title: Combining QOF data with the care bundle approach may provide a more meaningful measure of quality in general practice.
abstract: BACKGROUND
  A significant minority of patients do not receive all the evidence-based care recommended for their conditions. Health care quality may be improved by reducing this observed variation. Composite measures offer a different patient-centred perspective on quality and are utilized in acute hospitals via the 'care bundle' concept as indicators of the reliability of specific (evidence-based) care delivery tasks and improved outcomes. A care bundle consists of a number of time-specific interventions that should be delivered to every patient every time. We aimed to apply the care bundle concept to selected QOF data to measure the quality of evidence-based care provision.
  
  
  METHODS
  Care bundles and components were selected from QOF indicators according to defined criteria. Five clinical conditions were suitable for care bundles: Secondary Prevention of Coronary Heart Disease (CHD), Stroke & Transient Ischaemic Attack (TIA), Chronic Kidney Disease (CKD), Chronic Obstructive Pulmonary Disease (COPD) and Diabetes Mellitus (DM). Each bundle has 3-8 components. A retrospective audit was undertaken in a convenience sample of nine general medical practices in the West of Scotland. Collected data included delivery (or not) of individual bundle components to all patients included on specific disease registers. Practice level and overall compliance with bundles and components were calculated in SPSS and expressed as a percentage.
  
  
  RESULTS
  Nine practices (64.3%) with a combined patient population of 56,948 were able to provide data in the format requested. Overall compliance with developed QOF-based care bundles (composite measures) was as follows: CHD 64.0%, range 35.0-71.9%; Stroke/TIA 74.1%, range 51.6-82.8%; CKD 69.0%, range 64.0-81.4%; and COPD 82.0%, range 47.9-95.8%; and DM 58.4%, range 50.3-65.2%.
  
  
  CONCLUSIONS
  In this small study compliance with individual QOF-based care bundle components was high, but overall ('all or nothing') compliance was substantially lower. Care bundles may provide a more informed measure of care quality than existing methods. However, the acceptability, feasibility and potential impact on clinical outcomes are unknown.
authors.affiliation: Department of Postgraduate General Practice Education, NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland G3 8BW, United Kingdom.
authors.forename: Carl
authors.initials: C
authors.lastname: de Wet
authors.forename: John
authors.initials: J
authors.lastname: McKay
authors.forename: Paul
authors.initials: P
authors.lastname: Bowie
mesh_terms: D003327:Coronary Disease / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000517:prevention & control; D058006:General Practice / Q000592:standards*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control; D008485:Medical Audit; D029424:Pulmonary Disease, Chronic Obstructive / Q000517:prevention & control; D019984:Quality Indicators, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive / Q000592:standards* / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000517:prevention & control; D012189:Retrospective Studies; D012606:Scotland; D020521:Stroke / Q000517:prevention & control