Chronic disease care poorer in nursing and residential homes under GP target scheme

Mar 09, 2011

The quality of chronic disease care under the GP pay for performance system is poorer for residents of care homes than those living in the community, according to a study published in the British Medical Journal today.

The Quality and Outcomes Framework (QOF) for general practice is a voluntary system of , which has been in place since 2004. Part of the programme includes specific targets for GPs to demonstrate high quality care for patients with .

The study found that, although pay for performance systems do not invariably disadvantage residents of care homes, GPs are much more likely to exclude them from quality targets, which may compromise their care.

The authors, led by Dr Sunil Shah from St George's, University of London, say that pay for performance systems should include measures relevant to care home residents to improve chronic disease care in this often vulnerable group.

Dr Shah and his team studied data from The Health Improvement Network (THIN), a large database of primary care records from 326 UK , to assess the quality of chronic disease care for care home and community residents.

They identified 10,387 care home and 403,259 community residents aged 65 to 104 years who were registered for 90 or more days with their .

Even after adjusting for age, sex and dementia diagnosis, they found that attainment of quality targets was significantly lower for residents of care homes than for those in the community for 14 of 16 indicators suitable for older people in care homes.

The largest differences were for prescribing in heart disease and monitoring of diabetes. Smaller differences were seen for use of antiplatelet therapy and monitoring of blood pressure.

Residents of care homes were also more likely to be excluded from all QOF targets for a condition. For example, 34% of patients with stroke in care homes were excluded compared with 17% in the community, and 35% compared with 9% for diabetes.

This difference persisted even after taking account of patients with dementia or with limited life expectancy.

This is the first study to examine quality of care for residents in care home since the introduction of pay for performance in the primary care contract and shows a need to improve care for chronic diseases among older people in care homes, say the authors.

They acknowledge that, for some interventions, lower attainment of quality indicators may be appropriate, but argue that "high disease wide exceptions suggest a less individualised approach and may act as a disincentive to good disease management."

They conclude: "Our current findings support enhancement of pay for performance systems to include measures that are particularly relevant to residents of care homes and vulnerable older people in the community, such as pain management, falls and continence care."

Explore further: Instant noodles carry health risks for women: study

add to favorites email to friend print save as pdf

Related Stories

Hispanics appear to face poorer quality nursing home care

Apr 10, 2009

Nursing homes serving primarily Hispanic residents provided poorer quality care compared to facilities whose patients were mostly white, according to Brown University research. Details were published recently in the Journal of ...

Recommended for you

Many patients are discharged without a diagnosis

2 hours ago

Chest pain, breathing difficulties, fainting. Each year approx. 265,000 Danes are acutely admitted to medical departments with symptoms of serious illness. New research from Aarhus University and Aarhus University Hospital ...

Wellness visits, physicals need different documentation

2 hours ago

(HealthDay)—Documentation rules for annual wellness visits (AWVs) for Medicare differ from those for preventive visits, which are not covered by Medicare, according to an article published Aug. 5 in Medical Ec ...

User comments : 0