Authors: Mabotuwana, Thusitha¹; Warren, Jim²; Elley, C Raina³; Kennelly, John³; Paton, Chris⁴; Warren, Debra⁴; Chang Wai, Kuinileti³; Wells, Stewart⁴

Source: Quality in Primary Care, Volume 18, Number 2, April 2010 , pp. 93-101(9)

Publisher: Radcliffe Publishing Ltd.

Abstract:

Background: Pay for performance incentives are becoming increasingly popular, but are typically based on only a single point-in-time measurement as an indicator of chronic condition management.

Aims: To determine the association between three time-interval based indicators of suboptimal blood pressure (BP) control and two point-in-time indicators from the UK Quality and Outcomes Framework (QOF): BP5 (the percentage of patients with hypertension in whom the last BP in the previous nine months was ≤150/90) and DM12 (the percentage of patients with diabetes in whom the last BP in the previous 15 months was ≤145/85).

Methods: We extracted classification data and BP measurements from four New Zealand general practices with 4260 to 6130 enrolled patients. Data were analysed for three indicators with respect to a nine-month evaluation period for patients with hypertension and a 15-month period for patients with diabetes: (1) two or more consistently high BP measurements spaced over ≥90 days, (2) a high BP measurement followed by a lapse of >120 days in BP measurement and (3) no BP measurement for >180 days.

Results: For the four practices, 65-81% of the patients satisfied BP5 and 59-68% of patients satisfied DM12. Of the hypertension patients satisfying BP5, 31% (95% CI: 28-33%) failed at least one of the three interval based indicators; 42% (95% CI: 39-46%) of the diabetes patients satisfying DM12 failed at least one of the three interval based indicators.

Conclusion: Considering only a point-in-time controlled BP measurement provides an incomplete view of the quality of BP management in patients with hypertension or diabetes over a period of time.

Keywords: CLINICAL AUDIT; LONG-TERM CARE; PATIENT OUTCOME ASSESSMENT; QOF; QUALITY INDICATORS

Document Type: Research article

Affiliations: 1: Department of Computer Science - Tamaki Campus and National Institute for Health Innovation/Section for Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand 2: Chair in Health Informatics, Department of Computer Science - Tamaki Campus and National Institute for Health Innovation/Section for Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand 3: Department of General Practice and Primary Health Care, School of Population Health, The University of Auckland, Auckland, New Zealand 4: National Institute for Health Innovation/Section for Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand

Publication date: 2010-04-01

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