Kasteridis Panagiotis, Mason Anne, Goddard Maria, Jacobs Rowena, Santos Rita, Rodriguez-Sanchez Beatriz, McGonigal Gerard
Centre for Health Economics, University of York, York, United Kingdom.
Department of Economics, Econometrics and Finance, SOM Research Institute, University of Groningen, 9700 AV Groningen, The Netherlands.
PLoS One. 2016 May 26;11(5):e0155850. doi: 10.1371/journal.pone.0155850. eCollection 2016.
The Quality and Outcomes Framework, or QOF, rewards primary care doctors (GPs) in the UK for providing certain types of care. Since 2006, GPs have been paid to identify patients with dementia and to conduct an annual review of their mental and physical health. During the review, the GP also assesses the carer's support needs, including impact of caring, and ensures that services are co-ordinated across care settings. In principle, this type of care should reduce the risk of admission to long-term residential care directly from an acute hospital ward, a phenomenon considered to be indicative of poor quality care. However, this potential effect has not previously been tested.
Using English data from 2006/07 to 2010/11, we ran multilevel logit models to assess the impact of the QOF review on the risk of care home placement following emergency admission to acute hospital. Emergency admissions were defined for (a) people with a primary diagnosis of dementia and (b) people with dementia admitted for treatment of an ambulatory care sensitive condition. We adjusted for a wide range of potential confounding factors.
Over the study period, 19% of individuals admitted to hospital with a primary diagnosis of dementia (N = 31,120) were discharged to a care home; of those admitted for an ambulatory care sensitive condition (N = 139,267), the corresponding figure was 14%. Risk factors for subsequent care home placement included older age, female gender, vascular dementia, incontinence, fall, hip fracture, and number of comorbidities. Better performance on the QOF review was associated with a lower risk of care home placement but only when the admission was for an ambulatory care sensitive condition.
The QOF dementia review may help to reduce the risk of long-term care home placement following acute hospital admission.
质量与结果框架（QOF）对英国的基层医疗医生（全科医生）提供特定类型的医疗服务给予奖励。自2006年以来，全科医生因识别出痴呆症患者并对其身心健康进行年度评估而获得报酬。在评估过程中，全科医生还会评估护理人员的支持需求，包括护理的影响，并确保跨护理机构协调服务。原则上，这类护理应降低直接从急性医院病房入住长期寄宿护理机构的风险，这种现象被认为是低质量护理的表现。然而，这种潜在效果此前尚未得到验证。
利用2006/07年至2010/11年的英国数据，我们运行了多层次逻辑模型，以评估QOF评估对急性医院紧急入院后入住养老院风险的影响。紧急入院定义为：（a）以痴呆症为主要诊断的患者；（b）因门诊护理敏感疾病入院治疗的痴呆症患者。我们对一系列潜在的混杂因素进行了调整。
在研究期间，以痴呆症为主要诊断入院的患者中（N = 31,120），19%出院后入住养老院；因门诊护理敏感疾病入院的患者中（N = 139,267），相应比例为14%。后续入住养老院的风险因素包括年龄较大、女性、血管性痴呆症、失禁、跌倒、髋部骨折和合并症数量。QOF评估表现较好与入住养老院风险较低相关，但仅当入院是因门诊护理敏感疾病时。
QOF痴呆症评估可能有助于降低急性医院入院后入住长期养老院的风险。
