Ashworth M, Medina J, Morgan M. Effect of social deprivation on blood
pressure monitoring and control in England: a survey of data from the
quality and outcomes framework. BMJ, 2008;337:2030
3. Khunti K, Gadsby R, Millet C, Majeed A, Davies M. Quality of diabetes care
in the UK: comparison of published quality of care reports and the results of
the Quality and Outcome Framework for diabetes. Diabetic Medicine,
2007;24:1436-1441
4. Roland M. The Quality and Outcomes Framework: too early for a final
verdict. BJGP, 2007; 57:525-527
5. Campbell S, Roland M, Middleton E, Reeves D. Improvements in the quality
of clinical care in English general practice 1998-2003. BMJ 2005; 331:
1121-1123
20. Professor Mike Pringle, Valencia, 24th June 2010
6. Calvert M, Shankar A, McManus R, Lester H, Freemantle N. Effect of the
quality and outcomes framework on diabetes care in the United Kingdom:
retrospective cohort study. BMJ, 2009; 338:1870
7. Ashworth M, Armstrong D. The relationship between general practice
characteristics and quality of care: a national survey of quality indicators
used in the UK Quality and Outcomes Framework 2004-5. BioMed Central,
2006; 7:68 doi:10.1186/1471-2296-7-68
8. Wright J, Martin D, Cockings S, Polack C. Overall Quality and Outcomes
Framework scores lower in practices in deprived areas. BJGP, 2006; 56:
277-279
9. Ashworth M, Seed P, Armstrong D, 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. BJGP,
2007; 57: 441-448
10. 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 Epi and Comm Health, 2006; 60: 917-
922
21. Professor Mike Pringle, Valencia, 24th June 2010
11. Doran T, Fullwood C, Kontopantelis E, Reeves D. Effect of financial
incentives on inequalities in the delivery of primary clinical care in England:
analysis of clinical activity indicators in the quality and outcomes framework.
The Lancet, 2008; 372: 728-736
12. Mangin D, Toop L. The Quality and Outcomes Framework: what have you
done to yourselves? BJGP, 2007; 57: 435-437
13. Lester H, Sharp D, Hobbs F, Lakhani M. The Quality and Outcomes
Framework of the GMC Contract: a quiet evolution for 2006 BJGP, 2006;
56: 244-246
14. Gravelle H, Sutton M, Ma A. Doctor behaviour under a pay for performance
contract: further evidence from the quality and outcomes framework.
University of York, 2007
15. Roland M. Linking physicians’ pay to the quality of care – a major
experiment in the United Kingdom. NEJM, 2004; 351: 1448-1454
16. Downing A, Rudge G, Cheng Y, Tu Y-K, Keen J, Gilthorpe M. Do the UK
government’s new Quality and Outcomes Framework (QoF) scores
adequately measure primary care performance? BMC Health Services
Research, 2007; 7: 166
23. Professor Mike Pringle, Valencia, 24th June 2010
THE IMPACT OF THE QUALITY AND
OUTCOMES FRAMEWORK
Professor Mike Pringle
Professor of General Practice
University of Nottingham