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首页> 外文期刊>BMJ: British medical journal >QOF points: valuable to whom?
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QOF points: valuable to whom?

机译：QOF分:有价值的谁?

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Introduced in 2004, the UK Quality and Outcomes Framework (QOF) is the most comprehensive national primary care pay for performance scheme in the world. It includes financial incentives and information technology (computerised prompts and decision support) to achieve evidence based quality targets. The inducements are substantial, with a maximum of 1000 points available to practices, and an average payment per practice in 2011-12 of ￡130 (?150; $205) for each point achieved.2 Over half of these points are allocated to clinical indicators, which currently cover 22 chronic conditions, and the remainder to organisational indicators (see box, bmj.com). The QOF was designed to improve the management of chronic disease by rewarding practices for delivering interventions linked to improved health outcomes for heart disease, diabetes, and other major scourges. The money to implement the scheme was intended to raise pay for general practices. Subsequently, proposed changes have been agreed by the General Practitioners Committee of the British Medical Association and the Department of Health. Negotiations over revisions to the General Medical Services contract in England having stalled, the Department of Health recently announced that it intends to impose changes to the QOF in 2013-14. These include: ? Raising the upper threshold for the percentage of patients receiving the relevant interventions in order to achieve maximum points, and therefore payment ? Discontinuing the organisational domain. Implementing the National Institute for Health and Clinical Excellence (NICE) recommendations for new clinical indicators. The effects of the QOF on quality of care have generated considerable debate. Do payments reflect better recording rather than better care, and do practices achieve high scores by "gaming" the system? Drawing firm conclusions about the effects of the QOF is difficult because it was implemented across the UK, leaving no comparator practices. Improved processes (such as treating hypertension) may not always translate into improved outcomes (such as stroke prevention) because of other powerful influences on outcomes such as differential access to care, non-modifiable risk factors (genetic), or patterns of comorbidity. Nevertheless, the debate is now being informed by an accumulating body of research into both the benefits and costs of the QOF. We consider the implications of the government's proposed changes, whether the QOF is likely to have improved the population's health, and how its effect could be augmented.
机译：介绍了在2004年,英国的质量和结果框架(QOF)是最全面的国家初级保健支付绩效计划在这个世界上。和信息技术(计算机提示和决策支持)实现基于证据的质量目标。最大可用的1000点每个实践实践,和平均支付2011 - 12的￡130 (? 150;achieved.2分配给临床指标,目前覆盖22个慢性病,其余部分组织指标(见框,bmj.com)。QOF旨在改善管理慢性疾病的有益的实践提供干预措施与改进心脏病、糖尿病的健康结果其他主要灾难。计划旨在提高支付一般实践。同意的全科医生英国医学协会的委员会卫生部。修正的一般医疗服务合同在英格兰已经停滞不前,卫生部最近宣布它打算实施更改QOF在2013 - 14所示。这些包括:?病人接受相关的百分比干预措施以达到最大点,因此付款?组织域。健康和临床研究所(NICE)对新的临床的建议指标。护理产生相当大的争论。支付反映记录而不是更好更好的护理,做实践取得高分“游戏”系统?关于QOF的影响是困难的,因为这是实现整个英国,没有留下比较器实践。治疗高血压)可能并不总是翻译改进的结果(如中风预防),因为其他强大的影响微分获得医疗,等结果不可更改的风险因素(遗传),或疾病的模式。现在被告知是一个积累的身体吗研究的收益和成本QOF。政府提出的更改,QOF是否可能改善人们的健康,和如何增强其效果。

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