Indicators for Quality Improvement: A resource for local clinical teams providing a set of robust indicators which they

y can use as the basis for local quality improvement A source of indicators which can be used to benchmark between providers Assured by clinicians for use by clinicians
This report contains data signposted by The NHS Information Centre. The NHS Information Centre has not provided assurance for the data contained within the Indicators for Quality Improvement

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Anonymous

Acute units with 5/6 key characteristics (continuous physiological monitoring; access to scanning within 3 hours of admission/24 hour brain imaging; policy for direct admission from A&E; specialist ward round at least 5 times a week; acute stroke protocols/guidelines)
Library Reference Number/Identifier CV13 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale There are no nationally agreed standards for acute stroke units. These features are considered by the Intercollegiate Stroke working party to be key components of acute stroke unit care and could be used to identify resource allocation for acute stroke and they wish to know whether these acute features are also present on combined stroke units. The criteria have been tightened since Round 5. Definition Acute stroke unit features: a) continuous physiological monitoring (ECG, oximetry, blood pressure) b) access to scanning within 3 hours of admission c) a policy for direct admission from A&E d) specialist ward rounds at least 5 times a week e) acute stroke protocols Units There is currently no information for this item. Coverage England, Wales and Northern Ireland

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Anonymous

Source Sentinel Stroke Audit - Organisational Audit Calculations/Formula/Methodology Question 2.3 and/or 2.11 See full wording of questions for exceptions in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Creator / Producer Royal College of Physicians Status The data for this indicator is no longer available, so the results have been taken down from the website. Quality Permissable use if both feeder questions are used i.e. combined unit or acute unit Date 2010 Version History There is currently no information for this item. Update Frequency Usually every 2 years. Exceptionally 2008 and 2009. The interim data collection for the NAO report Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf

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Anonymous

Publisher / Owner Royal College of Physicians Other related PI's (relation) There is currently no information for this item. Additional Information *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Acute units with access to scanning for patients with a stroke within 3 hours of admission.
Library Reference Number/Identifier CV14 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale Hyperacute service is defined as a service which is able to see and investigate stroke patients within 3 hours of stroke to assess suitability for thrombolysis. Acute Service is defined as a service which is able to see and investigate stroke patients urgently after stroke to provide a full range of care to patients from admission but does not offer thrombolysis Rehabilitation service is defined as a service which is able to see patients for rehabilitation. Definition Type of service provided at the site Units There is currently no information for this item. Coverage England, Wales and Northern Ireland Source Sentinel Stroke Audit - Organisational Audit Calculations/Formula/Methodology Question A1 and question 5.1a) and 5.1b) Excludes rehabilitation only sites

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Anonymous

See full wording of questions for exceptions in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Creator / Producer Royal College of Physicians Status The data for this indicator is no longer available, so the results have been taken down from the website. Quality Elements are contained within the public report Date 2010 Version History There is currently no information for this item. Update Frequency Usually every 2 years. Exceptionally 2008 and 2009. The interim data collection for the NAO report Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf Publisher / Owner Royal College of Physicians Other related PI's (relation)

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There is currently no information for this item. Additional Information This question is a filter to define if a site fits in a broad category. There are also questions about scanning on weekdays and weekends and timescales involved. Please note this is from the organisational audit data and suggests what a site estimates the service can provide, the clinical data provide information about the actual delay experienced by a cohort of patients. Caveats/Notes in support of data - Please note this is from the organisational audit data and suggests what a site estimates the service can provide, the clinical data provide information about the actual delay experienced by a cohort of patients THESE HAVE BEEN ALLOCATED YES IF THEY HAVE AT LEAST ONE ASU OR ONE CSU WITH SELF-DECLARED 3-HOUR SCANNING *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4' National Sentinel Stroke organisational Audit (although clinical audit data may be more appropriate to use for this standard)

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Anonymous

Elective Readmissions following abdominal aortic aneurysm surgery

Library Reference Number/Identifier RA26 Subject Elective Readmission Category Hospital care Detailed Descriptor This measure is presented as a readmissions ratio on the NHS Choices website, full methodology is available at http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=6&OrgType=5 the title of this indicator has changed from emergency to elective readmissions Rationale Many clinicians use readmission rates to monitor and improve the quality of care in the services that they provide. Definition The rates are calculated from routinely collected hospital data, a full methodology is available at http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=6&OrgType=5 Units Below expected, as expected, above expected Coverage Acute non-specialist providers Source Commissioning Data Sets_12 Months Calculations/Formula/Methodology Full methodology is available at http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=6&OrgType=5 Creator / Producer Data is supplied to NHS Choices by the NHS Information Centre for health and social care

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Anonymous

Status In use Quality The indicator is derived from mandatory data sets (Hospital Episode Statistics) and the source data and the indicators themselves are validated with individual providers, there may be some variation in the way that data is recorded by hospitals or trusts and this may lead to a risk of misreporting. Data is updated monthly. Date M7 2011-12 Version History N/A Update Frequency The data will be updated monthly on a rolling one year cycle (for example, data published in September 2008 is based on the period January 2007 December 2007). Accessibility http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=6&OrgType=5 Publisher / Owner Data is published by NHS Choices and commissioned by NHS Choices from the NHS Information Centre for health and social care Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Emergency Readmissions following gallbladder surgery

Library Reference Number/Identifier RA25 Subject Emergency Readmission Category Hospital care Detailed Descriptor This measure is presented as a readmissions ratio on the NHS Choices website, full methodology is available at http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=6&OrgType=5 Rationale Many clinicians use readmission rates to monitor and improve the quality of care in the services that they provide. Definition ***DROPPED The rates are calculated from routinely collected hospital data, a full methodology is available at http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=6&OrgType=5 Units Below expected, as expected, above expected Coverage Acute non-specialist providers Source Commissioning Data Sets_12 Months Calculations/Formula/Methodology Full methodology is available at http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=6&OrgType=5 Creator / Producer

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Anonymous

Data is supplied to NHS Choices by the NHS Information Centre for health and social care Status ***DROPPED Quality The indicator is derived from mandatory data sets (Hospital Episode Statistics) and the source data and the indicators themselves are validated with individual providers, there may be some variation in the way that data is recorded by hospitals or trusts and this may lead to a risk of misreporting. Data is updated monthly. Date M6 2011-12 Version History N/A Update Frequency The data will be updated monthly on a rolling one year cycle (for example, data published in September 2008 is based on the period January 2007 December 2007). Accessibility http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=6&OrgType=5 Publisher / Owner Data is published by NHS Choices and commissioned by NHS Choices from the NHS Information Centre for health and social care Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Emergency readmissions to hospital within 28 days of discharge (data relates to 16+ years old only)
Library Reference Number/Identifier RA01 Subject Public health indicators Category Health outcomes Detailed Descriptor Percentage of emergency admission to any hospital in England occurring within 28 days of the last, previous discharge from hospital after admission Rationale This is a generic, cross-sectional annual comparative indicator of outcome. In the absence of an absolute standard, comparative data are useful for monitoring in relation to rates achieved in comparable organisations.Such data can be used to stimulate discussion and encourage local investigation, and to lead to improvement in data quality and quality of care. Definition Numerator data - The number of finished and unfinished continuous inpatient (CIP) spells that are emergency admissions within 0-27 days (inclusive) of the last, previous discharge from hospital (see denominator), including those where the patient dies, but excluding the following: those with a main specialty upon readmission coded under obstetric or mental health specialties; and those where the readmitting spell has a diagnosis of cancer (other than benign or in situ) or chemotherapy for cancer coded anywhere in the spell. Denominator data - The number of finished CIP spells within selected medical and surgical specialties, with a discharge date up to March 31st within the year of analysis. Day cases, spells with a discharge coded as death, maternity spells (based on specialty, episode type, diagnosis), and those with mention of a diagnosis of cancer or chemotherapy for cancer anywhere in the spell are excluded. Patients with mention of a diagnosis of cancer or chemotherapy for cancer anywhere in the 365 days prior to admission are excluded. Mental health specialties are also excluded. Further information is available at http://www.nchod.nhs.uk/NCHOD/Compendium.nsf/17b8958892856d44802573a30020fcd9/00cf7 b6d526313e6652570d1001cb7eb!OpenDocument

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Anonymous

Units Indirectly age, sex, method of admission of discharge spell, diagnosis (ICD 10 chapter / selected sub-chapters within medical specialties) and procedure (OPCS 4 chapter / selected sub-chapters within surgical specialties) standardised percent of emergency admission to any hospital in England occurring within 28 days of the last, previous discharge from hospital after admission Coverage England Source National Centre for Health Outcomes Development - Compendium indicators Calculations/Formula/Methodology Further information on methodology is available at http://www.nchod.nhs.uk/NCHOD/Compendium.nsf/17b8958892856d44802573a30020fcd9/00cf7 b6d526313e6652570d1001cb7eb!OpenDocument Creator / Producer There is currently no information for this item. Status Live Quality Annex 12 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) describes the criteria that should be used to judge the quality of this indicator. The application of the criteria is dependent on the context (e.g. describing a single organisation, comparing several organisations) and the level (e.g. national / regional with large numbers of events, local with small numbers of events) at which the data are to be used. Date 2010-11 Version History Variants of this indicator have been used by the Department of Health in the NHS Performance Indicators, and by the Commission for Health Improvement and the Healthcare Commission in NHS Performance Ratings, in various combinations between 1999 and 2005.

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Update Frequency Annually Accessibility http://www.nchod.nhs.uk/NCHOD/Compendium.nsf/17b8958892856d44802573a30020fcd9/00cf7 b6d526313e6652570d1001cb7eb!OpenDocument Publisher / Owner Produced for The NHS Information Centre for health and social care by the National Centre for Health Outcomes Development (NCHOD) Crown Copyright. Other related PI's (relation) This indicator is part of a set of indicators on emergency readmissions to hospital within 28 days of discharge. Others include: -Emergency readmissions to hospital within 28 days of discharge: fractured proximal femur -Emergency readmissions to hospital within 28 days of discharge: hysterectomy -Emergency readmissions to hospital within 28 days of discharge: primary hip replacement surgery -Emergency readmissions to hospital within 28 days of discharge: stroke Additional Information Data relates to 16+ years old. For data relating to other age groups please visit; http://www.nchod.nhs.uk/NCHOD/Compendium.nsf/17b8958892856d44802573a30020fcd9/00cf7 b6d526313e6652570d1001cb7eb!OpenDocument Further reading: 1. Mason A, Goldacre M, Daly E. Using Readmission Rates as a Health Outcome indicator a Literature Review. Report to the Department of Health. Oxford: National Centre for Health Outcomes Development, 2000. 2. Department of Health. NHS Performance Indicators. London: Department of Health, 2002. 3. Healthcare Commission. 2005 performance ratings: July 2005 website http://ratings2005.healthcarecommission.org.uk/. London: Healthcare Commission, 2005. Data produced by the National Centre for Health Outcomes Development (NCHOD) using Hospital Episode Statistics (HES)

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Anonymous

Emergency readmissions to hospital within 28 days of discharge: fractured proximal femur

Library Reference Number/Identifier RA18 Subject Compendium of Public Health Indicators Category Osteoporosis Detailed Descriptor Numerator data The number of finished and unfinished continuous inpatient (CIP) spells that are emergency admissions within 0-27 days (inclusive) of the last, previous discharge from hospital (see denominator). The date of the last, previous discharge from hospital, and the date and method of admission from the following CIP spell, are used to determine the interval between discharge and emergency readmission. The numerator is based on a pair of spells, the discharge spell and the next subsequent readmission spell (this spell must meet the numerator criteria). The selection process thus carries over the characteristics of the denominator for the discharge spell and applies additional ones to the readmission spell. The numerator is the number of denominator CIP spells with the following fields and values: The first episode in readmission CIP spell ADMIDATE minus the last episode in admission CIP spell DISDATE = 0-27 days inclusive (discharge date and admission date, includes negatives); AND the first episode in the readmission CIP spell has: ADMIMETH = 21, 22, 23, 24 or 28 (admission method); Fields used from the first episode in a spell where there is a valid patient postcode allowing the derivation of the following organisation of residence codes include: SPELLRESPCTC, SPELLRESLADSTC, SPELLRESSTHAC. Other organisational levels (E, GOR, ONS Areas, Counties) are aggregates of the SPELLRESLADSTC field. Fields used from the last episode in a spell include: PROCODETC (provider code, unmapped). Provider clusters are aggregates of the PROCODETC field. Counts are by:

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Anonymous

age / sex / organisation of residence in CIP spell (values for England are aggregates of these) Where: age bands are <1, 1-4, 5-9, , 80-84, 85+; sex is 1, 2 (male and female). Comments on numerator data Individual finished consultant episodes are linked to other episodes where all are part of one continuous spell of care for a patient (see CIP spell construction sections in Annex 4 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) for details). The selected diagnosis can occur in separate episodes and even in separate hospitals after transfer. A spell may contain HES data from another year only when one of its episodes spans years. For example, a spell which finished during April may contain admission information from an episode which started during the previous March. The numerator (readmissions) consists of CIP spells (see denominator) that include both finished and unfinished episodes (i.e. finished episodes from following years) i.e. readmissions can be finished and unfinished CIP spells. Where there is more than one readmission within 28 days, each readmission is counted once, in relation to the previous discharge. Readmissions that end in death are included in the numerator. Spells are attributed to the organisation of residence, based on the numerator. The indicator includes discharges occurring after transfer to another Trust. For residence based aggregations discharges are counted to the first valid organisation coded in the spell. For provider based aggregations (Provider Trusts and Clusters) discharges are counted to the organisation that performed the procedure. There is variation in the completeness of hospital records and quality of coding (see Data Quality sections in Annex 4 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk) for details). Denominator: Denominator data - The number of finished CIP spells following an emergency admission with a primary diagnosis on admission of fractured proximal femur (ICD 10 codes S72.0, S72.1, S72.2), with a discharge date up to March 31st within the year of analysis:

S72.0 Fracture of neck of femur; S72.1 Pertrochanteric fracture; S72.2 Subtrochanteric fracture Day cases and spells with a discharge coded as death are excluded. The following fields and values are used for the denominator:

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Anonymous

The first episode in the CIP spell has: DIAG_01 in the valid list for this indicator (primary diagnosis); AND EPITYPE = 1 (episode type); AND SEX = 1 or 2 (sex); AND EPIORDER = 1 (episode order); AND ADMIMETH = 12, 22, 23, 24 or 28 (admission method); AND EPISTART is valid (episode start date); AND CLASSPAT = 1 or 5 (patient classification); AND MAINSPEF is not between 700 and 715 (main specialty); AND STARTAGE is either 0-120 or 7001-7007 (age at start of episode); AND DOB not 01/01/1900 or 01/01/1901 (date of birth).

And the last episode in the CIP spell has: DISDATE is valid and < 31/03/YYYY+1 (discharge date); AND DISMETH = 1, 2 or 3 (discharge method). Fields used from the first episode in a spell where there is a valid organisation of residence code include: SPELLRESPCTC, SPELLRESLADSTC, SPELLRESSTHAC. Other organisational levels (E, GOR, ONS Areas, County) are aggregates of the SPELLRESLADSTC field. Fields used from the last episode in a spell include: PROCODETC (provider code, unmapped). Provider clusters are aggregates of the PROCODETC field. Counts are by: age / sex / organisation of residence in CIP spell (values for England are aggregates of these). where: age bands are <1, 1-4, 5-9, , 80-84, 85+; sex is 1, 2 (male and female). Source of denominator data - Hospital Episode Statistics (HES) for the respective financial year, England, The Information Centre for health and social care. Comments on denominator data There is variation in the completeness of hospital records and quality of coding (see Data Quality sections in Annex 4 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) for details). Quality of coding shows the proportion of diagnoses not coded. There may also be variation between hospitals in the way that

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Anonymous

they code diagnoses to the fourteen diagnosis fields in each episode, particularly primary diagnosis. For instance, they may code in the order in which the diagnoses were made, or according to their perceived importance or complexity. This may affect whether a particular spell is selected for inclusion in this indicator. The denominator consists of CIP spells that cover all continuous consultant episodes for the same patient, including those following a transfer to another hospital. Denominator CIP spells must start with an admission episode and finish with a (live) discharge episode in the year of analysis. CIP spells with a discharge code of death are excluded from the denominator because readmission is not possible. Rationale To help monitor National Health Service (NHS) success in avoiding (or reducing to a minimum) readmission following discharge from hospital, when readmission was not part of the originally planned treatment. Previous analyses have shown that around 9% of patients discharged from NHS hospitals following emergency admission with a fractured proximal femur (hip) are readmitted as an emergency within 28 days. There is wide variation between similar NHS organisations in rates of such emergency readmissions. Not all emergency readmissions are likely to be part of the originally planned treatment and some may be potentially avoidable. The NHS may be helped to prevent potentially avoidable readmissions by seeing comparative figures and learning lessons from organisations with low readmission rates. Definition Percentage of emergency admissions to any hospital in England occurring within 28 days of the last previous discharge from hospital after emergency admission with fractured proximal femur. Units Indirectly age and sex-standardised percent (standardised to 2002/03) Coverage England Source National Centre for Health Outcomes Development - Compendium indicators Calculations/Formula/Methodology The indicator is indirectly standardised by age using England age rates as standards. Indirect standardisation involves the calculation of the ratio of an organisations observed number of events and the number of events that would be expected if it had experienced the same event rates as those of patients in England, given the age mix of its patients. This standardised ratio is then converted into a rate by multiplying it by the overall event rate of patients in England.

