Does a higher 'quality points' score mean better care in stroke? An audit of general practice medical records.
BACKGROUND
The Royal College of Physicians (RCP) have produced guidelines for stroke management in primary care; this guidance is taken to be the gold standard for the care of people with stroke. UK general practitioners now have a quality-based contract which includes a Quality and Outcomes Framework (QOF). This consists of financially remunerated 'quality points' for specific disease areas, including stroke. Achievement of these quality points is measured by extracting a limited list of computer codes from practice computer systems.


OBJECTIVE
To investigate whether a high stroke quality score is associated with adherence to RCP guidelines.


METHODS
Examination of computer and written medical records of all patients with a diagnosis of stroke.


METHODS
Two general practices, one in southwest London, one in Surrey, with a combined practice population of over 20 000. Both practices had a similar age-sex profile and prevalence of stroke.


RESULTS
One practice scored 93.5% (29/31) of the available stroke quality points. The other practice achieved 73.4% (22.75/31), and only did better in one stroke quality target. However, the practice scoring fewer quality points had much better adherence to RCP guidance: 96% of patients were assessed in secondary care compared with 79% (P=0.001); 64% of stroke patients were seen the same day, compared with 44%; 56% received rehabilitation compared with 37%.


CONCLUSIONS
Higher quality points did not reflect better adherence to RCP guidance. This audit highlights a gap between relatively simplistic measures of quality in the QOF, dependent on the recording of a narrow range of computer codes, and the actual standard of care being delivered. Research is needed to see whether this finding is generalisable and how the Quality and Outcomes Framework might be better aligned with delivering best practice.
Williams
Peter Huw
PH
St. George's Hospital Medical School, London, UK.
de Lusignan
Simon
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000555:Ambulatory Care Information Systems; D002648:Child; D002675:Child, Preschool; D004739:England; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D002546:Ischemic Attack, Transient / Q000628:therapy*; D008297:Male; D008485:Medical Audit; D008499:Medical Records; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care; D020521:Stroke / Q000628:therapy*; D018875:Vocabulary, Controlled