Commissioning Outcomes Framework targets revealed by NICE

Cancer mortality, emergency admissions, and patients' quality of life are among targets against which commissioners will be held to account in the commisioning outcomes framework (COF), NICE has revealed.

NICE: 44 indicators for commissioners published
NICE: 44 indicators for commissioners published

NICE has published details of the first menu of 44 proposed indicators for the COF. The framework will be used to assess and reward the performance of clinical commissioning groups (CCGs).

The 44 indicators are listed below. They include mortality rates in people aged under 75 years, emergency admissions, emergency re-admissions within 30 days of hospital discharge and health-related quality of life for people with long-term conditions.

Dr Gillian Leng, NICE’s deputy chief executive and director of health and social care said that assessing care being measured would allow CCGs to be held to account.

‘By setting out the aspects of care that are essential in facilitating the best health outcomes, such as the need for people who have had an acute stroke to receive thrombolysis, the quality of care being commissioned for local populations can be measured,’ she said.

‘This will enable the groups responsible for commissioning NHS care to be held to account, and will ultimately drive up the standards of health care delivered.’

Dr Leng said that the proposed indicators would ‘support high quality commissioning of NHS services in England, to deliver the best health outcomes for patients. She added: ‘Each indicator has been through public consultation and feasibility testing, so commissioners can be reassured that they will work in practice.’

Earlier this year, the BMA raised concerns about proposals for the COF, warning that linking rewards to financial performance could undermine relationships with patients.

‘The BMA has grave ethical concerns about the potential for a reward based on financial performance to damage the doctor-patient relationship,’ it said.

The proposed COF indicators

Cardiovascular

  • Under 75 mortality rate from cardiovascular disease
  • Mortality within 30 days of hospital admission for stroke
  • People with stroke who are discharged from hospital with a joint health and social care plan
  • People who have received psychological support for mood behaviour and cognitive disturbance by 6 months after stroke
  • People with stroke who are reviewed 6 months after leaving hospital
  • People with stroke who are supported to leave hospital by a skilled stroke early supported discharge team
  • People who have had an acute stroke who receive thrombolysis
  • People who have had a stroke who are admitted to an acute stroke unit within 4 hours of arrival at hospital
  • People who have had an acute stroke whose swallowing is screened by a specially trained healthcare professional within 4 hours of admission to hospital

Gastrointestinal

  • Emergency admissions for alcohol related liver disease

Respiratory

  • Under 75 mortality rate from respiratory disease
  • People with COPD and Medical Research Council (MRC) Dyspnoea Scale ≥3 referred to a pulmonary rehabilitation programme
  • Emergency admissions for children with lower respiratory tract infections
  • Emergency re-admissions: COPD

Mental health

  • People with dementia prescribed anti-psychotic medication
  • People with severe mental illness who have received a list of physical checks
  • People on Care Programme Approach (CPA) followed-up within 7 days of discharge from psychiatric inpatient stay
  • Recovery following talking therapies for people of all ages
  • Recovery following talking therapies for people older than 65
  • Access to community mental health services by people from black and minority ethnic groups
  • Access to psychological therapies services by people from black and minority ethnic groups

Endocrine, nutritional and metabolic

  • Myocardial infarction, stroke and stage 5 chronic kidney disease in people with diabetes
  • People with diabetes who have received nine care processes
  • People with diabetes diagnosed less than a year who are referred to structured education
  • People with diabetes who have an emergency admission for diabetic ketoacidosis
  • Complications associated with diabetes
  • Lower limb amputation in people with diabetes

Maternity and reproductive

  • Antenatal assessments <13 weeks
  • Maternal smoking in pregnancy
  • Maternal smoking at delivery
  • Breast feeding initiation
  • Breast feeding prevalence at 6-8 weeks

Cancers and tumours

  • Under 75 mortality rate from cancer

Other/cross-cutting

  • Health-related quality of life for people with long-term conditions
  • Proportion of people feeling supported to manage their condition
  • Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)
  • Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s
  • Emergency admissions for acute conditions that should not usually need hospital admission
  • Emergency re-admissions within 30 days of discharge from hospital
  • Patient reported outcome measures for elective procedures: hip replacement
  • Patient reported outcome measures for elective procedures: knee replacement
  • Patient reported outcome measures for elective procedures: groin hernia
  • Patient reported outcome measures for elective procedures: varicose veins
  • Patient experience of GP out-of-hours services

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