NICE proposes rehab referral focus in QOF

GPs could be set to send more patients to rehabilitation programmes for conditions including CHD, COPD and heart failure if the latest proposals for QOF are approved.

Rheumatoid arthritis will be considered for inclusion in the 2013/14 QOF for the first time
Rheumatoid arthritis will be considered for inclusion in the 2013/14 QOF for the first time

The measures are among 20 potential targets proposed by NICE on Monday for inclusion in the 2013/14 framework.

Rheumatoid arthritis is being considered for the first time, while there are new indicators for diabetes, cancer and asthma.

But GPs could face a much tougher target for hypertension.

NICE also unveiled a new type of QOF indicator, for lipid control in diabetes, designed to allow flexible targets based on individual patients.

NICE has proposed three new indicators for referring patients to rehabilitation services.

GPs would be paid to ensure COPD patients are offered referral to pulmonary rehabilitation, while heart failure patients would be offered an exercised-based programme.

Patients with a prior MI would be sent to a cardiac rehabilitation programme.

It marks the concerted push by NICE to shift more of the QOF from simple registers to process measures and intermediate outcomes.

The announcement also contained some new potential targets for GPs.

Rheumatoid arthritis could be recognised in the framework for the first time after NICE proposed four new indicators for the disease area.

These are: a register of patients; the percentage with recorded C-reactive protein or erythrocyte sedimentation rate; assessment of fracture risk; and an annual review.

GPs could be required to achieve BP readings of lower than 140/90 among hypertensive patients under 80 years old in an ambitious new indicator.

Currently, the QOF only requires GPs to hit 150/90.

NICE has also proposed an alternative indicator that would maintain this level at 150/90 for those over 80 years.

Other suggestions include two indicators to provide advice and support for erectile dysfunction among people with diabetes.

Patients with depression could be offered a biopsychosocial assessment on diagnosis and a review within 10-35 days.

Meanwhile, GPs could be paid to ensure diagnosis of asthma in children is supported by current British Thoracic Society/SIGN guidelines.

An existing cancer indicator could be updated so they are reviewed within three months of diagnosis instead of  six months at present.

GPs can contribute to a consultation on the proposals until 6 February.

Click here to give your views to the consultation



Full list of proposed indicators for the QOF 2013/14:

COPD

The percentage of patients with COPD and Medical Research Council (MRC) Dyspnoea Scale ≥3 at any time in the preceding 15 months, with a record of oxygen saturation value within the preceding 15 months.

The percentage of patients with COPD and Medical Research Council (MRC) Dyspnoea Scale ≥3 at any time in the preceding 15 months, with a record of a referral to a pulmonary rehabilitation programme (excluding patients on the palliative care register).

HF

The percentage of patients with heart failure (diagnosed after 1/4/2013) with a record of referral for an exercise based rehabilitation programme.

Secondary prevention of CHD

The percentage of patients with an MI within the preceding 15 months with a record of a referral to a cardiac rehabilitation programme.

Diabetes

The percentage of male patients with diabetes with a record of being asked about erectile dysfunction in the preceding 15 months.

The percentage of male patients with diabetes who have a record of erectile dysfunction with a record of advice and assessment of contributory factors and treatment options in the preceding 15 months.

Depression

The percentage of patients with depression who have had a bio-psychosocial assessment by the point of diagnosis.

The percentage of patients with a new diagnosis of depression (in the preceding 1 April to 31 March) who have been reviewed within 10-35 days of the date of diagnosis.

Diabetes: Lipid management

The percentage of patients with Type-2 diabetes aged 40 years and over with successful lipid management defined as either:

  1. last recorded cholesterol in the preceding 12 months ≤4mmol/l
  2. last recorded cholesterol in the preceding 12 months >4mmol/l and commenced on a moderate dose generic statin within 90 days of cholesterol recording
  3. last recorded cholesterol in the preceding 12 months >4mmol/l and generic statin dose increased within 90 days of cholesterol recording
  4. or, last recorded cholesterol in the preceding 12 months >4mmol/l and cholesterol lowering therapy changed to a different drug within 90 days of cholesterol recording

Hypertension

The percentage of patients under 80 years old with hypertension in whom the last recorded BP (measured in the preceding nine months) is 140/90 or less.

The percentage of patients aged 80 years and over with hypertension in whom the last recorded BP (measured in the preceding nine months) is 150/90 or less.

Rheumatoid arthritis

The practice can produce a register of all patients aged 16 years and over with rheumatoid arthritis.

The percentage of patients with rheumatoid arthritis in whom CRP or ESR has been recorded at least once in the preceding 15 months.

The percentage of patients with rheumatoid arthritis aged 30-84 years who have had a cardiovascular risk assessment using a CVD risk assessment tool adjusted for RA in the preceding 15 months.

The percentage of patients with rheumatoid arthritis who have had an assessment of fracture risk using a risk assessment tool adjusted for RA.

The percentage of patients with rheumatoid arthritis who have had a face to face annual review in the preceding 15 months.

Asthma

The percentage of patients, five years and over, newly diagnosed as having asthma from 1 April 2013 in whom there is a record that the diagnosis of asthma has been made supported by the current BTS-SIGN guidelines.

The percentage of children reaching the age of five years after or on 1 April 2013 with an existing diagnosis of asthma in whom there is a record that the diagnosis of asthma has been reviewed and confirmed (supported by the current BTS-SIGN guidelines) within 15 months of becoming five years.

Cancer

The percentage of patients with cancer diagnosed within the preceding 18 months who have a review recorded as occurring within three months of the practice receiving confirmation of the diagnosis.

The percentage of patients with recurrent or distant metastatic cancer diagnosed within the preceding 18 months who have a review recorded as occurring within three months of the practice receiving confirmation of the diagnosis.

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