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Research learning from the UK Quality and Outcomes Framework : a review of existing research

(2010) QUALITY IN PRIMARY CARE. 18(2). p.117-125
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Abstract
Background A new contract between UK primary care practices and government was implemented in April 2004, with substantial financial rewards to general practice for achievement of standards set out in the Quality and Outcomes Framework (QOF). Aim We aimed to review the evidence about the effects of the QOF on health care, including unintended outcomes, and equity. Methods Relevant papers were identified by searching Medline and from the reference lists of published reviews and papers. A separate systematic literature review was conducted to identify papers with information on the impact of the framework on inequalities. Results All studies were observational, and so it cannot be assumed that any changes were caused by the framework. The results both for individual indicators and from different studies vary substantially. The diverse nature of the research precluded formal synthesis of data from different studies. Achievement of quality standards was high when the contract was introduced, and has risen each year roughly in line with the pre-existing trend. Inequalities in achievement of standards were generally small when the framework was implemented, and most have reduced further since. There is weak evidence that achievement for conditions outside the framework was lower initially, and has neither worsened nor improved since. Some interventions in the framework may be cost-effective. Professionals feel consultations and continuity have suffered to some extent. There is very little research about patients’ views, or about the aspects of general practice not measured, such as caring, context and complexity. Conclusion The evidence base about the impact of the QOF is growing, but remains patchy and inconclusive. More high quality research is needed to inform decisions about how the framework should change to maximise improvements in health and equity.
Keywords
incentive, primary health care, epidemiological factors, healthcare disparities, quality of health care, reimbursement

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Chicago
Steel, Nicholas, and Sara Willems. 2010. “Research Learning from the UK Quality and Outcomes Framework : a Review of Existing Research.” Quality in Primary Care 18 (2): 117–125.
APA
Steel, N., & Willems, S. (2010). Research learning from the UK Quality and Outcomes Framework : a review of existing research. QUALITY IN PRIMARY CARE, 18(2), 117–125.
Vancouver
1.
Steel N, Willems S. Research learning from the UK Quality and Outcomes Framework : a review of existing research. QUALITY IN PRIMARY CARE. 2010;18(2):117–25.
MLA
Steel, Nicholas, and Sara Willems. “Research Learning from the UK Quality and Outcomes Framework : a Review of Existing Research.” QUALITY IN PRIMARY CARE 18.2 (2010): 117–125. Print.
@article{1041447,
  abstract     = {Background A new contract between UK primary care practices and government was implemented in April 2004, with substantial financial rewards to general practice for achievement of standards set out in the Quality and Outcomes Framework (QOF).
Aim We aimed to review the evidence about the effects of the QOF on health care, including unintended outcomes, and equity.
Methods Relevant papers were identified by searching Medline and from the reference lists of published reviews and papers. A separate systematic literature review was conducted to identify papers with information on the impact of the framework on inequalities.
Results All studies were observational, and so it cannot be assumed that any changes were caused by the framework. The results both for individual indicators and from different studies vary substantially. The diverse nature of the research precluded formal synthesis of data from different studies.
Achievement of quality standards was high when the contract was introduced, and has risen each year roughly in line with the pre-existing trend. Inequalities in achievement of standards were generally small when the framework was implemented, and most have reduced further since. There is weak evidence that achievement for conditions outside the framework was lower initially, and has neither worsened nor improved since. Some interventions in the framework may be cost-effective. Professionals feel consultations and continuity have suffered to some extent. There is very little research about patients’ views, or about the aspects of general practice not measured, such as caring, context and complexity.
Conclusion The evidence base about the impact of the QOF is growing, but remains patchy and inconclusive. More high quality research is needed to inform decisions about how the framework should change to maximise improvements in health and equity.},
  author       = {Steel, Nicholas and Willems, Sara},
  issn         = {1479-1072},
  journal      = {QUALITY IN PRIMARY CARE},
  keywords     = {incentive,primary health care,epidemiological factors,healthcare disparities,quality of health care,reimbursement},
  language     = {eng},
  number       = {2},
  pages        = {117--125},
  title        = {Research learning from the UK Quality and Outcomes Framework : a review of existing research},
  volume       = {18},
  year         = {2010},
}