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Anonymous

The percentage change in rates from a previous year (or previous set of pooled years), plus the statistical significance of this change, have also been calculated. A positive percentage represents improvement and a negative percentage represents deterioration. Annex 3 Explanation of statistical methods (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) describes the methods used for indirect standardisation, calculation of improvement, estimation of confidence intervals, and banding of significance of improvement. (Link: http://www.nchod.nhs.uk/NCHOD/Method.nsf/List%20of%20Methods?OpenView) Creator / Producer NCHOD Status In use Quality There is currently no information for this item. Date 2010-11 Version History Version 1 Financial years 2006/07, 2005/06, 2004/05, 2003/04, 2002/03, 2001/02, 2000/01, 1999/00, 1998/99 Update Frequency 2009 Accessibility E, GOR, ONS Areas, County, LA (boundaries as at November 2006), SHA (boundaries as at July 2006), PCO (boundaries as at October 2006), deprivation group (5, 7 bands) http://www.nchod.nhs.uk/NCHOD/Compendium.nsf/17b8958892856d44802573a30020fcd9/2a44a 5a1940e70c3652570d1001cb7fd!OpenDocument

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Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Compendium of Public Health QA32F_535 Additional Information NEXT EXPECTED UPDATE 2009.12 (Dec)

Caveats in support of data: Data that may potentially identify an individual have been removed. However, the NHS version allows NHS staff access to such data, see lik available under accessibility. Primary diagnosis of the first episode in a spell. When comparing provider rates across more than one year, care must be taken to check for organisation restructuring which took place in between years (see note 3). Notes: Note 1: National Comparison, based on 95% and 99.8% confidence intervals of the rate; B1 = Significantly better than the national average at the 99.8% level; B5 = Significantly better than the national average at the 95% level but not at the 99.8% level; W = National average lies within expected variation (95% confidence interval); A5 = Significantly poorer than the national average at the 95% level but not at the 99.8% level; A1 = Significantly poorer than the national average at the 99.8% level. Note 2: Improvement banding, based on confidence interval of the change; A = Significant improvement (at 95% confidence), B = Moderate improvement (at 90% confidence); C = Some improvement (not significant), D = Some deterioration (not significant); E = Moderate deterioration (at 90% confidence), F = Significant deterioration (at 95% confidence); n/a = not applicable due to data issues in current or previous year; Note 3: Caution in interpretation of data; N = Numbers of patients too small for meaningful comparisons (i.e. below 200); D = Numbers under disclosure threshold (values between 0 and 4); Q = Concern about completeness and quality of data in year; I = Concern about completeness and quality of data over the improvement period i.e. two years; Rxx = Number of readmissions beginning prior to discharge > 10% of the numerator for this organisation (xx is the rounded percentage for these)*; M (applicable to providers only) = A known reorganisation took place between this year and the next, or previous, which effected all, or part, or this organisation.

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Anonymous

Hospital Episode Statistics (HES) for CIP spells intersecting the respective financial year, plus those up to 28 days in the next financial year, England, The Information Centre for Health and Social Care.

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Emergency readmissions to hospital within 28 days of discharge: hip replacement surgery

Library Reference Number/Identifier RA17 Subject Compendium of Public Health Indicators Category Osteoarthritis Detailed Descriptor Numerator data The number of finished and unfinished continuous inpatient (CIP) spells that are emergency admissions within 0-27 days (inclusive) of the last, previous discharge from hospital (see denominator). The date of the last, previous discharge from hospital, and the date and method of admission from the following CIP spell, are used to determine the interval between discharge and emergency readmission. The numerator is based on a pair of spells, the discharge spell and the next subsequent readmission spell (this spell must meet the numerator criteria). The selection process thus carries over the characteristics of the denominator for the discharge spell and applies additional ones to the readmission spell. The numerator is the number of denominator CIP spells with the following fields and values: The first episode in readmission CIP spell has: ADMIDATE minus last episode in discharge CIP spell DISDATE < 27 days inclusive (discharge date and admission date, includes negatives); AND the first episode in the readmission CIP spell ADMIMETH = 21, 22, 23, 24 or 28 (admission method). Fields used from the first episode in a spell where there is a valid patient postcode allowing the derivation of the following organisation of residence codes include: SPELLRESPCTC, SPELLRESLADSTC, SPELLRESSTHAC. Other organisational levels (E, GOR, ONS Areas, Counties) are aggregates of the SPELLRESLADSTC field. Fields used from the last episode in a spell include: PROCODETC (provider code, unmapped). Provider clusters are aggregates of the PROCODETC

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Anonymous

field.

Counts are by: age / sex / organisation of residence in CIP spell (values for England are aggregates of these).

where: age bands are <1, 1-4, 5-9, , 80-84, 85+; sex is 1, 2 (male and female). Comments on numerator data Individual finished consultant episodes are linked to other episodes where all are part of one continuous spell of care for a patient (see CIP spell construction sections in Annex 4 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) for details). A spell may contain HES data from another year only when one of its episodes spans years. For example, a spell which finished during April may contain admission information from an episode which started during the previous March. The numerator (readmissions) consists of CIP spells (see denominator) that include both finished and unfinished (i.e. finished episodes from following years) episodes, i.e. readmissions can be finished and unfinished CIP spells. Where there is more than one readmission within 28 days, each readmission is counted once, in relation to the previous discharge. Readmissions that end in death are included in the numerator. The indicator includes discharges occurring after transfer to another Trust. For residence based aggregations discharges are counted to the first valid organisation coded in the spell. For provider based aggregations (Provider Trusts and Clusters) discharges are counted to the organisation from where the patient was last discharged. There is variation in the completeness of hospital records and quality of coding (see Data Quality sections in Annex 4 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) for details). Denominator: Denominator data - The number of finished CIP spells for patients of all ages where there was a primary procedure of hip replacement surgery coded anywhere in the spell (OPCS 4 codes), with a discharge date up to March 31st within the year of analysis: W371 - Primary total prosthetic replacement of hip joint using cement W378 - Other specified W379 - Unspecified

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Anonymous

W381 - Primary total prosthetic replacement of hip joint not using cement W388 - Other specified W389 - Unspecified W391 - Primary total prosthetic replacement of hip joint NEC W398 - Other specified W399 - Unspecified W931 - Primary hybrid prosthetic replacement of hip joint using cemented acetabular component W938 - Other specified hybrid prosthetic replacement of hip joint using cemented acetabular component W939 - Unspecified hybrid prosthetic replacement of hip joint using cemented acetabular component W941 - Primary hybrid prosthetic replacement of hip joint using cemented femoral component W948 - Other specified hybrid prosthetic replacement of hip joint using cemented femoral component W949 - Unspecified hybrid prosthetic replacement of hip joint using cemented femoral component W951 - Primary hybrid prosthetic replacement of hip joint using cement NEC W958 - Other specified hybrid prosthetic replacement of hip joint using cement W959 - Unspecified hybrid prosthetic replacement of hip joint using cement Day cases, non-elective admissions and spells with a discharge coded as death are excluded. The following fields and values are used for the denominator: Any episode in the CIP spell has a procedure in the valid list for this indicator (in any position); The first episode in the CIP spell has: EPITYPE = 1 (episode type); AND SEX = 1 or 2 (sex); AND EPIORDER = 1 (episode order); AND ADMIMETH = 11, 12, 13, 81 (admission method); AND MAINSPEF NOT 501, 560, 610; AND EPISTART is valid (episode start date); AND CLASSPAT = 1 (patient classification); AND STARTAGE is either 0-120 or 7001-7007 (age at start of episode); AND DOB not 01/01/1900 or 01/01/1901 (date of birth).

AND the last episode in the CIP spell has: DISDATE is valid and < 31/03/YYYY+1 (discharge date); AND DISMETH = 1, 2 or 3 (discharge method). Fields used from the first episode in a spell where there is a valid organisation of residence code include: SPELLRESPCTC, SPELLRESLADSTC, SPELLRESSTHAC. Other organisational levels (E, GOR,

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Anonymous

ONS Areas, Counties) are aggregates of the SPELLRESLADSTC field. Fields used from the last episode in a spell include: PROCODETC (provider code, unmapped). Provider clusters are aggregates of the PROCODETC field. Counts are by: age / sex / organisation of residence in CIP spell (values for England are aggregates of these) where: age bands are <1, 1-4, 5-9, , 80-84, 85+; sex is 1, 2 (male and female). Source of denominator data Hospital Episode Statistics (HES) for CIP spells intersecting the respective financial year, England, The Information Centre for health and social care. Comments on denominator data There is variation in the completeness of hospital records and quality of coding (see Data Quality sections in Annex 4 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) for details). The denominator consists of CIP spells that cover all continuous, consultant episodes for the same patient, including those following a transfer to another hospital. Denominator CIP spells must start with an admission episode and finish with a (live) discharge episode in the year of analysis. CIP spells with a discharge code of death are excluded from the denominator because readmission is not possible. Rationale To help monitor National Health Service (NHS) success in avoiding (or reducing to a minimum) readmission following discharge from hospital, when readmission was not part of the originally planned treatment. Previous analyses have shown that around 6% of patients discharged from NHS hospitals following elective hip replacement surgery are readmitted as an emergency within 28 days. There is wide variation between similar NHS organisations in rates of such emergency readmissions. Not all emergency readmissions are likely to be part of the originally planned treatment, and some may be potentially avoidable. The NHS may be helped to prevent potentially avoidable readmissions by seeing comparative figures and learning lessons from organisations with low readmission rates. Definition Proportion of emergency admissions to any hospital in England occurring within 28 days of the last previous discharge from hospital after elective admission for primary hip replacement surgery.

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Anonymous

Units Indirectly age and sex-standardised percent (standardised to 2001/02, 2002/03, 2003/04 pooled) Indirectly age and sex-standardised percent (standardised to 2002/03) Coverage England Source National Centre for Health Outcomes Development - Compendium indicators Calculations/Formula/Methodology The indicator is indirectly standardised by age using England age rates as standards. Indirect standardisation involves the calculation of the ratio of an organisations observed number of events and the number of events that would be expected if it had experienced the same event rates as those of patients in England, given the age mix of its patients. This standardised ratio is then converted into a rate by multiplying it by the overall event rate of patients in England. The percentage change in rates from a previous year (or previous set of pooled years), plus the statistical significance of this change, have also been calculated. A positive percentage represents improvement and a negative percentage represents deterioration. Annex 3 Explanation of statistical methods (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) describes the methods used for indirect standardisation, calculation of improvement, estimation of confidence intervals, and banding of significance of improvement. (Link: http://www.nchod.nhs.uk/NCHOD/Method.nsf/List%20of%20Methods?OpenView) Creator / Producer NCHOD Status In use Quality There is currently no information for this item. Date

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Anonymous

2009-10 Version History Version 1 Financial years 2006/07, 2005/06, 2004/05, 2003/04, 2002/03, 2001/02, 2000/01, 1999/00, 1998/99 Update Frequency Annually Accessibility E, GOR, ONS Areas, County, LA (boundaries as at November 2006), SHA (boundaries as at July 2006), PCO (boundaries as at October 2006), deprivation group (5, 7 bands) http://www.nchod.nhs.uk/NCHOD/Compendium.nsf/17b8958892856d44802573a30020fcd9/3b7ba d6ad092b6db802573d7003bedaa!OpenDocument Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Compendium of Public Health RA33D_533 Additional Information NEXT EXPECTED UPDATE 2009.12 (Dec) Caveats/Notes in support of data: When comparing provider rates across more than one year, care must be taken to check for organisation restructuring which took place in between years (see note 3). Notes: Note 1: National Comparison, based on 95% and 99.8% confidence intervals of the rate; B1 = Significantly better than the national average at the 99.8% level; B5 = Significantly better than the national average at the 95% level but not at the 99.8% level; W = National average lies within expected variation (95% confidence interval); A5 = Significantly poorer than the national average at the 95% level but not at the 99.8% level; A1 = Significantly poorer than the national average at the 99.8% level.

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Anonymous

Note 2: Improvement banding, based on confidence interval of the change; A = Significant improvement (at 95% confidence), B = Moderate improvement (at 90% confidence); C = Some improvement (not significant), D = Some deterioration (not significant); E = Moderate deterioration (at 90% confidence), F = Significant deterioration (at 95% confidence); n/a = not applicable due to data issues in current or previous year; Note 3: Caution in interpretation of data; N = Numbers of patients too small for meaningful comparisons (i.e. below 200); D = Numbers under disclosure threshold (values between 0 and 4); Q = Concern about completeness and quality of data in year; I = Concern about completeness and quality of data over the improvement period i.e. two years; Rxx = Number of readmissions beginning prior to discharge > 10% of the numerator for this organisation (xx is the rounded percentage for these)*; M (applicable to providers only) = A known reorganisation took place between this year and the next, or previous, which effected all, or part, or this organisation. Hospital Episode Statistics (HES) for CIP spells intersecting the respective financial year, plus those up to 28 days in the next financial year, England, The Information Centre for Health and Social Care.

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Anonymous

Emergency readmissions to hospital within 28 days of discharge: hysterectomy

Library Reference Number/Identifier RA24 Subject Compendium of Public Health Indicators Category Surgery Detailed Descriptor Numerator data The number of finished and unfinished continuous inpatient (CIP) spells that are emergency admissions within 0-27 days (inclusive) of the last, previous discharge from hospital (see denominator). The date of the last, previous discharge from hospital, and the date and method of admission from the following CIP spell, are used to determine the interval between discharge and emergency readmission. The numerator is based on a pair of spells, the discharge spell and the next subsequent readmission spell (this spell must meet the numerator criteria). The selection process thus carries over the characteristics of the denominator for the discharge spell and applies additional ones to the readmission spell. The numerator is the number of denominator CIP spells with the following fields and values: The first episode in readmission CIP spell has: ADMIDATE minus last episode in discharge CIP spell DISDATE < 27 days inclusive (discharge date and admission date, includes negatives); AND first episode in the readmission CIP spell ADMIMETH = 21, 22, 23, 24 or 28 (admission method). Fields used from the first episode in a spell where there is a valid patient postcode allowing the derivation of the following organisation of residence codes include: SPELLRESPCTC, SPELLRESLADSTC, SPELLRESSTHAC. Other organisational levels (E, GOR, ONS Areas, Counties) are aggregates of the SPELLRESLADSTC field. Fields used from the last episode in a spell include: PROCODETC (provider code, unmapped). Provider clusters are aggregates of the PROCODETC field. Counts are by:

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Anonymous

age / organisation of residence in CIP spell (values for England are aggregates of these) where: age bands are <1, 1-4, 5-9, , 80-84, 85+; sex is 2 (female). Comments on numerator data Individual finished consultant episodes are linked to other episodes where all are part of one continuous spell of care for a patient (see CIP spell construction sections in Annex 4 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) for details). A spell may contain HES data from another year only when one of its episodes spans years. For example, a spell which finished during April may contain admission information from an episode which started during the previous March. The numerator (readmissions) consists of CIP spells (see denominator) that include both finished and unfinished (i.e. finished episodes from following years) episodes, i.e. readmissions can be finished and unfinished CIP spells. Where there is more than one readmission within 28 days, each readmission is counted once, in relation to the previous discharge. Readmissions that end in death are included in the numerator. The indicator includes discharges occurring after transfer to another Trust. For residence based aggregations, discharges are counted to the first valid organisation coded in the spell. For provider based aggregations (Provider Trusts and Clusters) discharges are counted to the organisation from where the patient was last discharged. There is variation in the completeness of hospital records and quality of coding (see Data Quality sections in Annex 4 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) for details). Denominator: Denominator data - The number of finished CIP spells for females of all ages where there was at least one mention of a hysterectomy coded anywhere in the spell (OPCS 4 codes Q07.1-Q08.9), with a discharge date up to March 31st within the year of analysis: Q07.- Abdominal excision of uterus Q08.- Vaginal excision of uterus Day cases, non-elective admissions and spells with a discharge coded as death are excluded. The following fields and values are used for the denominator: Any episode in the CIP spell has a procedure in the valid list for this indicator (in any position); The first episode in the CIP spell has: EPITYPE = 1 or 2 (episode type);

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Anonymous

AND SEX = 2 (sex); AND EPIORDER = 1 (episode order); AND ADMIMETH = 11,12,13, 81 (admission method); AND EPISTART is valid (episode start date); AND CLASSPAT = 1 or 5 (patient classification); AND STARTAGE is either 0-120 or 7001-7007 (age at start of episode); AND DOB not 01/01/1900 or 01/01/1901 (date of birth).

AND the last episode in the CIP spell has: DISDATE is valid and < 31/03/YYYY+1 (discharge date); AND DISMETH = 1, 2 or 3 (discharge method). Fields used from the first episode in a spell where there is a valid organisation of residence code include: SPELLRESPCTC, SPELLRESLADSTC, SPELLRESSTHAC. Other organisational levels (E, GOR, ONS Areas, Counties) are aggregates of the SPELLRESLADSTC field. Fields used from the last episode in a spell include: PROCODETC (provider code, unmapped). Provider clusters are aggregates of the PROCODETC field. Counts are by: age / organisation of residence in CIP spell (values for England are aggregates of these) where: age bands are <1, 1-4, 5-9, , 80-84, 85+; sex is 2 (female). Source of denominator data Hospital Episode Statistics (HES) for CIP spells intersecting the respective financial year, England, The Information Centre for health and social care. Comments on denominator data There is variation in the completeness of hospital records and quality of coding (see Data Quality sections in Annex 4 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) for details). The denominator consists of CIP spells that cover all continuous, consultant episodes for the same patient, including those following a transfer to another hospital. Denominator CIP spells must start with an admission episode and finish with a (live) discharge episode in the year of analysis. CIP spells with a discharge code of death are excluded from the denominator because readmission is not possible.

