Quality and Outcomes Framework


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:

OST004
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

Commissioning for Quality and Innovation


In November 2010, the Department of Health published a set of exemplar goals for the Commissioning for Quality and Innovation (CQUIN) payment framework. These included specific reference to the establishment of Fracture Liaison Services (referred to as Fracture Prevention Services in the document).

Best Practice Tariff for Hip Fracture


The Best Practice Tariff (BPT) for hip fracture was launched in April 2010 to incentivise delivery of the hip fracture component of the Department of Health Prevention Package for Older People.

•Surgery within 36 hours

•Shared care by surgeon and geriatrician

•Care protocol agreed by geriatrician, surgeon and anaesthetist

•Pre/post operative cognitive function assessment

•Perioperative assessment by geriatrician

•Geriatrician-led multidisciplinary rehabilitation

•Secondary prevention including falls and bone health assessment

BPT has led to dramatic improvements in the numbers of hip fracture patients receiving best practice care, from only 24% of patients at the initiation of the scheme, to 60% in the most recent data gathered.

In 2013-14 the differential between best practice and standard care will remain the same as that in 2012-13 at £1,335. The differential has been achieved by lowering the base tariff by the increased additional payment, so that the level of the BPT is the same each year but payment for spells not meeting best practice has reduced. Pbr Guidance 2013-2014

 
 
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