Quality and safety
Quality
Quality of care
We have worked over several years to develop ways of measuring quality of care, focusing mainly on care provided by general practices. We have developed ways of measuring the quality of care for major chronic diseases, and also developed questionnaires to assess patients'' experiences of primary care. A substantial part of our programme relates to the evaluation of the quality incentives in new GP contract. This includes a major longitudinal study (QUIP) in which we followed a representative set of practices over a nine year period from 1998 to 2007. We looked at how the activities and composition of primary care teams changed, and what changes occurred in the quality of care they provided. In addition, we undertook parallel studies using ethnographic and interview methods to study in detail the changes in practice culture that occurred as a result of the new contract. Analyses are ongoing but have already resulted in a number of publications.
Quality and Outcomes Framework (QOF)
We are also analysing national data on how practices have performed in the new contract and what factors effect their performance (Quality and Outcomes Framework Analysis - QOFa). Working with Kaiser Permanente we are comparing changes in quality of care for conditions incentivised in the new contract, and those which don't have any financial incentive attached to them (Impact of QOF on un-incentivised aspects of care).
In collaboration with York Health Economics Consortium and the Royal College of General Practitioners we are the external contractor for NICE for the QOF and have lead responsibility for reviewing all existing indicators and supporting the ongoing development of new indicators for the Framework. Previously we supported a review of the evidence base underpinning the QOF. Since 2007, the quality theme has been working with the RCGP to develop a new primary medical care provider accreditation scheme.
Quality indicators
We continue to work on ways of measuring quality of care, moving from measuring quality in single conditions to the problem of measuring quality in patients who have multiple conditions, exploring different ways of combining multiple indicators of quality of care. We have been working in collaboration with the RAND Corporation in the US to analyse data to see how the number of co-morbid conditions patients have affects the quality of care they receive. In other studies involving collaborators from abroad, we are working with the Centre for Quality of Care Research at Nijmegen and other partners to develop quality indicators that can be applied in primary care across Europe and A comparison of the use of performance indicators in the UK and Netherlands 1982- 2006 is examining the ways in which performance indicators have developed and been used in England and the Netherlands from 1982 to the present time
Our work on the GP contract suggests that practices in socio-economically deprived areas may be less likely to detect serious illness and we are working with the New England Research Institutes in Boston looking at how doctors make diagnostic decisions.
We are currently conducting a Comparison of incentive schemes for immunisations.
Patient safety
Background
The majority of people who have contact with health care providers will receive high quality care but unfortunately for some people this care will actually harm them or be potentially harmful to them. The identification and reduction of harm has become a major priority for the NHS and although the main impetus has come from highly publicised adverse events in the secondary sector there is now an increased focus on primary care. Recent interest in the field of patient safety has tended to focus on care delivered in hospitals. However, the potential for safety problems in primary care is significant, not least because of the volume of patient contacts that take place, the complexity of the interactions and the level of uncertainty associated with providing care in the community setting.
Our research
Because research on improving patient safety is relatively underdeveloped within primary care, our strategy has concentrated on identifying researchers who have an interest in improving patient safety from a variety of backgrounds and building alliances with them. Our emphasis has been on building multidisciplinary alliances with practitioners from the wider health related disciplines (nursing, pharmacy and clinical medicine) and with researchers from psychology, engineering, management sciences and law and ethics. This is particularly important in the field of patient safety research because of the complex interaction between human factors, organisations and technology in the genesis of critical incidents in health care Understanding and implementing solutions related to patient safety requires significant input from all these disciplines.
Our work to date has focused on describing the epidemiology of adverse events in primary care. We have also addressed methodological issues in relation to how we can utilise different sources of information to assess the extent of the problem in primary care and use these sources to develop learning strategies to improve patient safety, focusing on locally based initiatives rather than national interventions which have been a feature of attempts to improve patient safety in hospitals. We have also made a major contribution to the development of the Manchester Patient Safety Framework to assess safety culture in primary care, a tool which is used extensively in the NHS and has also been translated into several languages for use more widely in Europe.
Funding
In 2009, we were successful in obtaining a major European Union Framework 7 grant (€2.49 million) to develop a co-ordination and support action across the European Union. Professor Aneez Esmail is the PI on this project and further details can be found on the project website.
The development of this network will form the focus of our activities over the coming years.
Further details can also be obtained from Professor Esmail’s website.
Further information