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Anonymous

Rationale To help monitor National Health Service (NHS) success in avoiding (or reducing to a minimum) readmission following discharge from hospital, when readmission was not part of the originally planned treatment. Previous analyses have shown that around 6% of patients discharged from NHS hospitals following elective hysterectomy are readmitted as an emergency within 28 days. There is wide variation between similar NHS organisations in rates of such emergency readmissions. Not all emergency readmissions are likely to be part of the originally planned treatment, and some may be potentially avoidable. The NHS may be helped to prevent potentially avoidable readmissions by seeing comparative figures and learning lessons from organisations with low readmission rates. Definition Proportion of emergency admissions to any hospital in England occurring within 28 days of the last previous discharge from hospital after elective admission for hysterectomy. Units Indirectly age-standardised percent (standardised to 2001/02, 2002/03, 2003/04 pooled) Indirectly age-standardised percent (standardised to 2002/03) Coverage England Source National Centre for Health Outcomes Development - Compendium indicators Calculations/Formula/Methodology The indicator is indirectly standardised by age using England age rates as standards. Indirect standardisation involves the calculation of the ratio of an organisations observed number of events and the number of events that would be expected if it had experienced the same event rates as those of patients in England, given the age mix of its patients. This standardised ratio is then converted into a rate by multiplying it by the overall event rate of patients in England. The percentage change in rates from a previous year (or previous set of pooled years), plus the statistical significance of this change, have also been calculated. A positive percentage represents improvement and a negative percentage represents deterioration. Annex 3 Explanation of statistical methods (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) describes the methods used for indirect standardisation,

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Anonymous

calculation of improvement, estimation of confidence intervals, and banding of significance of improvement. (Link: http://www.nchod.nhs.uk/NCHOD/Method.nsf/List%20of%20Methods?OpenView) Creator / Producer NCHOD Status In use Quality There is currently no information for this item. Date 2009-10 Version History Version 1 Financial years 2006/07, 2005/06, 2004/05, 2003/04, 2002/03, 2001/02, 2000/01, 1999/00, 1998/99 Update Frequency Annually Accessibility E, GOR, ONS Areas, County, LA (boundaries as at November 2006), SHA (boundaries as at July 2006), PCO (boundaries as at October 2006), deprivation group (5, 7 bands) http://www.nchod.nhs.uk/NCHOD/Compendium.nsf/17b8958892856d44802573a30020fcd9/c0c31 7c92e21be13802573d7003d7fb9!OpenDocument Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Compendium of Public Health UA36D_534

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Anonymous

Additional Information NEXT EXPECTED UPDATE 2009.12 (Dec) Caveats/Notes in support of data: Data that may potentially identify an individual have been removed from the Internet version. However, the NHS version allows NHS staff access to such data. Primary diagnosis of the first episode in a spell. When comparing provider rates across more than one year, care must be taken to check for organisation restructuring which took place in between years (see note 3). Notes: Note 1: National Comparison, based on 95% and 99.8% confidence intervals of the rate; B1 = Significantly better than the national average at the 99.8% level; B5 = Significantly better than the national average at the 95% level but not at the 99.8% level; W = National average lies within expected variation (95% confidence interval); A5 = Significantly poorer than the national average at the 95% level but not at the 99.8% level; A1 = Significantly poorer than the national average at the 99.8% level. Note 2: Improvement banding, based on confidence interval of the change; A = Significant improvement (at 95% confidence), B = Moderate improvement (at 90% confidence); C = Some improvement (not significant), D = Some deterioration (not significant); E = Moderate deterioration (at 90% confidence), F = Significant deterioration (at 95% confidence); n/a = not applicable due to data issues in current or previous year; Note 3: Caution in interpretation of data; N = Numbers of patients too small for meaningful comparisons (i.e. below 200); D = Numbers under disclosure threshold (values between 0 and 4); Q = Concern about completeness and quality of data in year; I = Concern about completeness and quality of data over the improvement period i.e. two years; Rxx = Number of readmissions beginning prior to discharge > 10% of the numerator for this organisation (xx is the rounded percentage for these)*; M (applicable to providers only) = A known reorganisation took place between this year and the next, or previous, which effected all, or part, or this organisation. Hospital Episode Statistics (HES) for CIP spells intersecting the respective financial year, plus those up to 28 days in the next financial year, England, The Information Centre for Health and Social Care.

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Anonymous

Emergency readmissions to hospital within 28 days of discharge: stroke

Library Reference Number/Identifier RA20 Subject Compendium of Public Health Indicators Category Stroke Detailed Descriptor Numerator data The number of finished and unfinished continuous inpatient (CIP) spells that are emergency admissions within 0-27 days (inclusive) of the last, previous discharge from hospital (see denominator). The date of the last, previous discharge from hospital, and the date and method of admission from the following CIP spell, are used to determine the interval between discharge and emergency readmission. The numerator is based on a pair of spells, the discharge spell and the next subsequent readmission spell (this spell must meet the numerator criteria). The selection process thus carries over the characteristics of the denominator for the discharge spell and applies additional ones to the readmission spell. The numerator is the number of denominator CIP spells with the following fields and values: The first episode in readmission CIP spell has: ADMIDATE minus last episode in discharge CIP spell DISDATE < 27 days inclusive (discharge date and admission date, includes negatives); AND the first episode in the readmission CIP spell has: ADMIMETH = 21, 22, 23, 24 or 28 (admission method). Fields used from the first episode in a spell where there is a valid patient postcode allowing the derivation of the following organisation of residence codes include: SPELLRESPCTC, SPELLRESLADSTC, SPELLRESSTHAC. Other organisational levels (E, GOR, ONS Areas, Counties) are aggregates of the SPELLRESLADSTC field Fields used from the last episode in a spell include: PROCODETC (provider code, unmapped). Provider clusters are aggregates of the PROCODETC field. Counts are by:

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Anonymous

age / sex / organisation of residence in CIP spell (values for England are aggregates of these) where: age bands are <1, 1-4, 5-9, , 80-84, 85+; sex is 1, 2 (male and female). Source of numerator data Hospital Episode Statistics (HES) for CIP spells intersecting the respective financial year, plus those up to 28 days in the next financial year, England, The Information Centre for health and social care. Comments on numerator data Individual finished consultant episodes are linked to other episodes where all are part of one continuous spell of care for a patient (see CIP spell construction sections in Annex 4 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) for details). A spell may contain HES data from another year only when one of its episodes spans years. For example, a spell which finished during April may contain admission information from an episode which started during the previous March The numerator (readmissions) consists of CIP spells (see denominator) that include both finished and unfinished (i.e. finished episodes from following years) episodes, i.e. readmissions can be finished and unfinished CIP spells. Where there is more than one readmission within 28 days, each readmission is counted once, in relation to the previous discharge. Readmissions that end in death are included in the numerator. Spells are attributed to the organisation of residence, based on the numerator. The indicator includes discharges occurring after transfer to another Trust. For residence based aggregations discharges are counted to the first valid organisation coded in the spell. For provider based aggregations (Provider Trusts and Clusters) discharges are counted to the organisation that performed the procedure. There is variation in the completeness of hospital records and quality of coding (see Data Quality sections in Annex 4 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk for details). Denominator: Denominator data - The number of finished CIP spells following an emergency admission with a primary diagnosis on admission of stroke (ICD 10 codes I61-I64), with a discharge date up to March 31st within the year of analysis:

I61.- Intracerebral haemorrhage

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Anonymous

 I62.- Other nontraumatic intracranial haemorrhage I63.- Cerebral infarction I64.- Stroke not specified as haemorrhage or infarction Day cases, other non-emergency admissions and spells with a discharge coded as death are excluded. The following fields and values are used for the denominator:

The first episode in the CIP spell has: DIAG_01 in the valid list for this indicator (primary diagnosis); EPITYPE = 1 (episode type); AND SEX = 1 or 2 (sex); AND EPIORDER = 1 (episode order); AND ADMIMETH = 12, 22, 23, 24 or 28 (admission method); AND EPISTART is valid (episode start date); AND CLASSPAT = 1 (patient classification); AND STARTAGE is either 0-120 or 7001-7007 (age at start of episode); AND DOB not 01/01/1900 or 01/01/1901 (date of birth). AND the last episode in the CIP spell has: DISDATE is valid and < 31/03/YYYY+1 (discharge date); AND DISMETH = 1, 2 or 3 (discharge method).

Fields used from the first episode in a spell where there is a valid organisation of residence code include: SPELLRESPCTC, SPELLRESLADSTC, SPELLRESSTHAC. Other organisational levels (E, GOR, ONS Areas, Counties) are aggregates of the SPELLRESLADSTC field. Fields used from the last episode in a spell include: PROCODETC (provider code, unmapped). Provider clusters are aggregates of the PROCODETC field. Counts are by: age / sex / organisation of residence in CIP spell (values for England are aggregates of these). where: age bands are <1, 1-4, 5-9, , 80-84, 85+;

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Anonymous

sex is 1, 2 (male and female). Source of denominator data Hospital Episode Statistics (HES) for CIP spells intersecting the respective financial year, England, The Information Centre for health and social care. Comments on denominator data There is variation in the completeness of hospital records and quality of coding (see Data Quality sections in Annex 4 (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) for details). Quality of coding shows the proportion of diagnoses not coded. There may also be variation between hospitals in the way that they code diagnoses to the fourteen diagnosis fields in each episode, particularly primary diagnosis. For instance, they may code in the order in which the diagnoses were made, or according to their perceived importance or complexity. This may affect whether a particular spell is selected for inclusion in this indicator. The denominator consists of CIP spells that cover all continuous, consultant episodes for the same patient, including those following a transfer to another hospital. Denominator CIP spells must start with an admission episode and finish with a (live) discharge episode in the year of analysis. CIP spells with a discharge code of death are excluded from the denominator because readmission is not possible. Rationale To help monitor National Health Service (NHS) success in avoiding (or reducing to a minimum) readmission following discharge from hospital, when readmission was not part of the originally planned treatment. Previous analyses have shown that around 8% of patients discharged from NHS hospitals following emergency admission with a stroke are readmitted as an emergency within 28 days. There is wide variation between similar NHS organisations in rates of such emergency readmissions. Not all emergency readmissions are likely to be part of the originally planned treatment, and some may be potentially avoidable. The NHS may be helped to prevent potentially avoidable readmissions by seeing comparative figures and learning lessons from organisations with low readmission rates. Definition Percentage of emergency admissions to any hospital in England occurring within 28 days of the last previous discharge from hospital after emergency admission with a stroke Units Indirectly age and sex-standardised percent (standardised to 2002/03) Coverage

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Anonymous

England Source National Centre for Health Outcomes Development - Compendium indicators Calculations/Formula/Methodology The indicator is indirectly standardised by age using England age rates as standards. Indirect standardisation involves the calculation of the ratio of an organisations observed number of events and the number of events that would be expected if it had experienced the same event rates as those of patients in England, given the age mix of its patients. This standardised ratio is then converted into a rate by multiplying it by the overall event rate of patients in England. The percentage change in rates from a previous year (or previous set of pooled years), plus the statistical significance of this change, have also been calculated. A positive percentage represents improvement and a negative percentage represents deterioration. Annex 3 Explanation of statistical methods (Methods section of the Clinical and Health Outcomes Knowledge Base www.nchod.nhs.uk ) describes the methods used for indirect standardisation, calculation of improvement, estimation of confidence intervals, and banding of significance of improvement. (Link: http://www.nchod.nhs.uk/NCHOD/Method.nsf/List%20of%20Methods?OpenView) Creator / Producer NCHOD Status In use Quality There is currently no information for this item. Date 2010-11 Version History Version 1 Financial years 2006/07, 2005/06, 2004/05, 2003/04, 2002/03, 2001/02, 2000/01, 1999/00, 1998/99

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Anonymous

Update Frequency Annually Accessibility E, GOR, ONS Areas, County, LA (boundaries as at November 2006), SHA (boundaries as at July 2006), PCO (boundaries as at October 2006), deprivation group (5, 7 bands) http://www.nchod.nhs.uk/NCHOD/Compendium.nsf/17b8958892856d44802573a30020fcd9/a48b0 92bba7c6156652570d1001cb7f1!OpenDocument Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Compendium of Public Health JE10D_529 Additional Information NEXT EXPECTED UPDATE 2009.12 (Dec) Caveats/Notes in support of data: Data that may potentially identify an individual have been removed from the Internet version. However, the NHS version allows NHS staff access to such data. Primary diagnosis of the first episode in a spell. When comparing provider rates across more than one year, care must be taken to check for organisation restructuring which took place in between years (see note 3). Notes: Note 1: National Comparison, based on 95% and 99.8% confidence intervals of the rate; B1 = Significantly better than the national average at the 99.8% level; B5 = Significantly better than the national average at the 95% level but not at the 99.8% level; W = National average lies within expected variation (95% confidence interval); A5 = Significantly poorer than the national average at the 95% level but not at the 99.8% level; A1 = Significantly poorer than the national average at the 99.8% level. Note 2: Improvement banding, based on confidence interval of the change; A = Significant improvement (at 95% confidence), B = Moderate improvement (at 90% confidence); C = Some improvement (not significant), D = Some deterioration (not significant); E = Moderate deterioration (at 90% confidence), F = Significant deterioration (at 95% confidence); n/a = not applicable due to data issues in current or previous year;

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Anonymous

Note 3: Caution in interpretation of data; N = Numbers of patients too small for meaningful comparisons (i.e. below 200); D = Numbers under disclosure threshold (values between 0 and 4); Q = Concern about completeness and quality of data in year; I = Concern about completeness and quality of data over the improvement period i.e. two years; Rxx = Number of readmissions beginning prior to discharge > 10% of the numerator for this organisation (xx is the rounded percentage for these)*; M (applicable to providers only) = A known reorganisation took place between this year and the next, or previous, which effected all, or part, or this organisation. Hospital Episode Statistics (HES) for CIP spells intersecting the respective financial year, plus those up to 28 days in the next financial year, England, The Information Centre for Health and Social Care.

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Anonymous

Patients who spend at least 90% of their time on a stroke unit

Library Reference Number/Identifier CV10 Subject Vital Signs Category National Requirement Tier 1 Detailed Descriptor Patients who spend at least 90% of their time on a stroke unit and higher risk TIA cases who are scanned and treated within 24 hours Rationale 110,000 people have a stroke each year, around a third of whom die. Stroke is the largest single cause of adult disability there are around 300,000 people in England living with moderate to severe disabilities as a result of a stroke. Good care on a dedicated stroke unit is the single most effective way to improve outcomes for people with stroke. Early initiation of treatment for Transient Ischaemic Attacks (TIAs) or minor stroke can reduce the number of people going on to have a major stroke by 80%. Higher risk TIA cases are defined as those with an ABCD2 score of 4 or above. These indicators are a good proxy for reducing disability and death due to stroke. Current Performance: Neither of these are currently measured, however, 56% of people with stroke spend the majority of their time in a stroke unit, 35% of people with TIAs are treated in 7 days. Expected Position by the end of 2010/11: 80% of people with stroke spend at least 90% of their time on a stroke unit and 60% of higher risk TIA cases are treated within 24 hours by 2010/11. National Stroke Strategy and other related information (including Action on Stroke Services Toolkit) can be found on www.dh.gov.uk/stroke Direction: Current Performance: Neither of these are currently measured. The National Sentinel Stroke Audit, performed by the Royal College of Physicians every two years showed in 2006 that: 56% of

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Anonymous

individuals with stroke spend the majority of their time in a stroke unit; and 35% of TIAs are treated in 7 days. Expected Position by the end of 2010/11: 80% of patients spend at least 90% of their time on a stroke unit and 60% of higher risk TIA cases are scanned and treated within 24 hours by 2010/11 Definition Patients who spend at least 90% of their time on a stroke unit and higher risk TIA cases who are scanned and treated within 24 hours: Detailed definition: As defined by the National Sentinel Stroke Audit a Stroke unit is a multidisciplinary team including specialist nursing staff based in a discrete ward which has been designated for stroke patients. This category includes the following sub-divisions: Acute stroke units that accept patients acutely but discharge early (usually within 7 days). This could include an ""intensive"" model of care with continuous monitoring and high nurse staffing levels. Rehabilitation stroke units which accept patients after a delay of usually 7 days or more and focus on rehabilitation Combined stroke unit (ie no separation between acute and rehabilitation beds) that accept patients acutely but also provide rehabilitation for at least several weeks if necessary. A stroke unit should have at least four of the key characteristics of a good stroke unit as defined by the National Sentinel Stroke Audit. The five key characteristics of a stroke unit are: Consultant physician with responsibility for stroke Formal links with patient and carer organisations Multidisciplinary meetings at least weekly to plan patient care Provision of information to patients about stroke Continuing education programmes for staff Direction: Current Performance: Neither of these are currently measured. The National Sentinel Stroke Audit, performed by the Royal College of Physicians every two years showed in 2006 that: 56% of individuals with stroke spend the majority of their time in a stroke unit; and 35% of TIAs are treated in 7 days. Expected Position by the end of 2010/11: 80% of patients spend at least 90% of their time on a stroke unit and 60% of higher risk TIA cases are scanned and treated within 24 hours by 2010/11 Criteria for Plan Sign-off: The expected position is 80% of patients spend at least 90% of their time on a stroke unit and 60%

