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NICE publishes new asthma QOF indicators to improve misdiagnosis and overtreatment

NICE has published new indicators to improve diagnosis and care for patients with asthma, chronic obstructive pulmonary disease and heart failure, all of which could be adopted into next year’s QOF framework.

The range of indicators proposed by the clinical regulator follows the Government’s 2018 review which said one-quarter of QOF indicators would be scrapped. 

In its annual review, published last week, NICE proposed four new indicators related to improving the misdiagnosis and care of patients with asthma, including undertaking a validated asthma control questionnaire.

It also said assessing the use of short-acting beta agonists and recording exacerbations could ‘help identify people with asthma who are at increased risk of poor outcomes’, according to documents.

Other indicators include objective testing to confirm a COPD diagnosis, which NICE said should contribute to a reduction in ’both misdiagnosis and the risk of overtreatment in people with COPD,’ and an indicator for patients with heart failure that reduces the timeframe in which an echocardiogram or special assessment should be carried out.

NICE said the indicators are now subject to NHS England and BMA GP Committee negotiations and as a result, may be included in the next QOF framework in 2020/21.

NICE deputy chief executive and director of health and social care Professor Gillian Leng said: ’There is currently no gold standard test for asthma which makes diagnosing a particularly difficult task for clinicians. It’s important that GPs take the appropriate steps to avoid misdiagnosing the condition which can lead to overtreatment. These new indicators should increase the likelihood of improved outcomes and support the personalisation of care for people with asthma.’

It comes as NICE and BTS/SIGN announced they would produce joint guidance in the future, to alleviate 'confusion' for GPs

It follows the announcement at the start of the year that outlined an ‘overhaul’ of the framework as part of the GP contract, which would look into improving the management of heart failure, mental health and COPD. 

Last month, NHS England said it was going to review the disease indicators for asthma, heart failure, and COPD domains this year.

The seven new ’improvement modules’ recently announced by NHS England will include two yearly modules on areas such as mental health and CVD, each counting for 37 points each. The most recent modules in April’s QOF update focus on prescribing safety and end-of-life care.

New indicators published by NICE

Asthma

  • The contractor establishes and maintains a register of patients with asthma aged 5 or over.
  • The percentage of patients with asthma on the register from (start date) with a record of spirometry and one other objective test (FeNO or reversibility or variability) between 3 months before or 3 months after diagnosis.
  • The percentage of patients with asthma on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using a validated asthma control questionnaire (including assessment of short-acting beta agonist use), a recording of the number of exacerbations and a written personalised action plan.
  • The percentage of patients with asthma on the register aged 19 or under, in whom there is a record of smoking status (active or passive) in the preceding 12 months.

Chronic obstructive pulmonary disease

  • The contractor establishes and maintains a register of: 1. Patients with a clinical diagnosis of COPD before (start date), and 2. Patients with a clinical diagnosis of COPD on or after (start date) whose diagnosis has been confirmed by a quality assured post bronchodilator spirometry FEV1/FVC ratio below 0.7 between 3 months before or 3 months after diagnosis.
  • The percentage of patients with COPD on the register, who have had a review in the preceding 12 months, including a record of the number of exacerbations and an assessment of breathlessness using the Medical Research Council dyspnoea scale.
  • The percentage of patients with very severe chronic obstructive pulmonary disease (COPD) with a record of oxygen saturation value within the preceding 12 months.

Heart failure 

  • The percentage of patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, who are currently treated with an ACE-I or ARB.
  • The percentage of patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, who are currently treated with a beta-blocker licensed for heart failure.
  • The percentage of patients with heart failure on the register, who had a review in the preceding 12 months, including an assessment of functional capacity (using the New York Heart Association classification) and a review of medication.
  • The percentage of patients with one or more of the following conditions: CHD, atrial fibrillation, chronic heart failure, stroke or TIA, diabetes or dementia who have been screened for unsafe drinking using the FAST or AUDIT-C tool in the preceding 2 years.
  • The percentage of patients with a diagnosis of heart failure after (start date) which has been confirmed by an echocardiogram or by specialist assessment between 3 months before or 3 months after entering on to the register.

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