New QOF hypertension indicators put forward for next contract
NICE QOF advisors have approved three new hypertension indicators for potential inclusion in next year’s GP contract – and will suggest NHS managers could also consider incentivising them as a ‘bundle’ rather than individually.
The three new indicators are on three measurements of target organ damage in patients newly diagnosed with hypertension, rewarding practices for testing for haematuria, measuring the urinary albumin to creatinine ratio and performing – or referring on for – an ECG.
Pilots of each indicator - results of which were discussed at the QOF advisory board committee meeting this week in Manchester - showed they resulted in an increase in achievement of the respective measurement and were largely considered acceptable by practices.
Advisors also proposed the three measures could further be recommended as one ‘bundled’ indicator, given the earlier approval of a controversial bundled indicator in diabetes and that they believed all three tests should automatically follow any new diagnosis of hypertension as part of good clinical practice.
Summing up the discussion, QOF advisory board chair Dr Colin Hunter said: ‘We should put forward all three indicators on the slate with a sub-recommendation along the lines “consideration could be given to bundling these indicators”, to say we feel there are no barriers to doing this.’
The committee approved one other indicator, on giving women with serious mental illness advice on pregnancy, conception and contraception, despite doubts raised by practices over its acceptability and achievement actually falling during piloting.
However, advisors rejected a further two potential indicators on screening for alcohol in newly diagnosed hypertension patients, after pilot practices found them unworkable.
They also rejected the introduction of an indicator on rescue packs for self-management in COPD patients, following concerns raised during consultation about whether the intervention is actually beneficial in terms of preventing acute exacerbations and concerns it may only be suitable for a very small number of patients.
A further indicator on polypharmacy – face-to-face medication review for people over 65 prescribed ten or more medications – was also blocked after significant technical problems were encountered in piloting.
NICE - Potential new QOF indicators for 2015/16
Indicators approved for potential inclusion next year
Diabetes ‘bundled’ indicator
1. The percentage of patients with diabetes who have had the following care processes performed in the preceding 12 months:
•Record of smoking status
•Albumin: creatinine ratio
•Serum creatinine measurement
Target organ damage in newly diagnosed hypertension
The percentage of patients with a new diagnosis of hypertension in the preceding 1st April to 31st March who have a record of urinary albumin: creatinine ratio test in the three months before or after the date of entry to the hypertension register.
The percentage of patients with a new diagnosis of hypertension in the preceding 1st April to 31st March who have a record of a test for haematuria in the three months before or after the date of entry to the hypertension register.
The percentage of patients with a new diagnosis of hypertension in the preceding 1st April to 31st March who have a record of a 12 lead ECG performed in the three months before or after the date of entry to the hypertension register.
NB These three to be considered for ‘bundling’
Serious mental illness – preconception advice for women
The percentage of women with schizophrenia, bipolar affective disorder or other psychoses under the age of 45 years who have been given information and advice about pregnancy, conception or contraception tailored to their pregnancy and contraceptive intentions recorded in the preceding 12 months.
Indicators that were rejected
The percentage of patients with COPD recorded as having an exacerbation in the preceding 12 months who have been given a course of antibiotics and corticosteroids (rescue pack) as part of a personalised future exacerbation self-management strategy in the preceding 12 months
Alcohol screening in hypertension
The percentage of patients with a new diagnosis of hypertension in the preceding 1st April to 31st March who have been screened for hazardous or harmful alcohol consumption using a validated tool in the three months before or after the date of entry on the hypertension register.
The percentage of patients with a new diagnosis of hypertension in the preceding 1st April to 31st March who screen positive for hazardous or harmful alcohol consumption who have been given personalised feedback on their AUDIT score and a patient information leaflet about their level of alcohol related risk or harm within three months of the AUDIT score being recorded.
The percentage of patients aged 65 years and over who are prescribed 10 or more medications that have had a face to face medication review in the preceding 12 months.