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Anonymous

of higher risk TIA cases are treated within 24 hours by 2010/11 In order to deliver their contribution to the national position we would expect to see at Q4 2008/09 - 65%, at Q4 2009/10 -70%, at Q4 2010/11 -80% at Q4 2008/09 - 25%, at Q4 2009/10 -45%, at Q4 2010/11 -60% Units Percentage Coverage England Source DH - Stroke Calculations/Formula/Methodology Patients with the ICD10 codes I60-I69 should be reported against this line. If a patient has two episodes on a stroke unit they should be counted twice. Number of people who were admitted to hospital following a stroke: Detailed definition: The same ICD10 codes apply as above. If a patient has two episodes of admissions to hospital following a stroke they should be counted twice. Transient Ischaemic Attack (TIA) cases with a higher risk of stroke who are treated within 24 hours: Detailed definition: Higher risk TIA cases are defined as those with an ABCD2 score of 4 or above. The ABCD2 score is calculated using the patient's age (A); blood pressure (B); clinical features (C); duration of TIA symptoms (D); and presence of diabetes (2). Scores are between 0 and 7 points. Age (60 years, 1 point); Blood pressure at presentation (140/90 mm Hg, 1 point); Clinical features (unilateral weakness, 2 points; speech disturbance without weakness, 1 point); Duration of TIA symptoms (60 minutes, 2 points; 10-59 minutes, 1 point); and presence of diabetes (1 point). Low risk = 0-3 points; moderate risk = 4-5 points; high-risk = 6-7 points. If a patient has two episodes of TIA which are treated within 24 hours, in the period, they should

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Anonymous

be counted twice. Patients with the following ICD10 codes should be reported against this line. G450 Vertebro-basilar artery syndrome G451 Carotid artery syndrome (hemispheric) G452 Multiple and bilateral precerebral artery syndromes G453 Amaurosis fugax G458 Other transient cerebral ischaemic attacks and related synd G459 Transient cerebral ischaemic attack, unspecified Number of people who have a Transient Ischaemic Attack (TIA) who are at higher risk of stroke: Detailed definition: Higher risk TIA cases are defined as those with an ABCD2 score of 4 or above. If a patient has two episodes of TIA, in the period, they should be counted twice. The same ICD10 codes apply as above Denominator 1: number of people who have a stroke who admitted to hospital Numerator 1: number of people who spend at least 90% of their time on a stroke unit Denominator 2: number of people who have a TIA who are high risk Numerator 2: number of people who have a TIA who are scanned and treated within 24 hours UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: The expected position is 80% of patients spend at least 90% of their time on a stroke unit and 60% of higher risk TIA cases are treated within 24 hours by 2010/11 In order to deliver their contribution to the national position we would expect to see at Q4 2008/09 - 65%, at Q4 2009/10 -70%, at Q4 2010/11 -80% at Q4 2008/09 - 25%, at Q4 2009/10 -45%, at Q4 2010/11 -60% Creator / Producer There is currently no information for this item. Status In use

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Anonymous

Quality Baseline: The baseline for planning purposes will be the latest collection of Vital Signs Monitoring Return Date Q3 2012-13 Version History There is currently no information for this item. Update Frequency Quarterly Accessibility Department of Health Publisher / Owner Department of Health (DH) Other related PI's (relation) VSA14 Additional Information National Stroke Strategy and other related information (including Action on Stroke Services Toolkit) can be found on http://www.dh.gov.uk/stroke *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4' This data has not previously been collected. However, existing data on organisation of services for, and clinical treatment of, TIA and stroke can be found in the National Stroke Sentinel Audit (http://www.rcplondon.ac.uk/pubs/books/strokeaudit/)

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Anonymous

Percentage of ST-elevation myocardial infarction (STEMI) patients who received primary angioplasty within 120 minutes of call (call to balloon time)
Library Reference Number/Identifier CV35 Subject Myocardial Ischaemia National Audit Project (MINAP) Category Heart Disease Detailed Descriptor Percentage of ST-elevation myocardial infarction (STEMI) patients who received primary angioplasty within 120 minutes of call (call to balloon time) Rationale http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Application%20notes%20v5%20final.doc Definition Not defined yet Units % of eligible patients Coverage England and Wales Source Myocardial Ischaemia National Audit Project (MINAP) Calculations/Formula/Methodology http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Application%20notes%20v5%20final.doc Creator / Producer Myocardial Ischaemia National Audit Project (MINAP)

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Anonymous

Status In use Quality Good Date There is currently no information for this item. Version History First report produced in 2002 with updates annually. Update Frequency Annual NB continuous collection Accessibility Figures available for England and Wales and national and provider level. Percentages are not shown for less than 20 cases for thrombolytic treatment and analysis is not performed on less than 10 cases for primary angioplasty. General website: http://www.rcplondon.ac.uk/CLINICALSTANDARDS/ORGANISATION/PARTNERSHIP/Pages/MINAP-.aspx Latest report: http://www.rcplondon.ac.uk/clinicalstandards/organisation/partnership/Documents/Minap-2008.pdf Please note that the linked report contains details similar to that of the indicator, however there were differences, e.g. report does not state STEMI and time period noted was 90 minutes rather than 120 as noted by the indicator. Publisher / Owner Myocardial Ischaemia National Audit Project (MINAP) Other related PI's (relation) There is currently no information for this item. Additional Information MINAP or BCIS - BCIS ignore patients with balloon pumps - refer to John Birkhead and Peter Ludman. (BCIS exclude patients with with cardiogenic shock)

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Anonymous

Percentage of ST-elevation myocardial infarction (STEMI) patients who received thrombolytic treatment within 60 minutes of call (call to needle time)
Library Reference Number/Identifier CV34 Subject Myocardial Ischaemia National Audit Project (MINAP) Category Heart Disease Detailed Descriptor Percentage of STEMI patients who received Thrombolytic treatment within 60 minutes of call (call to needle time) Rationale Good evidence that early treatment with thrombolytic drugs improves mortality outcome following ST elevation infarction . This indicator measures performance of the ambulance service and the hospital in providing timely treatment Definition % of eligible patients (with initial diagnosis of definite MI, that did not self present, make own way to hospital or were transferred for PCI whose initial reperfusion treatment was thrombolytic treatment and did not have a justified delay to treatment) who received thrombolytic treatment within 60 mins of calling for help , Units % of eligible patients Coverage England and Wales Source Myocardial Ischaemia National Audit Project (MINAP) Calculations/Formula/Methodology % of eligible patients (with initial diagnosis of definite MI, that did not self present, make own way to hospital or were transferred for primary PCI, whose initial reperfusion treatment was

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Anonymous

thrombolytic treatment and did not have a justified delay to treatment) who received thrombolytic treatment within 60 mins of calling for help , Creator / Producer Myocardial Ischaemia National Audit Project (MINAP) Status In use Quality Good Date 2010-11 Version History First report produced in 2002 with updates annually. Update Frequency Annual NB continuous collection Accessibility Figures available for England and Wales and national and provider level. Percentages are not shown for less than 20 cases for thrombolytic treatment and analysis is not performed on less than 10 cases for primary angioplasty. General website: http://www.rcplondon.ac.uk/CLINICALSTANDARDS/ORGANISATION/PARTNERSHIP/Pages/MINAP-.aspx Latest report: http://www.rcplondon.ac.uk/clinicalstandards/organisation/partnership/Documents/Minap-2008.pdf Please note that the linked report contains details similar to that of the indicator, however there were differences, e.g. report does not state STEMI. Publisher / Owner Myocardial Ischaemia National Audit Project (MINAP) Other related PI's (relation) There is currently no information for this item.

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Anonymous

Additional Information There is currently no information for this item.

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Anonymous

Percentage of ST-elevation myocardial infarction (STEMI) patients who received thrombolytic treatment within 60 minutes of call (call to needle time) PLUS percentage of STEMI patients who received primary angioplasty within 120 minutes of call (call to balloon time)
Library Reference Number/Identifier CV36 Subject Myocardial Ischaemia National Audit Project (MINAP) Category Heart Disease Detailed Descriptor Percentage of ST-elevation myocardial infarction (STEMI) patients who received Thrombolytic treatment within 60 minutes of call (call to needle time) PLUS percentage of STEMI patients who received primary angioplasty within 120 minutes of call (call to balloon time) Rationale http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Application%20notes%20v5%20final.doc Definition Not defined yet Units % of eligible patients Coverage England and Wales Source Myocardial Ischaemia National Audit Project (MINAP) Calculations/Formula/Methodology http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Application%20notes%20v5%20final.doc

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Anonymous

Creator / Producer Myocardial Ischaemia National Audit Project (MINAP) Status In use Quality Good Date 2010-11 Version History First report produced in 2002 with updates annually. Update Frequency There is currently no information for this item. Accessibility Figures available for England and Wales and national and provider level. Percentages are not shown for less than 20 cases for thrombolytic treatment and analysis is not performed on less than 10 cases for primary angioplasty. General website: http://www.rcplondon.ac.uk/CLINICALSTANDARDS/ORGANISATION/PARTNERSHIP/Pages/MINAP-.aspx Latest report: http://www.rcplondon.ac.uk/clinicalstandards/organisation/partnership/Documents/Minap-2008.pdf Please note that the linked report contains details similar to that of the indicator, however there were differences, e.g. report does not state STEMI and time period noted was 90 minutes rather than 120 as noted by the indicator. Publisher / Owner Myocardial Ischaemia National Audit Project (MINAP) Other related PI's (relation) There is currently no information for this item.

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Anonymous

Additional Information Appears it is a combination of CV34 and 35

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Anonymous

Proportion of stroke patients given a brain scan within 24 hours of stroke

Library Reference Number/Identifier CV02 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale An important index date relevant to the care received. Some of the standards in the audit are linked to this. See help booklet for clinical audit at http://www.mqi.ic.nhs.uk/documents/2008%20Clinical%20audit%20help-booklet%20FINAL.doc Definition Sample of 60 The audit sample for 2008 includes the first 60 consecutive cases with a primary diagnosis of stroke (ICD 10 codes:I61, I63 and I64) admitted to the Trust between 01 April 30 June 2008. Please note due to coding issues the codes should not be used alone to identify stroke patients. Sample of 20 Trusts who have identified a small annual caseload should contact the CEEu for further advice. NB Exclusions - Cases with subarachnoid haemorrhage (I60), subdural and extradural haematoma (I62) are excluded from this audit sample. Units % Coverage England, Wales and Northern Ireland

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Anonymous

Source Sentinel Stroke Audit - Clinical Audit Calculations/Formula/Methodology Question 1.13iv See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc It is based on all who do not have a justifiable exception for not scanning see question 1.13i Creator / Producer Royal College of Physicians Status In use Quality It is in the public domain Date 2010 Version History There is currently no information for this item. Update Frequency Every two years depending on funding. Most recent round includes data on patients admitted between April and June 2008. Next data collection tbc estimated as April 2010 Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf

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Anonymous

Publisher / Owner Royal College of Physicians Other related PI's (relation) One of the CQC Performance Indicators Additional Information *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Anonymous

Proportion of stroke patients given a swallow screening within 24 hours of admission

Library Reference Number/Identifier CV06 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale See help booklet for clinical audit at http://www.mqi.ic.nhs.uk/documents/2008%20Clinical%20audit%20help-booklet%20FINAL.doc Screening for swallowing is question 3.3 Patients are routinely screened with a standardised screening procedure to check for dysphagia. The ability to swallow should be assessed within 24 hours of admission. Difficulties may be temporary but carry increased risk of complications. Visual fields and sensory testing are questions 3.1i and 3.1ii respectively. If the patient is alert and able to communicate, there is a formal assessment of visual fields. Recognition of field defects helps with localisation of the pathology and has therapeutic importance. Previous rounds of the audit have identified particularly low compliance with this element of the standard. Sensory deficits are often missed unless specifically looked for. It is a common reason for delayed recovery. The last 2 for visual fields and sensory testing are not in the public domain. Definition There is currently no information for this item. Units

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Anonymous

% Coverage England, Wales and Northern Ireland Source Sentinel Stroke Audit - Clinical Audit Calculations/Formula/Methodology Questions 3.3, 3.1i and 3.1ii See full wording of questions for exceptions in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Calculation of % compliance yes/(yes+no) Creator / Producer Royal College of Physicians Status Only 1 feeder question is included in the public domain (swallow screen) Quality Only 1 feeder question is included in the public domain (swallow screen) Date 2010 Version History There is currently no information for this item. Update Frequency Every two years depending on funding. Most recent round includes data on patients admitted between April and June 2008. Next data collection tbc estimated as April 2011 Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Current-

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Anonymous

work/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf Publisher / Owner Royal College of Physicians Other related PI's (relation) Swallow screening is one of the CQC Performance Indicators Additional Information *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Anonymous

Proportion of stroke patients given Aspirin or alternative e.g. clopidogrel within 48 hours of stroke (secondary prevention)
Library Reference Number/Identifier CV01 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale See help booklet for clinical audit at http://www.mqi.ic.nhs.uk/documents/2008%20Clinical%20audit%20help-booklet%20FINAL.doc re question 3.4 Definition Proportion of stroke patients given Aspirin or alternative e.g. clopidogrel within 48 hours of stroke (secondary prevention) Exceptions are: if patient is receiving palliative care; patient died; patient has an intra-cerebral haemorrhage Units % Coverage England, Wales and Northern Ireland Source Sentinel Stroke Audit - Clinical Audit Calculations/Formula/Methodology Question 3.4 See full wording of questions for exceptions in

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Anonymous

http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Calculation of % compliance yes/(yes+no) Creator / Producer Royal College of Physicians Status In use Quality It is in the public domain Date 2010 Version History There is currently no information for this item. Update Frequency Every two years depending on funding. Most recent round includes data on patients admitted between April and June 2008. Next data collection tbc estimated as April 2012 Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf Publisher / Owner Royal College of Physicians Other related PI's (relation) One of the CQC Performance Indicators

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Anonymous

Additional Information *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Anonymous

Sites offering thrombolysis to stroke patients.

Library Reference Number/Identifier CV20 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale With the increasing use of thrombolysis in appropriate stroke patients this will enable national benchmarking of rollout Definition Provision of thrombolysis at your site i) If yes, number thrombolysed in previous 12 months ii) Level of service offered hours per day on weekdays and; iii) Level of service offered hours per day on weekends NB This is thrombolysis for treating patients presenting with stroke (not patients who happen to have an MI on this admission) NB This alone does not provide information about whether or not any patients have been thrombolysed and needs to take into account the number of patients thrombolysed either at a collaborating site or on site. Hence other data must be used in combination. Units There is currently no information for this item. Coverage England, Wales and Northern Ireland Source

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Anonymous

Sentinel Stroke Audit - Organisational Audit Calculations/Formula/Methodology Question 1.6 and Q1.8 as it is not necessarily appropriate for every hospital to thrombolyse Excludes rehabilitation only sites See full wording of questions for exceptions in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Creator / Producer Royal College of Physicians Status In use Quality Modified form in the public report Date 2010 Version History There is currently no information for this item. Update Frequency Usually every 2 years. Exceptionally 2008 and 2009. The interim data collection for the NAO report Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf

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Anonymous

Publisher / Owner Royal College of Physicians Other related PI's (relation) There is currently no information for this item. Additional Information Caveats/Notes in support of data: This alone does not provide information about whether or not any patients have been thrombolysed and needs to take into account the number of patients thrombolysed either at a collaborating site or on site. Hence other data must be used in combination SOME OF THESE SITES OFFER BUT HAVE NOT ACTUALLY DONE ANY THROMBOLYSIS *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Anonymous

Surgical site infections - Open reduction of long bone fracture (ORLBF)

Library Reference Number/Identifier HC24 Subject Health Protection Agency (HPA) Category Surgical Site Infections (SSI) Detailed Descriptor Rate of surgical site infection following open reduction of long bone fracture (ORLBF) Rationale SSIs are of public health importance given their impact on patient care and associated costs to the health service. Surveillance of SSIs enables Trusts to benchmark their rates of infection against national rates, providing a means for identifying and investigating elevated rates of SSI. Definition Numerator: number of SSIs detected during hospital stay and at readmission in each category of surgery. Denominator: number of operations within each category of surgery. Units % Coverage England Source Surgical Site Infection Surveillance Service (Health Protection Agency) Calculations/Formula/Methodology The % SSI represents the number of SSIs detected during the post-operative stay in hospital or during readmission divided by the number of operations performed in that category of surgery. Eligible procedures are defined by a set of OPCS codes for each category of surgery. Trusts must undertake surveillance for a minimum of one quarter in one of four orthopaedic categories and have the option of participating in any number of 14 other surgical categories. The surveillance must include all patients undergoing an eligible procedure during the surveillance period. Further

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Anonymous

details on the methodology including standard case definitions for SSI are described in the surveillance protocol. Creator / Producer Health Protection Agency Status Live Quality Data are submitted via a web-based data entry system with in-built data validation systems. The data are subsequently checked comprehensively for errors by HPA surveillance staff. The following limitations should be borne in mind in interpreting these data: 1) Surveillance protocols were amended in July 2008 and participating hospitals required to collect data on SSIs identified at readmission in addition to those detected in the post-operative stay previously. This increased the rate of detection of SSIs. 2) Some Trusts perform small numbers of operations and their rates of SSI may therefore be imprecise. 3) No adjustment has been made for the case mix of patients or other important risk factors that may affect Trusts' rates of SSI which should be taken into account when comparing rates. Date 2011-12 Version History v2.0 Update Frequency Annually Accessibility Data available from: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/SurgicalSiteInfectionSurveillanceSe rvice/ http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1227774003731 Publisher / Owner Health Protection Agency

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Anonymous

Other related PI's (relation) There is currently no information for this item. Additional Information *The confidence limits represent the range of rates between which the true rate of infection could feasibly lie and will be wider for those Trusts with fewer operations. Very low, or very high rates that are based on a small number of procedures should therefore not be taken at face value but should be interpreted in conjunction with the confidence limits. The conventional method of calculating confidence limits could be misleading for rates based on less than 50 operations, as they overestimate the true upper 95% limit, and for this reason they have not been included for Trusts with less than 50 operations in a particular orthopaedic category. Hammersmith NHS Trust merged with Imperial College Healthcare NHS Trust on 1st October 2007. Imperial College Healthcare NHS Trust was formed on 1st October 2007 by merging St Mary's NHS Trust and Hammersmith NHS Trust. Surrey & Sussex Healthcare NHS TrusT: Includes Redwood Diagnosis and Treatment Centre merged with Surrey & Sussex Healthcare NHS Trust after March 2008.

