The QOF data for Wales in 2006/7 is now available. It actually came out about six weeks ago but I missed it at the time and heard via a reader last week.

This completes the data for 2006/7 although I do still need to update the downloads section of the site over the next couple of days.

Labels: published_data, site news

# posted by Gavin Jamie @ 13:46 0 Comments Links to this post

In all of the general excitement(!) of the release of the 2006/7 QOF data it would be quite easy to miss the QOF exception bulletin produced by the Information Centre for England for the same year. Not perhaps the most gripping of documents but very useful none the less. It is rather dry with plenty of statistics but relatively little comment and no exploration of the reasons behind individual indicators. If you are not familiar with exception reporting in QOF it may be worth looking back at past exception articles.

I am not going to repeat any of the data there, rather to try to provide a little background to help understand what is going on. Page 11 (and to their credit the page numbered 11 is also the 11th page of the PDF - certainly not universal) shows a table of the top ten excepted indicators. There is also the bottom ten but I will concentrate, as I imagine most people will, on the highest figures.

Top of the list is CKD 3 (CKD and hypertension with BP less than 140/85) which has an exception rate of nearly 30%. The equivalent indicator for hypertension alone (BP5) does not even reach the top ten. What is going on here? Well firstly hypertension is very difficult to control in kidney disease so maximum tolerated can quite easily be reached. There is, however, a bigger and more technical issue. Following diagnosis of a condition a patient is automatically excepted for the next nine months if they don't meet the target. This was a new indicator this year and was not really a commonly made diagnosis before. With a simple assumption that practices started work on this QOF a year before (April 2006) then three quarters of the patients could have been excepted if they did not hit the target ( 9/12 ). Suddenly 30% seems fairly good. We can expect to see this drop next year.

Next is CHD 10 (beta blockers in CHD) which has always had a high exception reporting component. Rises a bit this year may be due to the advice that beta blockers are not much use after a year following a heart attack. They are also used much less first line for hypertension than previous due to new research. QOF is looking a bit dated here. Expect a rise again next year.

At third is AF 02 (ECG to diagnose atrial fibrillation) at 21%. Once again this indicator is for quite a short period - looking back over a year. Thus in this case 25% could be excepted automatically. Still fairly high though.

The timescale issue is also true of Asthma 8 (reversibility) at 20%, Stroke 11 (referred for investigation) at 18% and Dep 2 (depression scoring) at 17%. Again these only apply since first of April 2006.

MH 6 (comprehensive care plan) actually seems quite low at 17% due to the mental health register containing everyone who has ever had a psychosis or bipolar disorder - whether they still have the condition or not. MH 9 (annual review) is much the same at 15%.

Finally in the top ten is Epilepsy 8 (fit free for a year) at 17%. This reflects the difficulty in controlling some forms of epilepsy combined with a general lack of problem seen by some patients with occasional fits.

What is interesting is that only Epilepsy and beta blocker indicators have some clinical relevance in the exception reporting. All of the others (eight out of ten) say more about the business rules and the administrative nature of the indicator rather than patients or practices. So the take home message has to be don't place too much importance on exception reporting rates.

Labels: exceptions, published_data

# posted by Gavin Jamie @ 22:14 0 Comments Links to this post

The English data is now on the QOF database joining the Scottish and Northern Ireland data which has also been tidied up a little. The English data was a little delayed by the postal strike eventually arrived safely.

There are a couple of "virtual" indicators, largely relating to prevalence. I have created two depression indicators relating to the prevalence of people requiring screening for depression and those who have a history of depression recorded in the past. I would avoid putting too much weight on the latter as historical coding may be really quite variable between practices. In fact as practices were not specifically working towards these virtual indicators they should all be used with some caution.

