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Journal of Public Health Advance Access originally published online on June 29, 2006
Journal of Public Health 2006 28(3):221-225; doi:10.1093/pubmed/fdl028
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© The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

Using the UK primary care Quality and Outcomes Framework to audit health care equity: preliminary data on diabetes management



L. A. Sigfrid, Honorary Research Fellow –Public Health1

C. Turner, Public Health Practitioner1

D. Crook, Senior Research Fellow and Research Advisor2

S. Ray, Consultant in Public Health Medicine1
1 Department of Public Health, Brighton and Hove City Primary Care Trust, Prestamex House, 171-173 Preston Road, Brighton BN1 6AG, East Sussex, UK
2 Division of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, Falmer, Brighton BN1 9PH, East Sussex, UK

Address correspondence to C. Turner, E-mail: claire.turner{at}bhcpct.nhs.uk

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.

Keywords: deprivation, diabetes, equity audit, exception reporting, inequality, Quality, Outcomes Framework


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