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Anonymous

Number of hospital occupied bed days on adult psychiatric wards of patients aged 16 or 17, on admission, under the care of a psychiatric specialist
Library Reference Number/Identifier CF02 Subject When providing data for line 5412 (16/17 year olds on adult psychiatric wards): if it is possible to discount the days within a quarter after the 18th birthday, then that should be done; and anybody who starts the quarterly period aged 18 or over should not be counted for the purpose of this indicator. Similarly for line 5410 (in relation to under 18s on CAMHS wards), and for line 5411 (under 16s on adult psychiatric wards). So once a patient moves out of the age group referred to by the line in question, bed days no longer need to be reported. Category There is currently no information for this item. Detailed Descriptor There is currently no information for this item. Rationale There is currently no information for this item. Definition There is currently no information for this item. Units There is currently no information for this item. Coverage Psychiatric specialists are consultants with specialty code 710, 711, 712, 713, 715. CAMHS patients who are on part of an adult ward that has been set aside specifically to meet the requirements of a CAMHS patient should be included in item 5410 and excluded from this item. Source Child and Adolescent Mental Health Service

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Anonymous

Calculations/Formula/Methodology There is currently no information for this item. Creator / Producer There is currently no information for this item. Status DROPPED - NO LONGER IN THE VITAL SIGNS/INTEGRATED PERFORMANCE MEASURE SO NOT COLLECTED BY DH Quality There is currently no information for this item. Date Q4 2010-11 Version History There is currently no information for this item. Update Frequency There is currently no information for this item. Accessibility There is currently no information for this item. Publisher / Owner There is currently no information for this item. Other related PI's (relation) http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/index.ht m Additional Information There is currently no information for this item.

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Anonymous

Number of hospital occupied bed days on adult psychiatric wards of patients aged under 16, on admission, under the care of a psychiatric specialist
Library Reference Number/Identifier CF01 Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor There is currently no information for this item. Rationale There is currently no information for this item. Definition Psychiatric specialists are consultants with specialty code 710, 711, 712, 713, 715. CAMHS patients who are on part of an adult ward that has been set aside specifically to meet the requirements of a CAMHS patient should be included in item 5410 and excluded from this item. Units There is currently no information for this item. Coverage There is currently no information for this item. Source Child and Adolescent Mental Health Service Calculations/Formula/Methodology There is currently no information for this item. Creator / Producer There is currently no information for this item.

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Anonymous

Status DROPPED - NO LONGER IN THE VITAL SIGNS/INTEGRATED PERFORMANCE MEASURE SO NOT COLLECTED BY DH Quality There is currently no information for this item. Date Q4 2010-11 Version History There is currently no information for this item. Update Frequency There is currently no information for this item. Accessibility http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/index.ht m Publisher / Owner There is currently no information for this item. Other related PI's (relation) There is currently no information for this item. Additional Information When providing data for line 5412 (16/17 year olds on adult psychiatric wards): if it is possible to discount the days within a quarter after the 18th birthday, then that should be done; and anybody who starts the quarterly period aged 18 or over should not be counted for the purpose of this indicator. Similarly for line 5410 (in relation to under 18s on CAMHS wards), and for line 5411 (under 16s on adult psychiatric wards). So once a patient moves out of the age group referred to by the line in question, bed days no longer need to be reported.

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Anonymous

Proportion of children who complete DTP immunisation by their 5th Birthday

Library Reference Number/Identifier WCC 2.11 Subject World Class Commissioning (WCC) Category 2 - Health Outcomes and Targets 1 - This chapter encompasses health outcomes and national targets which are broken down into the Darzi service model, four of which are covered here Detailed Descriptor Proportion of children aged 5 who complete immunisation for diphtheria, polio, tetanus and pertussis booster Rationale There is currently no information for this item. Definition There is currently no information for this item. Units There is currently no information for this item. Coverage There is currently no information for this item. Source Immunisation Team - Information Centre Calculations/Formula/Methodology There is currently no information for this item. Creator / Producer There is currently no information for this item. Status There is currently no information for this item.

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Anonymous

Quality There is currently no information for this item. Date 2010-11 Version History There is currently no information for this item. Update Frequency Annually Accessibility Data can be found in '5 years' tab of Excel tables http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1204031522581?p=12 04031522581 Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) WCC 2.11 Additional Information (1) The following 5 PCTs experienced data quality issues and thus may not present an accurate reflection of actual uptake; 5N1, 5N9, 5K5, 5C5, 5QM (2) The following 13 PCTs experienced data quality issues as a result of a recent migration to a new Child Health system or problems with their existing Child Health system, leading to a lack of confidence in data reported; 5J2, 5C2, TAK, 5K7, 5C3, 5C9, 5A4, 5AT, 5HY, 5K8, 5A5, 5NA, 5K3 (3) 1 PCT (5P5 - Surrey PCT) submitted partial datasets due to the unavailability of data from certain regions. (4) The following 3 PCTs submitted data based upon quarter data due to problems with the reporting of an annual figure; 5J5, 5J2, 5A5 Trusts' data: where there has been missing data, or large movements year on year, these have been queried with the trusts and data withdrawn, estimated or published in agreement with them.

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Anonymous

Proportion of children who complete MMR immunisation (1st and 2nd dose) by their 5th Birthday
Library Reference Number/Identifier WCC 2.10 Subject World Class Commissioning (WCC) Category 2 - Health Outcomes and Targets 1 - This chapter encompasses health outcomes and national targets which are broken down into the Darzi service model, four of which are covered here Detailed Descriptor Proportion of children aged 5 who complete immunisation for MMR (1st and 2nd dose) Rationale There is currently no information for this item. Definition There is currently no information for this item. Units There is currently no information for this item. Coverage There is currently no information for this item. Source Immunisation Team - Information Centre Calculations/Formula/Methodology There is currently no information for this item. Creator / Producer There is currently no information for this item. Status

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Anonymous

There is currently no information for this item. Quality There is currently no information for this item. Date 2010-11 Version History There is currently no information for this item. Update Frequency Annually Accessibility Data can be found in '5 years' tab of Excel tables http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1204031522581?p=12 04031522581 Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) WCC 2.10 Additional Information There is currently no information for this item.

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Anonymous

Proportion of children who complete MMR immunisation by 2nd Birthday

Library Reference Number/Identifier WCC 2.09 Subject World Class Commissioning (WCC) Category 2 - Health Outcomes and Targets 1 - This chapter encompasses health outcomes and national targets which are broken down into the Darzi service model, four of which are covered here Detailed Descriptor Proportion of children aged 2 who complete immunisation for MMR Rationale There is currently no information for this item. Definition There is currently no information for this item. Units There is currently no information for this item. Coverage There is currently no information for this item. Source Immunisation Team - Information Centre Calculations/Formula/Methodology There is currently no information for this item. Creator / Producer There is currently no information for this item. Status There is currently no information for this item.

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Anonymous

Quality There is currently no information for this item. Date 2010-11 Version History There is currently no information for this item. Update Frequency Annually Accessibility Data can be found in '24 months' tab of Excel tables http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1204031522581?p=12 04031522581 Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) WCC 2.09 Additional Information There is currently no information for this item.

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Anonymous

Percentage of all deaths that occur at home

Library Reference Number/Identifier WCC 3.24 Subject World Class Commissioning (WCC) Category 3 - Health Outcomes and Targets 2 - This chapter covers health outcomes and targets. All indicators have been broken into the eight Darzi service model of which four are included in this chapter Detailed Descriptor Numerator data - Deaths at home from all causes, classified by underlying cause of death (ICD-10 A00-Y99), registered in the respective calendar year(s). Source of numerator data - Office for National Statistics (ONS). Comments on numerator data Mortality data for years 1993-2006 were extracted by ONS in June 2007 with organisational codes assigned using the postcode of usual residence and the November 2006 edition of the National Statistics Postcode Directory (NSPD). Data for 2007 were extracted in June 2008 using the November 2007 NSPD. Information about the place of death is found on the mortality record in the communal establishment field. It contains one of: a 5 digit code identifying a communal establishment or institution (e.g. hospital, nursing home, residential home); an H code which indicates that the person is certified as having died at their home address and that this is not a communal establishment or; an E code which indicates that the person died elsewhere. The communal establishments are themselves classified into 84 categories (e.g. general hospital, mental nursing home, nursing home etc) and can be further distinguished by whether they are an NHS or Non-NHS establishment. It is currently ONS practice to include nursing homes with hospitals under a broader group - Other hospitals and communal establishments for the care of the sick - and also to include residential homes under Other communal establishments. This is because of concerns highlighted by the ONS regarding the accuracy of the recorded status of some communal establishments,

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Anonymous

particularly nursing homes and residential homes. It is therefore not possible to include nursing home or residential home deaths as a home death. For this indicator, a home death is defined as one that has the H code in the communal establishment field, i.e. where the death has occurred at the home address and that address is not of a communal establishment. Denominator data - All deaths from all causes, classified by underlying cause of death (ICD-10 A00-Y99), registered in the respective calendar year(s). Source of denominator data - ONS. Comments on denominator data - Includes deaths in all categories of communal establishment code, i.e. deaths in all communal establishments, at home, and elsewhere. From the 2003 Compendium onwards, data are based on the original causes of death rather than the final causes used in earlier Compendia. See Annex 2 for more details. Rationale To improve palliative care and service planning for patients in the terminal stages of life, allowing more of them the choice of dying at home. Definition Proportion of deaths from all causes (ICD-10 A00-Y99) that occur at home. Units Percent of deaths at home (2007, 2008, 2009 pooled) Indirectly age-standardised rate per 100 deaths (standardised to 2007, 2008, 2009 pooled) Coverage England Source National Centre for Health Outcomes Development - Compendium indicators Calculations/Formula/Methodology The age-standardised deaths at home rate utilises the indirect method of standardisation. The direct method was found not to be robust as it was affected by small numerator and denominator counts in specific age groups.

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Anonymous

Indirect standardisation requires the computation of the ratio of an areas observed number of events to its expected number of events if it had experienced the standard age-specific rates. This age-standardised ratio can be converted into a rate by multiplying it by the crude rate of the standard population. The standard rates used are those of England for the respective calendar year(s). Male and female rates have been standardised separately. The rate for persons is standardised for both age and sex. This methodology is similar to that used for the Clinical Indicators and is described in detail in: Annex 3: Explanations of statistical methods used in the Compendium (under the sections entitled Indirectly Standardised Rates For Clinical Indicators and Confidence Intervals Of Indirectly Standardised Rates For Clinical Indicators). (Link: http://www.nchod.nhs.uk/NCHOD/Compendium.nsf/17b8958892856d44802573a30020fcd9/37353 698180d191d6525751a00363101!OpenDocument) Creator / Producer NCHOD Status In use Quality There is currently no information for this item. Date 2009-10 Version History Version 1 Years 2005-2007 Update Frequency Annually. Updated 30/01/2013

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Anonymous

Accessibility http://www.nchod.nhs.uk/NCHOD/Compendium.nsf/17b8958892856d44802573a30020fcd9/37353 698180d191d6525751a00363101!OpenDocument E&W, E, GOR, ONS area, SHA, LA, PCO, CTY Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) WCC 3.24 Additional Information NEXT EXPECTED UPDATE 2010.12 (Dec)

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Anonymous

The practice has a complete register available of all patients in need of palliative care/support irrespective of age
Library Reference Number/Identifier QOF PC 3 Subject QOF Clinical domain : Palliative care Category Records Detailed Descriptor The practice has a complete register available of all patients in need of palliative care/support irrespective of age Rationale About 1% of the population in the UK die each year (over half a million), an average of 20 deaths per GP per year. A quarter of all deaths are due to cancer, a third from organ failure, a third from frailty or dementia, and only one twelfth of patients have a sudden death. It should be possible therefore to predict the majority of deaths, however, this is difficult, with errors occurring, 30 per cent of the time. Two thirds of errors are based on over optimism and one third on over pessimism. However the considerable benefits of identifying these patients include providing the best health and social care to both patients and families and avoiding crises, by prioritising them and anticipating need. Identifying patients in need of palliative care, assessing their needs and preferences and proactively planning their care, are the key steps in the provision of high quality care at the end of life in general practice. Therefore this QOF indicator set is focused on the maintenance of a register, (identifying the patients) and on regular multidisciplinary meetings where the team can ensure that all aspects of a patients care have been assessed and future care can be coordinated and planned proactively. A patient should be included on the register if any of the following apply: 1. their death in the next 12 months can be reasonably predicted (rather than trying to predict, clinicians often find it easier to ask themselves the surprise question Would I be surprised if this patient were still alive in 12 months?). 2. they have advanced or irreversible disease and clinical indicators of progressive deterioration

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Anonymous

and thereby a need for palliative care e.g. they have 1 core and 1 disease specific indicator in accordance with the GSF Prognostic Indicators Guidance (see QOF section of GSF website. www.goldstandardsframework.nhs.uk) 3. they are entitled to a DS 1500 form. (The DS 1500 form is designed to speed up the payment of financial benefits and can be issued when a patient is considered to be approaching the terminal stage of their illness. For these purposes, a patient is considered as terminally ill if they are suffering from a progressive disease and are not expected to live longer than six months.) The register applies to all patients fulfilling the criteria regardless of age or diagnosis. The creation of a register will not in itself improve care but it enables the wider practice team to provide more appropriate and patient focussed care. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence

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Anonymous

Date 2011-12 Version History There is currently no information for this item. Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF PC 3 Additional Information There is currently no information for this item.

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Anonymous

The practice has regular (at least 3 monthly) multidisciplinary case review meetings where all patients on the palliative care register are discussed
Library Reference Number/Identifier QOF PC 2 Subject QOF Clinical domain : Palliative care Category Ongoing management Detailed Descriptor The practice has regular (at least 3 monthly) multidisciplinary case review meetings where all patients on the palliative care register are discussed Rationale The QOF monitors occurrence of the multi-disciplinary meetings but it is up to the practice to ensure the meetings are effective. The aims of the meetings are to: ensure all aspects of the patients care have been considered (this should then be documented in the patients notes) improve communication within the team and with other organisations (e.g. care home, hospital, community nurse specialist) and particularly improve handover of information to out of hours services co-ordinate each patients management plan ensuring the most appropriate member of the team takes any action, avoiding duplication ensure patients are sensitively enabled to express their preferences and priorities for care, including preferred place of care ensure that the information and support needs of carers are discussed, anticipated and addressed where ever reasonably possible. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical

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Anonymous

Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF PC 2

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Anonymous

Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients with learning disabilities

Library Reference Number/Identifier QOF LD 1 Subject QOF Clinical domain : Learning disabilities Category Records Detailed Descriptor The practice can produce a register of patients with learning disabilities Rationale The idea of a learning disability register for adults in primary care has been widely recommended by professionals and charities alike (See Treat Me Right, Mencap, 2004; www.mencap.org.uk). Learning disability is defined in Valuing People (and The Same as You) as the presence of: a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence); with a reduced ability to cope independently (impaired social functioning); which started before adulthood (18 years), with a lasting effect on development. The definition encompasses people with a broad range of disabilities. It includes adult with autism who also have learning disabilities, but not people with a higher level autistic spectrum disorder who may be of average or above average intelligence. The presence of an Intelligence Quotient below 70, should not, in isolation, be used in deciding whether someone has a learning disability. The definition does not include all those people who have a learning difficulty, i.e. specific difficulties with learning, such as dyslexia. For many people, there is little difficulty in reaching a decision whether they have a learning disability or not. However, in those individuals where there is some doubt about the diagnosis and the level of learning disability, referral to a multidisciplinary specialist learning disability team may be necessary to assess the degree of disability and diagnose any underlying condition. Locality Community Learning Disability Teams, working along with Primary Care Organisations, have provided expertise and data about and for people with learning disabilities. Practices should liaise with Social Services Departments, Community Learning Disability Teams and Primary Healthcare Facilitators where employed by PCTs to assist in the construction of a primary care database.

