How does the quality of outcomes framework impact on the quality of life of adult patients with diabetes? A cross-section study in England using GP Patient Survey data
File(s)
Published version
Author(s)
Xiao, Mimi
Núñez-Elvira, Alberto
Kristensen, Soren
Type
Journal Article
Abstract
Background
Existing studies on the assessment of the Quality and Outcomes Framework (QOF) have found that the QOF affects clinical outcomes and quality of care. However, there is little evidence of its impact on health-related quality of life (HQoL).
Aim
To investigate the association between QOF and HQoL through the assessment of different measures. First, the percentage of overall achievement scores and the five clinical domains were based on EQ-5D-5L. Second, the percentage of achievement scores and individual domains of HQoL.
Design and setting
The analysis linked the national GP Patient Survey (GPPS) with the performance score in the QOF for three years (2015-/16-2017/18).
Methods
Patient-level analysis was conducted on HQoL using the GPPS and the percentage of achievement scores from the QOF. We then regressed multilevel models on patient-level estimates. Finally, we estimated the impact of QOF on the individual dimensions of the EQ-5D-5L using ordered logit regression models.
Results
From a total sample size of 3,489,691patients (44% male), our findings convey that patients in a practice with 1% increase in the overall achievement percentage have 0.022 (95% CI = 0.00530, 0.0386) points higher EQ-5D utility scores than those in a practice without performance improvement. Moreover, a 1% increase in the achievement percentage on diabetes mellitus (DMpc) was associated with a 0.0167 (95% CI = 0.00445, 0.0289) point increase in diabetic patients’ EQ-5D, and a positive association was observed for chronic obstructive pulmonary disease (COPD). Furthermore, patients who experienced an improvement in performance were more likely to report a better health state in one of the five dimensions of the EQ-5D (anxiety) than those in practices without performance improvement.
Conclusion
QOF was associated with a limited, but positive and statistically significant impact on patients’ HRQoL.
Existing studies on the assessment of the Quality and Outcomes Framework (QOF) have found that the QOF affects clinical outcomes and quality of care. However, there is little evidence of its impact on health-related quality of life (HQoL).
Aim
To investigate the association between QOF and HQoL through the assessment of different measures. First, the percentage of overall achievement scores and the five clinical domains were based on EQ-5D-5L. Second, the percentage of achievement scores and individual domains of HQoL.
Design and setting
The analysis linked the national GP Patient Survey (GPPS) with the performance score in the QOF for three years (2015-/16-2017/18).
Methods
Patient-level analysis was conducted on HQoL using the GPPS and the percentage of achievement scores from the QOF. We then regressed multilevel models on patient-level estimates. Finally, we estimated the impact of QOF on the individual dimensions of the EQ-5D-5L using ordered logit regression models.
Results
From a total sample size of 3,489,691patients (44% male), our findings convey that patients in a practice with 1% increase in the overall achievement percentage have 0.022 (95% CI = 0.00530, 0.0386) points higher EQ-5D utility scores than those in a practice without performance improvement. Moreover, a 1% increase in the achievement percentage on diabetes mellitus (DMpc) was associated with a 0.0167 (95% CI = 0.00445, 0.0289) point increase in diabetic patients’ EQ-5D, and a positive association was observed for chronic obstructive pulmonary disease (COPD). Furthermore, patients who experienced an improvement in performance were more likely to report a better health state in one of the five dimensions of the EQ-5D (anxiety) than those in practices without performance improvement.
Conclusion
QOF was associated with a limited, but positive and statistically significant impact on patients’ HRQoL.
Date Issued
2025-10-28
Date Acceptance
2025-06-23
Citation
BMC Primary Care, 2025, 26
ISSN
2731-4553
Publisher
BMC
Journal / Book Title
BMC Primary Care
Volume
26
Copyright Statement
© The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1186/s12875-025-02930-x
Subjects
Quality outcome framework
Quality of life
EQ-5D
Achievement score
Publication Status
Published
Article Number
ARTN 327
Date Publish Online
2025-10-28