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

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.