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Anonymous

Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level

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Anonymous

Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF LD 1 Additional Information There is currently no information for this item.

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Anonymous

Breast Symptom Two Week Wait

Library Reference Number/Identifier VSA08 Subject Vital Signs Category National Requirement Tier 1 Detailed Descriptor Two week wait standard for patients referred with breast symptoms not currently covered by two week waits for suspected breast cancer Rationale Currently cancer waiting times standards do not apply to all treatments or referral routes into acute services, which means that there are often delays for patients who are not identified early by GPs and/or who are awaiting subsequent treatments after they have received their first definitive treatment. This extension to the standard will ensure that more of the patient pathway will be carried out at a faster pace thus providing a better patient experience and improving survival and mortality rates. Performance (expressed as a percentage) should be rising within the planning period. Definition Two week wait standard for patients referred with breast symptoms not currently covered by two week waits for suspected breast cancer Denominator: All patients first seen within a period following a referral for evaluation/investigation of breast symptoms by a primary care professional within a period, excluding those referred urgently for suspected breast cancer. Numerator: Patients referred for evaluation/investigation of breast symptoms by a primary care professional during a period (excluding those referred urgently for suspected breast cancer) who are FIRST SEEN within 14 calendar days. All referrals to a breast clinical team, excluding those for suspected cancer, and those to family history clinics should be included within the trajectory. All definitions covering this standard were released in DSCN 20/2008, which is due for implementation on 01 January 2009.

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Anonymous

For the calculation of the 14 day period: Day 0: This is the CANCER REFERRAL TO TREATMENT PERIOD START DATE (which in this instance would be the ORIGINAL REFERRAL REQUEST RECEIVED DATE) for the first outpatient appointment on a clinical pathway for the investigation and evaluation of breast symptoms. DATE FIRST SEEN: This is the date upon which the patient is first seen in an outpatient setting following the referral described above. PRIORITY TYPE: All patients monitored within this cohort will have a PRIORITY TYPE of code 3 (two week wait). TWO WEEK WAIT CANCER OR SYMPTOMATIC BREAST REFERRAL TYPE: All patients monitored within this cohort will have a TWO WEEK WAIT CANCER OR SYMPTOMATIC BREAST REFERRAL TYPE of code 16 (exhibited (non-cancer) breast symptoms-cancer not initially suspected) Direction: Performance (expressed as a percentage) should be rising within the planning period. UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: The information that DH and/or SHAs are able to use to test whether plans produced are robust. This may include indicative milestones or national assumptions about trajectories or direction of travel. Units % performance Coverage England Source DH - Cancer Waiting Time Database

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Anonymous

Calculations/Formula/Methodology For the calculation of the 14 day period: Day 0: This is the CANCER REFERRAL TO TREATMENT PERIOD START DATE (which in this instance would be the ORIGINAL REFERRAL REQUEST RECEIVED DATE) for the first outpatient appointment on a clinical pathway for the investigation and evaluation of breast symptoms. DATE FIRST SEEN: This is the date upon which the patient is first seen in an outpatient setting following the referral described above. PRIORITY TYPE: All patients monitored within this cohort will have a PRIORITY TYPE of code 3 (two week wait). TWO WEEK WAIT CANCER OR SYMPTOMATIC BREAST REFERRAL TYPE: All patients monitored within this cohort will have a TWO WEEK WAIT CANCER OR SYMPTOMATIC BREAST REFERRAL TYPE of code 16 (exhibited (non-cancer) breast symptoms-cancer not initially suspected)

UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: The information that Department of Health (DH) and/or SHAs are able to use to test whether plans produced are robust. This may include indicative milestones or national assumptions about trajectories or direction of travel. Creator / Producer There is currently no information for this item. Status In use Quality Baseline: It is anticipated that NHS organisations (provider and commissioners) will (working with their local cancer networks) establish a baseline using local data. An operational standard (to account for clinical exceptions and patient choice) will be investigated,

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Anonymous

but NHS organisations are to consider a target of 100% in their planning assumptions. Date Q3 2012-13 Version History All definitions covering this standard were released in DSCN 20/2008, which is due for implementation on 01 January 2009 Update Frequency Monthly monitoring for performance management purposes, with a quarterly formal assessment against trajectory. Accessibility Available at:http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/Hospi talWaitingTimesandListStatistics/CancerWaitingTimes/index.htm http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_11632 8.xls Publisher / Owner Department of Health (DH) Other related PI's (relation) VSA08 Additional Information Delivery of this target will require NHS organisations, working with local cancer networks, to plan for increases in radiotherapy capacity. Please see the Cancer Reform Strategy available at: http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Cancer/index.htm DSCN 20/2008 is available at: http://www.connectingforhealth.nhs.uk/dscn/dscn-2008/data-setchange-1/dscn20-2008.pdf Behavioural guidance to support implementation of DSCN 20/2008 is available at: http://nww.connectingforhealth.nhs.uk/nhais/cancerwaiting/WaitsGuideV6-3.pdf

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Anonymous

Cancer 31-Day Subsequent Treatments Target (Drug Treatments)

Library Reference Number/Identifier VSA11b Subject Vital Signs Category National Requirement Tier 1 Detailed Descriptor 31-day standard for subsequent cancer treatments (Chemotherapy) Rationale Currently cancer waiting times standards do not apply to all treatments or referral routes into acute services, which means that there are often delays for patients who are not identified early by GPs and/or who are awaiting subsequent treatments after they have received their first definitive treatment. This extension to the standard will ensure that more of the patient pathway will be carried out at a faster pace thus providing a better patient experience and improving survival and mortality rates. Performance (expressed as a percentage) should be rising within the planning period. Definition 31-Day Standard for Subsequent Cancer Treatments (Chemotherapy) Direction: Performance (expressed as a percentage) should be rising within the planning period. Criteria for Plan Sign-off: The information that Department of Health (DH) and/or SHAs are able to use to test whether plans produced are robust. This may include indicative milestones or national assumptions about trajectories or direction of travel. Units % Performance Coverage England

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Anonymous

Source DH - Cancer Waiting Time Database Calculations/Formula/Methodology Denominator: Total number of patients receiving subsequent/adjuvant treatment within a given period, including patients with recurrent cancer. Numerator: Number of patients receiving subsequent/adjuvant treatment within a maximum waiting time of 31-days during a given period, including patients with recurrent cancer. All definitions covering this standard were released in DSCN 20/2008, which is due for implementation on 01 January 2009. Patient Scope: Include only those patients who are receiving subsequent treatments (CANCER TREATMENT EVENT TYPE is not codes 01 or 07) and who are receiving the following treatment modalities: CANCER TREATMENT MODALITY is equal to: o Code 01 surgery o Code 02 anti-cancer drug regimen (cytotoxic chemotherapy) o Code 03 anti-cancer drug regimen (hormone therapy) o Code 14 anti-cancer drug regimen (other) o Code 15 anti-cancer drug regimen (immunotherapy) For the calculation of the 31 day period: Day 0: This is the date the patient was added to a waiting list for subsequent/adjuvant treatment and is known as the CANCER TREATMENT PERIOD START DATE. This may be either a second DECISION TO TREAT DATE or an EARLIEST CLINICALLY APPROPRIATE DATE for the patient to undergo the next event on their care pathway.. START DATE: This is the start date of the subsequent/adjuvant treatment episode and is defined as the TREATMENT START DATE (CANCER). If the treatment modality is surgery the start date should be considered to be the date of admission. UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: The information that DH and/or SHAs are able to use to test whether plans produced are robust. This may include indicative milestones or national assumptions about trajectories or direction of travel.

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Anonymous

Creator / Producer There is currently no information for this item. Status In use Quality Baseline: It is anticipated that NHS organisations (provider and commissioners) will (working with their local cancer networks) establish a baseline using local data. A provider-based PTL template which is currently being tested on the UNIFY system may be helpful in constructing plans. An operational standard (to account for clinical exceptions and patient choice) will be considered, but NHS organisations are to consider a target of 100% in their planning assumptions. Date Q3 2012-13 Version History There is currently no information for this item. Update Frequency Monthly monitoring for performance management purposes, with a quarterly formal assessment against trajectory. Accessibility Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/Hospital WaitingTimesandListStatistics/CancerWaitingTimes/index.htm Publisher / Owner Department of Health (DH) Other related PI's (relation) VSA11a Additional Information Please see the Cancer Reform Strategy available at: http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Cancer/index.htm DSCN 20/2008 is available at: http://www.connectingforhealth.nhs.uk/dscn/dscn-2008/data-set-

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Anonymous

change-1/dscn20-2008.pdf Behavioural guidance to support implementation of DSCN 20/2008 is available at: http://nww.connectingforhealth.nhs.uk/nhais/cancerwaiting/WaitsGuideV6-3.pdf

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Anonymous

Cancer 31-Day Subsequent Treatments Target (Radiotherapy)

Library Reference Number/Identifier VSA12 Subject Vital Signs Category National Requirement Tier 1 Detailed Descriptor 31-day standard for subsequent cancer treatments (Radiotherapy) Rationale Currently cancer waiting times standards do not apply to all treatments or referral routes into acute services, which means that there are often delays for patients who are not identified early by GPs and/or who are awaiting subsequent treatments after they have received their first definitive treatment. This extension to the standard will ensure that more of the patient pathway will be carried out at a faster pace thus providing a better patient experience and improving survival and mortality rates. Criteria for Plan Sign-off: The information that Department of Health (DH) and/or SHAs are able to use to test whether plans produced are robust. This may include indicative milestones or national assumptions about trajectories or direction of travel. Definition 31-Day Standard for Subsequent Cancer Treatments (Radiotherapy) Denominator: Total number of patients receiving subsequent/adjuvant radiotherapy treatment within a given period, including patients with recurrent cancer. Numerator: Number of patients receiving subsequent/adjuvant radiotherapy treatment within a maximum waiting time of 31-days during a given period, including patients with recurrent cancer. All definitions covering this standard were released in DSCN 20/2008, which is due for implementation on 01 January 2009. Patient Scope: Include only those patients who are receiving subsequent treatments (CANCER TREATMENT EVENT TYPE is not codes 01 or 07) and who are receiving the following treatment

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Anonymous

modalities: CANCER TREATMENT MODALITY is equal to: o Code 05 teletherapy o Code 06 brachytherapy o Code 13 proton therapy o Code 04 chemoradiotherapy o For the calculation of the 31 day period: Day 0: This is the date the patient was added to a waiting list for subsequent/adjuvant treatment and is known as the CANCER TREATMENT PERIOD START DATE. This may be either a second DECISION TO TREAT DATE or an EARLIEST CLINICALLY APPROPRIATE DATE for the patient to undergo the next event on their care pathway.. START DATE: This is the start date of the subsequent/adjuvant treatment episode and is defined as the TREATMENT START DATE (CANCER). If the treatment modality is surgery the start date should be considered to be the date of admission. Direction: Performance (expressed as a percentage) should be rising within the planning period in line with planned efficiency gains and increases in radiotherapy capacity. Units % Performance Coverage England Source DH - Cancer Waiting Time Database Calculations/Formula/Methodology Denominator: Total number of patients receiving subsequent/adjuvant radiotherapy treatment within a given period, including patients with recurrent cancer. Numerator: Number of patients receiving subsequent/adjuvant radiotherapy treatment within a maximum waiting time of 31-days during a given period, including patients with recurrent cancer. All definitions covering this standard were released in DSCN 20/2008, which is due for

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Anonymous

implementation on 01 January 2009. Patient Scope: Include only those patients who are receiving subsequent treatments (CANCER TREATMENT EVENT TYPE is not codes 01 or 07) and who are receiving the following treatment modalities: CANCER TREATMENT MODALITY is equal to: o Code 05 teletherapy o Code 06 brachytherapy o Code 13 proton therapy o Code 04 chemoradiotherapy o For the calculation of the 31 day period: Day 0: This is the date the patient was added to a waiting list for subsequent/adjuvant treatment and is known as the CANCER TREATMENT PERIOD START DATE. This may be either a second DECISION TO TREAT DATE or an EARLIEST CLINICALLY APPROPRIATE DATE for the patient to undergo the next event on their care pathway.. START DATE: This is the start date of the subsequent/adjuvant treatment episode and is defined as the TREATMENT START DATE (CANCER). If the treatment modality is surgery the start date should be considered to be the date of admission. UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: The information that DH and/or SHAs are able to use to test whether plans produced are robust. This may include indicative milestones or national assumptions about trajectories or direction of travel. Creator / Producer There is currently no information for this item. Status In use Quality

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Anonymous

Baseline: It is anticipated that NHS organisations (provider and commissioners) will (working with their local cancer networks) establish a baseline using local data. A provider-based PTL template which is currently being tested on the UNIFY system may be helpful in constructing plans. An operational standard (to account for clinical exceptions and patient choice) will be considered, but NHS organisations are to consider a target of 100% in their planning assumptions. A supporting measure to monitor increases in radiotherapy capacity will be considered. Date Q3 2012-13 Version History Updated for 11/12 Refresh Update Frequency Monthly monitoring for performance management purposes, with a quarterly formal assessment against trajectory. Accessibility Available at: https://www.hub.info4local.gov.uk/DIHWEB/Logon/default.aspx?Timeout=True Disaggregated by: Commissioner Publisher / Owner Department of Health (DH) Other related PI's (relation) VSA12 Additional Information Please see the Cancer Reform Strategy and the report of the National Radiotherapy Advisory Group available at: http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Cancer/index.htm http://www.cancerimprovement.nhs.uk/View.aspx?page=/treatments/radiotherapy_docs/nrag.html DSCN 20/2008 is available at: http://www.connectingforhealth.nhs.uk/dscn/dscn-2008/data-setchange-1/dscn20-2008.pdf Behavioural guidance to support implementation of DSCN 20/2008 is available at: http://nww.connectingforhealth.nhs.uk/nhais/cancerwaiting/WaitsGuideV6-3.pdf

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Anonymous

Cancer 31-Day Subsequent Treatments Target (Surgery Treatments)

Library Reference Number/Identifier VSA11a Subject Vital Signs Category National Requirement Tier 1 Detailed Descriptor 31-day standard for subsequent cancer treatments Rationale Currently cancer waiting times standards do not apply to all treatments or referral routes into acute services, which means that there are often delays for patients who are not identified early by GPs and/or who are awaiting subsequent treatments after they have received their first definitive treatment. This extension to the standard will ensure that more of the patient pathway will be carried out at a faster pace thus providing a better patient experience and improving survival and mortality rates. Performance (expressed as a percentage) should be rising within the planning period. Definition 31-Day Standard for Subsequent Cancer Treatments (Surgery) Direction: Performance (expressed as a percentage) should be rising within the planning period. Criteria for Plan Sign-off: The information that Department of Health (DH) and/or SHAs are able to use to test whether plans produced are robust. This may include indicative milestones or national assumptions about trajectories or direction of travel. Units % Performance Coverage England

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Anonymous

Source DH - Cancer Waiting Time Database Calculations/Formula/Methodology Denominator: Total number of patients receiving subsequent/adjuvant treatment within a given period, including patients with recurrent cancer. Numerator: Number of patients receiving subsequent/adjuvant treatment within a maximum waiting time of 31-days during a given period, including patients with recurrent cancer. All definitions covering this standard were released in DSCN 20/2008, which is due for implementation on 01 January 2009. Patient Scope: Include only those patients who are receiving subsequent treatments (CANCER TREATMENT EVENT TYPE is not codes 01 or 07) and who are receiving the following treatment modalities: CANCER TREATMENT MODALITY is equal to: o Code 01 surgery o Code 02 anti-cancer drug regimen (cytotoxic chemotherapy) o Code 03 anti-cancer drug regimen (hormone therapy) o Code 14 anti-cancer drug regimen (other) o Code 15 anti-cancer drug regimen (immunotherapy) For the calculation of the 31 day period: Day 0: This is the date the patient was added to a waiting list for subsequent/adjuvant treatment and is known as the CANCER TREATMENT PERIOD START DATE. This may be either a second DECISION TO TREAT DATE or an EARLIEST CLINICALLY APPROPRIATE DATE for the patient to undergo the next event on their care pathway.. START DATE: This is the start date of the subsequent/adjuvant treatment episode and is defined as the TREATMENT START DATE (CANCER). If the treatment modality is surgery the start date should be considered to be the date of admission. UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: The information that DH and/or SHAs are able to use to test whether plans produced are robust. This may include indicative milestones or national assumptions about trajectories or direction of travel.

