Skip to main content

Unintended consequences of quality measurement

Although pay-for-performance programs and public reporting of the performance of health care providers - such as general practices in the UK - have become integral components of strategies to improve the quality of health care, measurement and reporting of the quality of healthcare can also have unintended consequences. In a recent article published in the Annals of Internal Medicine, I discuss 'exception reporting', a method whereby patients who will not benefit from an intervention (such as those who are terminally ill) are excluded from quality measurement and not treated inappropriately.

Exception reporting rates in the UK Quality & Outcomes Framework vary widely among general practices that take part in the scheme. When Dalton et al examined exception reporting rates among people with diabetes from 23 general practices in London, they found that patients who were exception-reported by their physicians were significantly less likely to achieve treatment targets for haemoglobin A1c, blood pressure and cholesterol control. The highest rates of exception reporting occurred among already disadvantaged groups at greatest risk for diabetes complications and poorer health outcomes, such as older patients, patients from ethnic minority groups, and patients with longer durations of diabetes and increased levels of co-morbidity.

The findings of this study - published in the journal Diabetic Medicine - highlight the importance of monitoring exclusions from pay-for-performance and public reporting programs.

Comments

Popular posts from this blog

Example ADHD Referral Letter

Dear Dr, I am writing to refer a 28-year-old male patient of mine, Mr [Patient's Name], for assessment for the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD). After a thorough clinical assessment, I believe that Mr. [Patient's Name] meets the criteria for adult ADHD as outlined in NHS guidance for primary care teams in SE London. Mr [Patient's Name] has been under my care for XX years and, during this time, he reports several symptoms (greater than five symptoms in total) consistent with ADHD in adults that have been present for more than six months. These symptoms include difficulties in focusing, following through on tasks, hyperactivity, forgetfulness, impulsiveness, restlessness, and irritability. Mr [Patient's Name] also reports being easily distracted, struggling with time management, organisation, and completing tasks efficiently. Many of Mr [Patient's Name]'s symptoms have been present since he was under 12 years old; and have

Dr Curran and Partners – Clinical Update 10 August 2023

1. Measles The UKHSA has warned that unless MMR vaccination rates improve, London could experience a large measles outbreak. Measles is potentially a very serious illness with important complications - but is preventable though vaccination.  Please ensure patients and their families are up to date with their vaccinations. Please also check the vaccine status of new patients - particular migrants - and enter details onto the medical record of any vaccines given elsewhere. https://www.gov.uk/government/news/london-at-risk-of-measles-outbreaks-with-modelling-estimating-tens-of-thousands-of-cases 2. Shingles vaccination The shingles vaccine programme is being expanded. From September, GP practices will offer: - Those aged 70-79, 1 dose of Zostavax or 2 doses of Shingrix - People aged 50+ with a weak immune system, 2 doses of Shingrix - Those turning 65 & 70, two doses of Shingrix vaccine. For further details, see https://www.gov.uk/government/publications/shingles-vacc

Why we need to put an end to the GANFYD culture in the UK

One of the causes of increased workload in general practice are the many requests that doctors get for letters, reports and forms from patients or from external organisations. It’s now so common that doctors have coined a term for it: GANFYD – Get A Note From Your Doctor.  It’s seems that large sections of society can’t function without these “letters from doctors”. Instead of using common sense or employing their own clinical advisers, external organisations make repeated requests to NHS doctors for letters which are often not at all needed. Often the worst offenders come from the public sector – e.g. universities who seem to look upon NHS general practice as a source of free occupational health advice for their students. Universities never – of course - offer to pay for this advice they get from NHS GPs. Instead, university requests will come with a mealy-mouthed statement that any fee is the responsibility of the student. Like doctors are going to impose heavy fees on impoverished s