Information stations

Tom Morgan and Nick Coyle on how valuable data from QOF results can help compare GP performance and improve patient care

Quality and outcomes framework information is standard in almost every practice in England and hence is a valuable source of information, providing that the numerators and denominators are understood.

QOF information is divided into four domains: clinical; organisational; additional services; and patient experience. Quality of service offered by a practice may not necessarily match the achievement scores as measured by QOF, but recording of fundamental information is likely to be of high quality.

The clinical domain in 2005-06 was subdivided into coronary heart disease, stroke, hypertension, diabetes, chronic obstructive pulmonary disease, epilepsy, hypothyroidism, cancer, mental health and asthma.

Many health professionals are interested in knowing the burden of these diseases in their local populations. Rates of disease need to be studied in order to compare different populations of different sizes in different geographical areas.

Crude QOF prevalence rates are useful in the absence of data that has been further standardised to take the profile of the population into account. Summary tables of QOF prevalence rates are freely available but are not easily synthesised.

CHD and cancer
Managing chronic diseases more effectively in different communities and different practices requires more than just prevalence data. Many GPs and practice managers lack the time or analytical skills to make full use of this data, hence the need for a more user-friendly way of presenting the information.

Richmond and Twickenham primary care trust's public health intelligence team wanted to provide a single graph that would allow health professionals to quickly compare the prevalence of a given disease in their practice or PCT with wider areas. A summary table just provides more figures without any context for the information.

The graphs show the synthesis of complex tabulated data in a format that engages all healthcare professionals. At a glance, busy GPs, their practice managers and PCT managers will be fully aware of the prevalence rate as they compare their practice to others in the PCT, in the region and across England.

Two graphs are presented here (the same practice has been used in each example, although we have blanked out the practice name and code), one showing the prevalence of coronary heart disease and one showing cancer.

CHD prevalence is shown by the vertical green line in figure 1. This intercepts the x-axis to show that the prevalence for this particular practice is 2.2 per cent. The mean prevalence is approximately the same in the PCT and across the whole of London.

Disease prevalence overview
The breadth of prevalence is wider in London than in Richmond and Twickenham PCT, which means there is a greater variation across London. The distribution of prevalence in England is even broader, with a mean prevalence almost double that seen in the London region.

For this particular practice, the CHD prevalence is approximately the same as the mean for Richmond and Twickenham PCT (and London region) but towards the lower end of the distribution for England.

Cancer prevalence is shown by the vertical line in the second graph. This intercepts the x-axis to show that the prevalence for this particular practice is 0.4 per cent. The mean prevalence in the PCT as a whole is slightly higher than the mean across the whole of London.

The breadth of prevalence is only slightly narrower in Richmond and Twickenham PCT than the London region. The distribution of prevalence in England is broader than in the London region, which means there is a wider variation in prevalence rates throughout England.

Nationally, the mean prevalence is only slightly higher than in Richmond and Twickenham (which in turn is higher than in London region). The prevalence of cancer for this practice is below the average for the PCT and for England, but it is very similar to the average cancer prevalence for London.

Such an easily digestible presentation of information brings everyone swiftly up to speed on disease prevalence to inform discussion regarding, for example, tailored programmes for more effective care of the population.

Dr Tom Morgan is public health intelligence manager and Nick Coyle is public health statistician at Richmond and Twickenham PCT.