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Anonymous

Creator / Producer There is currently no information for this item. Status In use Quality Baseline: It is anticipated that NHS organisations (provider and commissioners) will (working with their local cancer networks) establish a baseline using local data. A provider-based PTL template which is currently being tested on the UNIFY system may be helpful in constructing plans. An operational standard (to account for clinical exceptions and patient choice) will be considered, but NHS organisations are to consider a target of 100% in their planning assumptions. Date Q3 2012-13 Version History There is currently no information for this item. Update Frequency Monthly monitoring for performance management purposes, with a quarterly formal assessment against trajectory. Accessibility Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/Hospital WaitingTimesandListStatistics/CancerWaitingTimes/index.htm Publisher / Owner Department of Health (DH) Other related PI's (relation) VSA11b Additional Information Please see the Cancer Reform Strategy available at: http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Cancer/index.htm DSCN 20/2008 is available at: http://www.connectingforhealth.nhs.uk/dscn/dscn-2008/data-set-

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Anonymous

change-1/dscn20-2008.pdf Behavioural guidance to support implementation of DSCN 20/2008 is available at: http://nww.connectingforhealth.nhs.uk/nhais/cancerwaiting/WaitsGuideV6-3.pdf

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Anonymous

Development of continuing education programmes on stroke units for qualified and unqualified staff
Library Reference Number/Identifier CV16 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale A characteristic of stroke unit care, commensurate with better clinical outcomes (Stroke Unit Trialists Collaboration 2003). (Guidelines 2004 ) Definition This may include regular seminars on the ward/unit, external courses or attendance at conferences on stroke rehabilitation or issues related to it. This is not reported in the public domain Units There is currently no information for this item. Coverage England, Wales and Northern Ireland Source Sentinel Stroke Audit - Organisational Audit Calculations/Formula/Methodology Question 7.1 See full wording of questions for exceptions in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc

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Anonymous

Creator / Producer Royal College of Physicians Status The data for this indicator is no longer available, so the results have been taken down from the website. Quality As part of a composite in public domain Date 2010 Version History There is currently no information for this item. Update Frequency Usually every 2 years. Exceptionally 2008 and 2009. The interim data collection for the NAO report Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf Publisher / Owner Royal College of Physicians Other related PI's (relation) There is currently no information for this item.

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Anonymous

Additional Information *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Anonymous

Extended 62-Day Cancer Treatment Targets

Library Reference Number/Identifier VSA13 Subject Vital Signs Category National Requirement Tier 1 Detailed Descriptor Part A: 62-day standard for patients treated for cancer following the detection of an abnormality by an NHS Cancer Screening Programme. This is for patients treated for cancer who were not originally referred via an urgent GP/GDP referral for suspected cancer, but who were directly referred by an NHS Cancer Screening Programme. Part B: 62-day standard for patients treated for cancer who were not originally referred via an urgent GP/GDP referral for suspected cancer, but have been seen by a clinician who suspects cancer, who has upgraded their priority status. All definitions covering this standard were released in DSCN 20/2008, which is due for implementation on 01 January 2009. Rationale Currently cancer waiting times standards do not apply to all treatments or referral routes into acute services, which means that there are often delays for patients who are not identified early by GPs and/or who are awaiting subsequent treatments after they have received their first definitive treatment. This extension to the standard will ensure that more of the patient pathway will be carried out at a faster pace thus providing a better patient experience and improving survival and mortality rates. Definition Part A Denominator: Total number of patients receiving first definitive treatment following referral from an NHS Cancer Screening Service within a given period. Numerator: Number of patients receiving first definitive treatment within 62-days following referral from an NHS Cancer Screening Service during a given period. Part B Denominator: Total number of patients receiving first definitive treatment for cancer following a consultant decision to upgrade their priority status within a given period

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Anonymous

Numerator: Number of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status. Direction: Performance (expressed as a percentage) should be rising within the planning period. Criteria for Plan Sign-off: To be confirmed. This may include indicative milestones or national assumptions about trajectories or direction of travel Units % Performance Coverage England Source DH - Cancer Waiting Time Database Calculations/Formula/Methodology Part A Patient Scope: Include all patients who have a malignancy/possible malignancy identified by an NHS Cancer Screening Service and are subsequently referred to an NHS acute (within primary or secondary care) service for further investigation or treatment. In these cases the PRIORITY TYPE will be code 2 (urgent), the SOURCE OF REFERRAL FOR OUTPATIENTS will be code 17 (referral from an NHS screening service) and they will have been referred with a suspicion of a disease with a PRIMARY DIAGNOSIS (ICD) within the range C00-C97 or D05. For the calculation of the 62-day period: Day 0: This is the CANCER REFERRAL TO TREATMENT PERIOD START DATE, and, in practice is the date the ORIGINAL REFERRAL REQUEST RECEIVED DATE for the patient being referred from the NHS Screening Service. START DATE: This is the TREATMENT START DATE (CANCER) of the first definitive treatment episode (CANCER TREATMENT EVENT TYPE code 01 or 07), as per DSCN 20/2008 Part B Patient Scope: All patients diagnosed with cancer upgraded by consultant following triage of referral, outpatient episode or diagnostic intervention. The upgrade will be for patients suspected of having a PRIMARY DIAGNOSIS (ICD) within the range C00 to C97 or D05,and will be undertaken in line with the guidance in DSCN 20/2008 relating to points within a CANCER

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Anonymous

REFERRAL TO TREATMENT PERIOD where a CONSULTANT UPGRADE DATE can be issued. For the calculation of the 62-day period: Day 0: Is the DATE that the CONSULTANT responsible for the care of the PATIENT (or an authorised member of the CONSULTANT team as defined by local policy) decided that the PATIENT should be upgraded onto an urgent Cancer PATIENT PATHWAY. START DATE: This is the TREATMENT START DATE (CANCER) of the first definitive treatment episode (CANCER TREATMENT EVENT TYPE code 01 or 07), as per DSCN 20/2008 UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: To be confirmed. This may include indicative milestones or national assumptions about trajectories or direction of travel Creator / Producer There is currently no information for this item. Status In use Quality Baseline: Part A It is anticipated that NHS organisations (provider and commissioners) will (working with their local cancer networks) establish a baseline using local data. A provider-based PTL template which is currently being tested on the UNIFY system may be helpful in constructing plans. An operational standard (to account for clinical exceptions and patient choice) will be considered, but NHS organisations are to consider a target of 100% in their planning assumptions. Part B It is anticipated that NHS organisations (providers and commissioners) will (working with their local cancer networks) establish a baseline using local data. A provider-based PTL template which is currently being tested on the UNIFY system may be helpful in constructing plans. Date Q3 2012-13

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Anonymous

Version History There is currently no information for this item. Update Frequency Monthly monitoring for performance management purposes, with a quarterly formal assessment against trajectory. Accessibility Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_11632 8.xls Publisher / Owner Department of Health (DH) Other related PI's (relation) VSA13 Additional Information NOTE: THE NHS CANCER PLAN ALL CANCER 62-DAY REFERRAL TO TREATMENT STANDARD DATASET INCLUDES THOSE PATIENTS SEPARATELY IDENTIFIED IN THE 31DAY REFERRAL TO TREATMENT STANDARD FOR RARE CANCERS. If you are using these data to compare to Vital Signs trajectories you should use the NHS only version available on UNIFY2. Please see the Cancer Reform Strategy available at: http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Cancer/index.htm DSCN 20/2008 is available at: http://www.connectingforhealth.nhs.uk/dscn/dscn-2008/data-setchange-1/dscn20-2008.pdf Behavioural guidance to support implementation of DSCN 20/2008 is available at: http://nww.connectingforhealth.nhs.uk/nhais/cancerwaiting/WaitsGuideV6-3.pdf

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Anonymous

Extension of NHS Bowel Cancer Screening Programme to men and women aged up to 75 (FUTURE INDICATOR)
Library Reference Number/Identifier VSA10 Subject Vital Signs Category National Requirement Tier 1 Detailed Descriptor Percentage of 60-74 year-old adult population screened for bowel cancer in the previous two years Rationale Evidence suggests that implementation of national screening programme should reduce bowel cancer mortality by around 16% in those people screened, and contribute to the delivery of the PSA target for all cancers that will achieve a 20% reduction in mortality by 2010 National roll-out of the NHS Bowel Cancer Screening Programme for men and women aged 60 to 69 began in April 2006, with first invitations sent out in July 2006, and is expected to complete by December 2009 Evidence suggests efficacy of screening up to age 75, and 61% of bowel cancers occur in those aged 70 and over Five early implementer local screening centres will begin inviting men and women up to age 75 from January 2009 to inform national roll-out. Local planning for roll-out of the extension should concentrate on the development of robust plans to prepare for roll-out, particularly in ensuring adequate capacity for endoscopy services and ensuring eligible populations are covered by the current programme The percentage of eligible men and women aged 60-74 with a screening test result in the previous two years should increase with time until full roll out is achieved after which it is likely to plateau Definition Percentage of 60-74 year-old adult population screened for bowel cancer in the previous two years There is further work to be done to develop detailed definitions for this plan line, to ensure

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Anonymous

consistency with proposed monitoring collection Direction: The percentage of eligible men and women aged 60-74 with a screening test result in the previous two years should increase with time until full roll out is achieved after which it is likely to plateau Criteria for Plan Sign-off: The percentage of men and women aged 60-74 with a screening test result in the previous two years should increase until optimum rate of 60% (based on research/pilots) is achieved, or exceeded Units To be developed. Data line definitions to be developed in line with monitoring definitions when data collection is set up. An annual statistical collection is in development with the Information Centre for Health and Social Care Coverage England Source NHS Bowel Cancer Screening Programme Calculations/Formula/Methodology Evidence suggests that implementation of national screening programme should reduce bowel cancer mortality by around 16% in those people screened, and contribute to the delivery of the PSA target for all cancers that will achieve a 20% reduction in mortality by 2010 National roll-out of the NHS Bowel Cancer Screening Programme for men and women aged 60 to 69 began in April 2006, with first invitations sent out in July 2006, and is expected to complete by December 2009 UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: The percentage of men and women aged 60-74 with a screening test result in the previous two years should increase until optimum rate of 60% (based on research/pilots) is achieved, or exceeded

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Anonymous

Creator / Producer NHS Cancer Screening Programme / NHS Information Centre for Health and Social Care Status In use Quality Baseline: From 2010 Date Future indicator Version History Updated for 09/10 Refresh (V1.21) Update Frequency Annually Accessibility Available at: https://www.hub.info4local.gov.uk/DIHWEB/Logon/default.aspx?Timeout=True Disaggregated by: Commissioner General information on subject area available from http://www.cancerscreening.nhs.uk/bowel/index.html Publisher / Owner Department of Health (DH) Other related PI's (relation) VSA10 Additional Information FUTURE INDICATOR NHS Cancer Screening Programmes: 0114 2711060 www.cancerscreening.nhs.uk The KC forms for data collection are still being designed by the NHS Cancer Screening Programme which will then require ROCR approval for the collection.

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Anonymous

For patients with newly diagnosed angina (diagnosed after 1 April 2011), the percentage who are referred for specialist assessment
Library Reference Number/Identifier QOF CHD 13 Subject QOF Clinical domain : Secondary prevention of coronary heart disease Category Diagnosis and initial management Detailed Descriptor Replaces QOF CHD 2. For patients with newly diagnosed angina (diagnosed after 1 April 2011), the percentage who are referred for specialist assessment Rationale Angina due to coronary artery disease (CAD) can be diagnosed on clinical grounds but many patients require referral for specialist assessment to confirm or exclude the diagnosis. Patients may then undergo functional or anatomical testing. Functional testing includes myocardial perfusion scanning, anatomical testing includes coronary angiography. It has been common clinical practice to use exercise testing (also termed exercise electrocardiogram (ECG), stress ECG or exercise tolerance test) to help establish a diagnosis of suspected angina. However, the NICE clinical guideline on chest pain of recent onset2 explicitly states that exercise ECG should not be used to diagnose or exclude stable angina in people without known coronary artery disease (CAD). This represents a significant shift in current practice. Recommendation 1.3.1.1 of the NICE guideline states that a diagnosis of stable angina should be based on one of the following: - clinical assessment alone or - clinical assessment plus diagnostic testing (that is, anatomical testing for obstructive coronary artery disease [CAD] and/or functional testing for myocardial ischaemia) In order to make a diagnosis on clinical assessment alone, clinicians should take a detailed clinical history and perform a physical examination (see recommendations 1.3.2.1 and 1.3.2.2).

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Anonymous

Anginal pain is identified as: - a constricting discomfort in the front of the chest, or in the neck, shoulders, jaw, or arms - which is precipitated by physical exertion - and which is relieved by rest or GTN (glyceryl trinitrate) within about five minutes. The NICE guideline states that when all three of the features described above are identified, this is defined as typical angina. When only two are present this is defined as atypical angina and when only one or none are present then this is defined as non-anginal chest pain. In addition to the typicality of the reported chest pain, a clinical assessment needs to take account of the patients age, sex and presence of additional risk factors (diabetes, smoking and hyperlipidaemia). The clinician can then use an estimate of the prevalence of CAD in the population to inform their clinical decision as to the likelihood of an individual patient having angina due to CAD and whether or not they need to be referred for further specialist assessment. In those people who have features of typical angina and their population estimated likelihood of CAD is greater than 90 per cent clinical assessment alone is appropriate to make a diagnosis of stable angina. These patients should be managed as having angina. For example, men aged over 65 years with typical angina symptoms do not need to be referred to confirm the diagnosis. Where the diagnosis is made by clinical assessment alone, then an explanation of how the diagnosis of angina has been made should be included in the patients notes. Quality and Outcomes Framework guidance for GMS contract 2011/12 In people with suspected angina where there is uncertainty regarding the diagnosis (people with a population estimated likelihood of CAD of 1090 per cent), clinical assessment and referral for specialist assessment (diagnostic testing) is required. In people with a population estimated likelihood of CAD of less than ten per cent, causes of chest pain other than angina should be considered first. These patients are not included in the target population for this indicator unless they are subsequently diagnosed with angina. Further information SIGN clinical guideline 96 (2007). Management of stable angina. www.sign.ac.uk/guidelines/fulltext/96 Definition The practice reports the percentage of patients diagnosed with angina from 1 April 2011 who have been referred for specialist assessment within 12 months of being added to the register. The

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Anonymous

practice should also report patients who have been referred up to three months before being added to the register. Where a patient has been diagnosed on clinical assessment alone, then an explanation should be included in the patient notes as to how the diagnosis has been made. These patients will need to be exception reported against this indicator as referral for specialist assessment only applies to those patients in whom it was not possible to make a diagnosis of angina on clinical grounds alone. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end

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Anonymous

Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Replaces QOF CHD 2 Additional Information There is currently no information for this item.

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Anonymous

Histological Confirmation Rate

Library Reference Number/Identifier CA41 Subject NCASP Cancer Category Lung Cancer Detailed Descriptor Percentage of patients submitted to the audit reported to have a histologically or cytologically confirmed diagnosis of lung cancer Rationale Proxy marker for standard of care Definition Percentage of patients submitted to the audit reported to have a histologically or cytologically confirmed diagnosis of lung cancer Units Percent Coverage England Wales Source National Lung Cancer Audit Calculations/Formula/Methodology Denominator is all patients submitted to the audit for 2010-11. Numerator is patients submitted to the audit who have their lung cancer diagnosis confirmed by histology or cytology Creator / Producer There is currently no information for this item. Status

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Anonymous

Live Quality NLCA standard Date 2010-11 Version History There is currently no information for this item. Update Frequency Annually Accessibility NLCA report and related data Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) No Additional Information There is currently no information for this item.

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Anonymous

Median number of lymph nodes excised

Library Reference Number/Identifier CA40 Subject NCASP Cancer Category Bowel Cancer Detailed Descriptor Median number of lymph nodes excised for cases reported to the audit Rationale NICE guideline Definition The audit data item NO_OF _LYMPH_NODES_EXCISED records the number of lymph nodes excised from the surgical resection specimen. Units Number Coverage England Wales N. Ireland Source National Bowel Cancer Audit Calculations/Formula/Methodology The audit data item NO_OF _LYMPH_NODES_EXCISED records the number of lymph nodes excised from the surgical resection specimen. The median is calculated for each trust participating in the audit. Creator / Producer There is currently no information for this item. Status

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Anonymous

Live Quality NCASP standard Date 2010 Annual Report Data Version History There is currently no information for this item. Update Frequency Annually Accessibility Annual Reports Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) No Additional Information There is currently no information for this item.

