The Quality and Outcomes Framework (QOF) is a voluntary incentive scheme for GP practices in the UK that rewards high-quality care. Three indicators relating to osteoporosis and fragility fractures continue to be included in the 2014/15 QOF.
Changes to the 2014/15 QOF guidance (England) include that those over 75 years with a fragility fracture since 1/4/14 and a diagnosis of osteoporosis should be on bone-sparing treatment. The rheumatoid arthritis (RA) QOF (England) 2014-2015 no longer requires a fragility fracture assessment on 50-90 year olds with RA. From 2014 a forum has been created between Northern Ireland, Scotland and Wales so that they deliver a harmonised approach to QOF.
QOF assumes that the NICE treatment thresholds (NICE TA161) are applied to men as well as women.
The following are the indicator sets for 2014/2015.
The contractor establishes and maintains a register of patients:
Aged 50 or over and who have not attained the age of 75 with a record of a fragility fracture on or after 1 April 2012 and a diagnosis of osteoporosis confirmed on DXA scan; and
Aged 75 or over with a record of a fragility fracture on or after 1 April 2014 and a diagnosis of osteoporosis.
•OST002. The percentage of patients aged 50 or over and who have not attained the age of 75, with a fragility fracture on or after 1 April 2012, in whom osteoporosis is confirmed on DXA scan, who are currently treated with an appropriate bone-sparing agent.
•OST005. The percentage of patients aged 75 or over with a record of a fragility fracture on or after 1 April 2014 and a diagnosis of osteoporosis, who are currently treated with an appropriate bone-sparing agent.
Three QOF points have been awarded to each of the indicators. The thresholds have been set at 30-60%.
NOTE: OST005 - This indicator does not require that a diagnosis of osteoporosis is confirmed by DXA scan in patients aged 75 or over with a fragility fracture. NICE recommends that a diagnosis of osteoporosis may be assumed in women aged 75 or over with a fragility fracture if the responsible clinician considers a DXA scan to be clinically inappropriate or unfeasible.
SIGN recommends that in frail elderly women (aged 80 or over) a DXA scan would be a prerequisite to establish BMD is sufficiently low before starting treatment with bone-sparing agents (bisphosphonates), unless the patient has suffered multiple vertebral fractures.
For further advice in the Implementation section