title: Using the UK primary care Quality and Outcomes Framework to audit health care equity: preliminary data on diabetes management.
abstract: BACKGROUND
  The incentivization of UK primary care through the Quality and Outcomes Framework (QOF) has released an unprecedented supply of data that in theory could aid health equity audit and reduce health inequalities. The current system allows for 'exception reporting' whereby patients can be excluded from calculation of payment for reasons such as failure to attend review. We speculated that such exclusions could be linked to socioeconomic deprivation.
  
  
  METHODS
  We assessed 'exception reporting' rates for 15 diabetes indicators using 2004/05 QOF data for 49 general practitioner (GP) practices in Brighton and Hove and related it to a deprivation ranking for each practice.
  
  
  RESULTS
  The standardized diabetes prevalence was 26% higher (P < 0.001) in the highest compared to the lowest quintile of deprivation. Correlations between 'exception reporting' and deprivation were seen for 10 of the 15 diabetes indicators (r = 0.20-0.41, P < 0.05). Practices with a more deprived patient population were more likely to report 'exceptions' for QOF indicators, although there was no such relationship with the achievement of QOF targets.
  
  
  CONCLUSIONS
  Strategies to reduce health inequalities need to take into account that high levels of exception reporting, particularly in practices with deprived populations, may be disguising unmet need in those populations.
authors.affiliation: Department of Public Health, Brighton and Hove City Primary Care Trust, Prestamex House, 171-173 Preston Road, Brighton BN1 6AG, East Sussex, UK.
authors.forename: L A
authors.initials: LA
authors.lastname: Sigfrid
authors.forename: C
authors.initials: C
authors.lastname: Turner
authors.forename: D
authors.initials: D
authors.lastname: Crook
authors.forename: S
authors.initials: S
authors.lastname: Ray
mesh_terms: D001071:Appointments and Schedules; D003920:Diabetes Mellitus / Q000628:therapy*; D006297:Health Services Accessibility; D006801:Humans; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012959:Socioeconomic Factors; D006113:United Kingdom