QOF statuses
Upcoming changes to QOF status handling
The Proactive Monitoring tool continually tracks the needs of the population of your practice, matching each patient to national guidelines that are most relevant to their individual care needs. Combining the most up-to-date guidance, clinical experience and cutting-edge technology, Abtrace helps guide appropriate use of resources and investigations by cohorting patients into three groups:
- Up-to-date (green) - not requiring any intervention
- Opportunistic (amber) – suggesting intervention will soon be overdue and can be organised in a resource sparing manner
- Overdue (red) – suggesting intervention now
Until now, patients have been largely cohorted in one of two ways: a) is there a record of an intervention within a financial year (QOF)? or b) is there a record of an intervention in the preceding months (often 6 months or 1 year)?. Using this methodology mirrors national and regional guidelines and provides clear instructions to clinicians and managers within practices to see which patients currently meet payment incentive criteria.
However, this leaves no distinction of when a patient truly becomes 'overdue' (red) for the action, ie when it is now a year ago (or more for certain QOF rules).
In our latest iteration, we’ve updated our cohorting system to combine fixed incentive payment schedules with expert clinical knowledge for each rule. By considering whether patients have had an intervention within the current financial year or within a clinical appropriate window we can ensure patients are recommended the right interventions, at the right time, whilst maximising financial renumeration for practices.
As such, for most QOF rules, patients will turn 'opportunistic' (orange) from the start of the Financial Year (as actioning it will attract payment) and 'overdue' (red) from when it is one-year (or other appropriate interval) since the action was done.
Rules that don't require X action every Y financial years, will be handled differently. For example requiring a Diabetes Structured Education Referral within 9 months of diagnosis will go red from the diagnosis date, before disappearing at 9 months.
What you will see
- Patients in the patient view will now have red QOF-linked actions
- The population view, particularly when filtered to QOF long-term conditions, will now have a clearer ranking of patients in terms of how overdue they are. The overall number of 'red' patients will likely increase at all practices for filter-sets which include QOF rules.
Future changes
In due course, we also propose to add:
1. 'Back-stop' rules All patients will go red at a certain point in the financial year, for example February 1st. This ensures that QOF is aimed for completion in advance of the end of the financial year, with no patients turning red on March 31st.
2. 'Front-stop' rules In some cases, it would be paid by QOF to do an action that might be clinically inappropriate. For example a patient could have an 'annual' HbA1c done on 31st March 2023, attracting payment for FY2223. They could then have it done two days' later on 2nd April 2023 attracting payment for FY2324. Although this is contractually correct, it doesn't make clinical sense. We will propose to introduce a 'front-stop' to some actions, such that they are not recommended in non-sensible windows, for example HbA1cs not being recommended at less than 3 month intervals from one another.