Singing from the QOF hymn sheet: Stairway to Heaven or Mephisto Waltz?

[摘要] The general practice research community has lost no time in exploring the impact of the new general practice contract that was implemented in 2004, and this issue of the BJGP publishes a number of articles that offer food for thought. We find that QOF scores were related to practice size, but that smaller practices lost out through lower scores in the organisational rather than the clinical domain.1 Wright et al,2 in a study covering 8 569 practices in England showed that deprivation was inversely related to QOF score contradicting the findings of an earlier but much smaller study which showed that higher QOF scores were positively associated with deprivation.3 However their findings agree with Wang et al1 that larger practices achieved higher QOF scores. On the other hand Wang et al1 found no effect of deprivation on quality scores and also acknowledge that ‘quality, as measured by the QOF, may … reflect quality in data recording [as much as] quality in delivered care’. Guthrie et al4 demonstrate wide variation in financial reward per quality point, with the most affluent practices gaining substantially, and the most deprived losing out, thus institutionalising the inverse care law.

[学科分类] 卫生学