I have also been asked about smoking prevalence. There is therefore a virtual indicator here too. Here it relates to the number of smokers amongst those covered by the smoking area (those with CHD, LVD, stroke, asthma, COPD and hypertension) who have been asked. This is not the only way to do it and is purely a judgement call on my part. In particular it may not correlate with some of the "official" registers and is not the one used for payment.

You may also notice that I do not put prevalence information for the palliative care domain on the main prevalence list. For one thing this prevalence is not used for payment. Secondly the numbers are generally so small as to be unreliable and thirdly they are so small they are suppressed for confidentiality reasons in many cases by the departments of health.

There are about half a dozen English practices without names or addresses. There was not a comprehensive look up table included with the English data this time so I have used several different sources. I will try to correct these in time.

Finally we are still awaiting the Welsh data. I have heard nothing official but will keep asking!

Labels: published_data, site news

# posted by Gavin Jamie @ 09:29 0 Comments Links to this post

Although we don't have full practice level data for Wales and England yet there is some national level data. We can work out prevalence in all four of the countries and for the UK as a whole. They are listed below. Smoking is not in the table as it is not listed at the national level but should be available when the practice level data comes through.

On the subject of practice level data there is some more information on the information centre website. They are planning to send out CDs so I will apply for one. Unfortunately there is a postal strike over the next week which may affect delivery somewhat. There should certainly be some demand. The 2006 full data database has been downloaded from this site over eight hundred times.

No news from Wales as yet.

Labels: prevalence, published_data, site news

# posted by Gavin Jamie @ 20:33 2 Comments Links to this post

The data for Scotland and Northern Ireland was released last Monday and is now on the site. It has been a little more awkward uploading the data this year due to the changes in the areas and the appearance of areas without prevalences (palliative care) and depression having two different prevalences. I hope this makes some sense when viewing the data but nothing is set in stone and bright ideas welcome!

Wales also released some data this week but this did not go down to practice level and is therefore not particularly useful for many purposes. The statistical release was described as release one so there may be more although the site also suggests that there will not be an update for a further year. I am enquiring about further data.

Even more oddly is the English data. The Information Centre has spreadsheets of data at national, SHA and PCT level but not practice level. Practice level data is available but only one practice at a time through their own web interface. I have emailed them asking about spreadsheets but have not year heard back. In fairness they were probably quite busy on Friday.

Labels: published_data, site news

# posted by Gavin Jamie @ 16:39 1 Comments Links to this post

I do get asked quite a bit when the new data is due to come onto the site. Well all the data comes from the various departments of health in the four countries. The current plans from England and Scotland are to release the data sometime in September. Something of a relief for me, at least, as I have to get all of the new data into the database.

As an aside the English GP patient survey 2007 has been released. As this is down to practice level and is in a reasonably friendly format I will try to put this onto the site in addition. It also includes interesting figures such as rurality (really horrible word!) and deprivation factors. For largely presentation reasons however this is unlikely to precede the full QOF data (it will be linked from the 2006/7 QOF data).

Labels: published_data, site news

# posted by Gavin Jamie @ 10:09 0 Comments Links to this post

Prevalence data is starting to get out! In the table below you can see the data from England and Northern Ireland. The English data was taken from QMAS at the start of April and the NI data from their official prevalence bulletin. I would recommend the NI bulletin for further reading as there are a lot of nice charts showing the spread of the prevalence. When comparing the data with previous years it is important to remember that there have been big rule changes in mental health and smaller one in LVD. Also of note is that the palliative care prevalence is for information only and does not change the cash value of points as the others do.

There are couple of figures in the NI bulletin I don't understand - mainly the depression 2 and LVD 3 listings. I can't quite see the relevance but I will ask!

* I am not sure exactly what this depression figure means. I think it is the number of people eligible for depression screening.

** This is the number of people eligible to be asked regularly about their smoking. It is the combined prevalence of diabetes, hypertension, heart disease, COPD and stroke

Labels: prevalence, published_data

# posted by Gavin Jamie @ 19:01 2 Comments Links to this post