Differences in the quality of primary medical care for CVD and diabetes across the NHS: evidence from the quality and outcomes framework

Background: Health policy in the UK has rapidly diverged since devolution in 1999. However, there is relatively little comparative data available to examine the impact of this natural experiment in the four UK countries. The Quality and Outcomes Framework of the 2004 General Medical Services Contract provides a new and potentially rich source of comparable clinical quality data through which we compare quality of primary medical care for coronary heart disease (CHD), stroke, hypertension and diabetes across the four UK countries. <p/>Methods: A cross-sectional analysis was undertaken involving 10,064 general practices in England, Scotland, Wales and Northern Ireland. The main outcome measures were prevalence rates for CHD, stroke, hypertension and diabetes. Achievement on 14 simple process, 3 complex process, 9 intermediate outcome and 5 treatment indicators for the four clinical areas. <p/>Results: Prevalence varies by up to 28% between the four UK countries, which is not reflected in resource distribution between countries, and penalises practices in the high prevalence countries (Wales and Scotland). Differences in simple process measures across countries are small. Larger differences are found for complex process, intermediate outcome and treatment measures, most notably for Wales, which has consistently lower quality of care. Scotland has generally higher quality than England and Northern Ireland is most consistently the highest quality. <p/>Conclusion: Previously identified weaknesses in Wales related to waiting times appear to reflect a more general quality problem within NHS Wales. Identifying explanations for the observed differences is limited by the lack of comparable data on practice resources and organisation. Maximising the value of cross-jurisdictional comparisons of the ongoing natural experiment of health policy divergence within the UK requires more detailed examination of resource and organisational differences

Societal output and use of research performed by health research groups

The last decade has seen the evaluation of health research pay more and more attention to societal use and benefits of research in addition to scientific quality, both in qualitative and quantitative ways. This paper elaborates primarily on a quantitative approach to assess societal output and use of research performed by health research groups (societal quality of research). For this reason, one of the Dutch university medical centres (i.e. the Leiden University Medical Center (LUMC)) was chosen as the subject of a pilot study, because of its mission to integrate top patient care with medical, biomedical and healthcare research and education. All research departments were used as units of evaluation within this university medical centre

Assessment or referral tool: the unintended consequences of a dual purpose common assessment framework form

The Common Assessment Framework (CAF) was designed to facilitate early intervention through multi-agency working and the active involvement of families. The underlying principle was to move away from a risk-focused, needs-led or service-led culture to assess need and match needs to identified services. It was anticipated that services and assessments would become more evidence-based, and a common language between professionals and agencies would evolve. Taking a social constructionist approach this study explored professionals’ experiences of the use of the Common Assessment Framework form. Forty-one professionals from four different local authorities and a variety of agencies took part in semi-structured interviews. Data were analyzed utilizing thematic analysis. Findings suggest the unintended consequences of the use of the CAF were influenced by local authority policy. As the local authorities adopted the policy of utilizing the CAF as a referral mechanism, rather than to assess needs, profes-sionals unintentionally perceived the CAF form as a referral tool, to refer families to existing service provision. Further to this, professionals referred to the CAF form itself, as a ‘means to an end’, implying that this was a step that had to be overcome in order to access services

Automatic frequency-domain inference on semiparametric and nonparametric models

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