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Anonymous

NHS Breast Screening Programme to women aged 53-70

Library Reference Number/Identifier VSA09 Subject Vital Signs Category National Requirement Tier 1 Detailed Descriptor Percentage of women with a breast screening test result and percentage of 53-70 year-old women screened for breast cancer Rationale Around 130,000 people die from cancer each year, of whom about 65,000 are aged under 75. In 2006/2007, 1.64 million women were screened for breast cancer in England, and nearly 13,500 cancers were detected. In February 2006, a report from the Advisory Committee on Breast Cancer Screening (Screening for Breast Cancer in England: Past and Future, NHSBSP Publication No 61) estimated that the breast screening programme in England is saving 1,400 lives per year. The International Agency for Research on Cancer (IARC) of the World Health Organisation (WHO) evaluated the evidence on breast cancer screening in March 2002. IARC concluded that trials have provided sufficient evidence for the efficacy of mammography screening of women between 50 and 70 years, and that the reduction in mortality from breast cancer among women who choose to participate in screening programmes was estimated to be about 35%. At present, women are invited for screening seven times at three yearly intervals between 50 and 70 years. Over time, this will be extended to nine screening rounds between 47 and 73 years with a guarantee that women will have their first invitation for screening before the age of 50 at present some women wait until nearly their 53rd birthday before they receive their first invitation. There is also increasing evidence of the clinical and cost-effectiveness of screening women up to age 73. The Cancer Reform Strategy (December 2007) stated that the extension of the breast screening programme will start from April 2008 and will be managed by NHS Cancer Screening Programmes in partnership with local health services. The necessary phasing in of this expansion will be carefully considered to ensure that the most useful epidemiological data can be gathered to inform future decisions about the programme. Full implementation is expected by the end of 2012. The percentage of 50 year-old women with a breast screening test result and the percentage of 50-73 year-old women screened for breast cancer in the last three years should increase with time

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Anonymous

Definition Current data is for: Percentage of 50 year-old women with a breast screening test result and percentage of 50-73 year-old women screened for breast cancer. In the future, this indicator will include women aged 47-49 and 71-73. There is further work to be done to develop detailed definitions for this plan line, but likely to include: Patient scope: Include all eligible women aged 50 and all eligible women aged 50-73 Percentage of 50 year-old women with a breast screening test result and percentage of 50-73 year-old women screened for breast cancer Direction: The percentage of 50 year-old women with a breast screening test result and the percentage of 50-73 year-old women screened for breast cancer in the last three years should increase with time UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: The percentage women aged 50 with a screening test result and the percentage of women aged 50-73 screened for breast cancer in the last three years should increase until optimum rate of 75% (based on current screening programme) is achieved, or exceeded Units Numerator 1: The number of 50 year-old women with a breast screening test result Denominator 1: The number of 50 year-old women eligible for breast screening Numerator 2: The number of women aged 50-73 screened for breast cancer in the last three years Denominator 2: The number of women aged 50-73 eligible for screening Coverage England Source Screening statistics - Breast Cancer Calculations/Formula/Methodology

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Anonymous

UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: The percentage women aged 50 with a screening test result and the percentage of women aged 50-73 screened for breast cancer in the last three years should increase until optimum rate of 75% (based on current screening programme) is achieved, or exceeded Numerator 1: The number of 50 year-old women with a breast screening test result Denominator 1: The number of 50 year-old women eligible for breast screening Numerator 2: The number of women aged 50-73 screened for breast cancer in the last three years Denominator 2: The number of women aged 50-73 eligible for screening Creator / Producer NHS Cancer Screening Programmes / NHS Information Centre for Health and Social Care Status In use Quality Baseline: From 2008 Date 2010-11 Version History Updated for 09/10 Refresh (V1.21) Update Frequency Annually Accessibility Available at: https://www.hub.info4local.gov.uk/DIHWEB/Logon/default.aspx?Timeout=True and http://www.ic.nhs.uk/statistics-and-data-collections/screening/breast-cancer/breast-screeningprogramme-england-2007-08 Disaggregated by: Commissioner Website requires an account

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Anonymous

General information available from http://www.cancerscreening.nhs.uk/breastscreen/index.html Publisher / Owner Department of Health (DH) Other related PI's (relation) VSA09 Additional Information These data will be collected following an amendment to KC63 return, this modification will be communicated to the NHS by Data Set Change Notice (DSCN) at the earliest possible time NHS Cancer Screening Programmes: 0114 2711060 www.cancerscreening.nhs.uk

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Anonymous

Participation rates in the Cardiac Rehabilitation Audit

Library Reference Number/Identifier CV38 Subject National Audit of Cardiac Rehabilitation and Central Cardiac Audit Database Category Heart Disease Detailed Descriptor Participation rates in the Cardiac Rehabilitation Audit Rationale There is currently no information for this item. Definition Yes or No that Trust has participated in the audit. A Trust is considered to have participated if it has 1) registered with the heart failure audit 2) has submitted 20 or more cases per month Units Y/N Coverage There is currently no information for this item. Source Central Cardiac Audit Database (CCAD) Calculations/Formula/Methodology A Trust is considered to have participated if it has 1) registered with the heart failure audit 2) has submitted 20 or more cases per month http://www.cardiacrehabilitation.org.uk/dataset.htm Creator / Producer National Clinical Audit Support Programme (NCASP)

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Anonymous

Status There is currently no information for this item. Quality Good Date There is currently no information for this item. Version History There is currently no information for this item. Update Frequency Annual Accessibility National Audit for Cardiac Rehabilitation at University of York http://www.cardiacrehabilitation.org.uk/dataset.htm Publisher / Owner National Clinical Audit Support Programme (NCASP) Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Participation Rates in the National Heart Failure Audit

Library Reference Number/Identifier CV37 Subject Heart Failure Category Heart Disease Detailed Descriptor Acute NHS Trusts in England & Health Boards in Wales that submitted data to the National Heart Failure Audit database for inclusion in the 2011/12 report Rationale There is currently no information for this item. Definition 20 patient admissions per month were submitted to the National Heart Failure Audit between 01/04/2011 and 31/03/2012. More information about the National Heart Failure Audit can be found in the 2011/12 Annual Report, published at http://www.ucl.ac.uk/nicor/audits/heartfailure/additionalfiles. Units Yes, Partial or No. Coverage England and Wales Source National Heart Failure Audit report Calculations/Formula/Methodology The National Heart Failure Audit produces a report with a count of Admission/Readmissions by NHS Trusts. If the Trust has submitted data on at least 20 patient admissions per month or has achieved 70% case ascertainment, then it is deemed to participate in the audit. Case ascertainment is measured against the number of patients discharged with a primary diagnosis of heart failure, as recorded by HES for English Trusts and PEDW for Welsh Health Boards. If the Trust has submitted any records for the 2011/12 period, their participation is recorded as Partial.

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Anonymous

Creator / Producer National Institute for Cardiovascular Outcomes Research (NICOR). Status Live Quality Good Date 2011-12 Version History There is currently no information for this item. Update Frequency Annually Accessibility Annual Reports and as a CQC indicator on line (For England Only) Publisher / Owner University College London (UCL) Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Percentage of acute coronary syndrome patients who are seen by a cardiologist during admission.
Library Reference Number/Identifier CV47 Subject Myocardial Ischaemia National Audit Project (MINAP) Category Heart Disease Detailed Descriptor Percentage of acute coronary syndrome patients who are seen by a cardiologist during admission. Rationale http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Application%20notes%20v5%20final.doc Definition Not defined yet Units There is currently no information for this item. Coverage England and Wales Source Myocardial Ischaemia National Audit Project (MINAP) Calculations/Formula/Methodology http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Application%20notes%20v5%20final.doc Creator / Producer Myocardial Ischaemia National Audit Project (MINAP)

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Anonymous

Status There is currently no information for this item. Quality Good Date Future indicator Version History last used in 2006 http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/minap-2006-survey.pdf Update Frequency No (check with MINAP) Accessibility General website: http://www.rcplondon.ac.uk/CLINICALSTANDARDS/ORGANISATION/PARTNERSHIP/Pages/MINAP-.aspx Latest report: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Current-work/Documents/minap2006-survey.pdf Publisher / Owner Myocardial Ischaemia National Audit Project (MINAP) Other related PI's (relation) There is currently no information for this item. Additional Information Issue - 100% (+/-) for STEMI but 80% NonStemi

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Anonymous

Percentage of bowel cancer cases where there is a histological report on the presence or absence of tumour in the resection margin
Library Reference Number/Identifier CA36 Subject NCASP Cancer Category Bowel Cancer Detailed Descriptor Percentage of cases reported to the audit where there is a histological report on the presence or absence of tumour in the resection margin Rationale Professional guideline Definition The audit data item CIRCUMFERENTIAL_MARGINS was used to determine the number of patients for whom this data item was reported. The denominator for the analyses was all rectal cancer patients submitted to the audit who underwent a major resection. Units Percent Coverage England Wales Scotland N. Ireland Source National Bowel Cancer Audit Calculations/Formula/Methodology The audit data item CIRCUMFERENTIAL_MARGINS was used to determine the number of patients for whom this data item was reported. The denominator for the analyses was all rectal cancer patients submitted to the audit who underwent a major resection.

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Anonymous

Creator / Producer There is currently no information for this item. Status DROPPED - THE DATA FOR THIS INDICATOR IS NO LONGER PRODUCED Quality NCASP standard Date 2007/08 Version History There is currently no information for this item. Update Frequency Annually Accessibility Annual Reports Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) No Additional Information There is currently no information for this item.

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Anonymous

Percentage of patients first seen by a specialist within two weeks when urgently referred with suspected cancer
Library Reference Number/Identifier CWT 1 Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor There is currently no information for this item. Rationale There is currently no information for this item. Definition There is currently no information for this item. Units There is currently no information for this item. Coverage England Source DH - Cancer Waiting Time Database Calculations/Formula/Methodology There is currently no information for this item. Creator / Producer There is currently no information for this item. Status There is currently no information for this item.

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Anonymous

Quality http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/Hospital WaitingTimesandListStatistics/CancerWaitingTimes/index.htm Date Q3 2012-13 Version History There is currently no information for this item. Update Frequency Quarterly Accessibility http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_112966 Publisher / Owner Department of Health (DH) Other related PI's (relation) There is currently no information for this item. Additional Information The trusts listed in the progress reports include all those who we expect to treat some cancer patients in a year. Some specialist trusts treat very few cancer patients, and will not necessarily report patients treated in every quarter. Starting from 1 January 2009, the basis for reporting waiting times data changed and the scope widened to cover the new standards that came into force on 1 January 2009 (as set out in last years Cancer Reform Strategy), and we will make collection simpler by not using clock pauses. This will bring cancer waiting times data in line with practice under the 18 weeks programme. The first set of data reported on this new basis and covering the extended waiting times standards was published in the spring. From Q2 2005-2006 onwards there has been a change in the way the referral to treatment figures are calculated at trust level. Where two NHS organisations (cancer unit and cancer centre) are involved in the care of the patient, this is taken into account by recording half the activity against the unit that initially sees the patient and half against the centre that provides the first definitive treatment. In the past all the activity was recorded against the centre that provided the first definitive treatment. For more information please visit

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Anonymous

http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/Hospital WaitingTimesandListStatistics/CancerWaitingTimes/index.htm

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Anonymous

Percentage of patients presenting to a nephrologist less than 90 days before RRT initiation.
Library Reference Number/Identifier LT13 Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor Percentage of patients starting Renal Replacement Therapy (RRT) whose date of first referral to a nephrologist, as recorded within the renal centre's IT system, is less than 90 days before the recorded start date of Renal Replacement Therapy. Rationale Patients referred within 3 months of needing dialysis therapy have increased complication rates characterised by failure to establish permanent vascular access, increased infection rates and hospitalisation rates and ultimately worse survival than those referred in a more timely fashion. Timely referral of patients with chronic kidney disease is supported by the National Service Framework for Renal Services and by NICE clinical guidelines for the identification, management, and referral of adults with chronic kidney disease. Definition Each renal centre in England and Wales maintains a database that holds, amongst other items, laboratory values, and electronically submits an extract of these data on a quarterly basis to the UK Renal Registry. After validation and data cleaning, analyses are performed by the UK Renal Registry. Numerator: The number of new RRT patients who first attended a nephrologist less than 3 months/90 days before commencing dialysis. Denominator: The number of new RRT patients in that centre in one year. Other things being equal, lower values of this indicator are better. Units Percentage Coverage

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Anonymous

England Source The data item is included in the National Renal Dataset and will become routinely collected by the UK Renal Registry once the NRD gets established. Calculations/Formula/Methodology The date first seen in a renal centre and the date of starting RRT were used to calculate the referral time. Late referral is defined as being seen by a nephrologist within 90 days of requiring RRT. Results are only given for centres with at least 10 new patients in the year and with 75% or more completeness for these dates. Data were excluded for centres in the years where 10% or more of the patients were reported to have started RRT on the same date as the first presentation (as these are thought to be data extraction errors). Creator / Producer UK Renal Registry, www.renalreg.com Status In use. Quality Recording of the date of first referral to a nephrologist within renal IT systems currently shows variation from centre to centre, making comparisons between centres unreliable. The indicator is intended to reflect the efficiency of the pathway between primary care and the renal service, including the use of referral criteria, education and support of professionals providing care to patients with chronic kidney disease in primary care, and the availability of outpatient appointments. However, the numerator will also include patients whose late presentation was unavoidable; not all patients who ultimately require renal replacement therapy can be identified in advance. It is possible that the proportion of 'unavoidable' late presenting patients will vary from centre to centre as a result of casemix differences in the population served. This performanace indicator is published in the UK Renal Registry Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. Date 2010 Version History There is currently no information for this item.

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Anonymous

Update Frequency Annually. Data are submitted to the UK Renal Registry on a quarterly basis. However, at present, the UK Renal Registry only prepare reports on this and other clinical performance indicators on an annual basis. Accessibility Figures available for England,Wales and NI by renal centre Latest report: http://www.renalreg.com Publisher / Owner Raw data from NHS trusts and Renal Units and collated nationally by the UK Renal Registry Other related PI's (relation) There is currently no information for this item. Additional Information Missing data will cause problems; some centres are better at submitting data than others

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Anonymous

Percentage of patients waiting no more than 31 days for cancer treatment

Library Reference Number/Identifier WCC 2.25 Subject World Class Commissioning (WCC) Category 2 - Health Outcomes and Targets 1 - This chapter encompasses health outcomes and national targets which are broken down into the Darzi service model, four of which are covered here Detailed Descriptor Percentage of patients with diagnosis to treatment time less than or equals to one month Rationale There is currently no information for this item. Definition There is currently no information for this item. Units There is currently no information for this item. Coverage There is currently no information for this item. Source Annual Health Check Calculations/Formula/Methodology There is currently no information for this item. Creator / Producer There is currently no information for this item. Status DROPPED - DATA NO LONGER AVAILABLE

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Anonymous

Quality There is currently no information for this item. Date 2009-10 Version History There is currently no information for this item. Update Frequency There is currently no information for this item. Accessibility http://www.cqc.org.uk/publications.cfm?fde_id=13183 Publisher / Owner Care Quality Commission Other related PI's (relation) WCC 2.25 Additional Information Last publication date: Nov 2010

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Anonymous

Percentage of patients with BP <130/80 mmHg: PD

Library Reference Number/Identifier LT20a Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor Percentage of peritoneal dialysis patients with blood pressure of less than 130/80 mmHg Rationale Patients receiving renal replacement therapy are at greatly increased risk of cardiovascular disease. http://www.renal.org/pages/pages/guidelines/current/complications.php#Summary_S1 Definition Each renal centre in England and Wales maintains a database that holds, amongst other items, laboratory values, and electronically submits an extract of these data on a quarterly basis to the UK Renal Registry. After validation and data cleaning, analyses are performed by the UK Renal Registry. The denominator is 'all patients currently receiving peritoneal dialysis (PD) under the supervision of each renal centre who have been on PD in the same centre for at least 3 months and have a measurement available'; the numerator is 'the number of these patients whose BP is <130/80'. The last available measurement from each patient from the last two quarters of the year is used. Units Percentage Coverage England Source The data item is routinely collected by the UK Renal Registry Calculations/Formula/Methodology Results are only given for those centres which had more than 20 patients with a value and for which at least 50% of the relevant patients had a value available. This performanace indicator is

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Anonymous

published in the UK Renal Registry Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. Creator / Producer UK Renal Registry Status In use Quality Good. Results are only given for those centres which had more than 20 patients with a measurement and for which at least 50% of the relevant patients had a measurement available. This performanace indicator is published in our Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. Date 2010 Version History There is currently no information for this item. Update Frequency Annual. Data are submitted to the UK Renal Registry on a quarterly basis. However, at present, the UK Renal Registry only prepare reports on this and other clinical performance indicators on an annual basis. Accessibility Results available for England, Wales and NI by renal centre Latest report: http://www.renalreg.com Publisher / Owner UK Renal Registry Other related PI's (relation) There is currently no information for this item. Additional Information There are currently no defined targets for BP in HD patients due to a lack of randomized controlled trials of hypertension management within this population. Therefore, BP for HD patients is not included as one of these performance indicators. However, the UKRR has decided to continue to

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Anonymous

publish information on HD patients using the previous RA standards for BP in these patients (prehaemodialysis BP<140/90mmHg and post-haemodialysis <130/80mmHg) to enable comparison with previous annual UKRR reports.

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Anonymous

Percentage of patients with BP <130/80 mmHg: Tx

Library Reference Number/Identifier LT20b Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor Percentage of renal transplant patients with blood pressure of less than 130/80 mmHg Rationale Patients receiving renal replacement therapy are at greatly increased risk of cardiovascular disease. http://www.renal.org/pages/pages/guidelines/current/complications.php#Summary_S1 Definition Each renal centre in England and Wales maintains a database that holds, amongst other items, laboratory values, and electronically submits an extract of these data on a quarterly basis to the UK Renal Registry. After validation and data cleaning, analyses are performed by the UK Renal Registry. The denominator is 'all transplant patients under the supervision of each renal centre who have been transplant patients in the same centre for at least 3 months and have a measurement available'; the numerator is 'the number of these patients whose BP is <130/80'. The last available measurement from each patient from the last two quarters of the year is used. Units Percentage Coverage England Source The data item is routinely collected by the UK Renal Registry Calculations/Formula/Methodology Results are only given for those centres which had more than 20 patients with a value and for which at least 50% of the relevant patients had a value available. This performanace indicator is published in the UK Renal Registry Annual Report (available at www.renalreg.com) and

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Anonymous

undergoes validation checks before publication therein. Creator / Producer UK Renal Registry Status In use Quality Good. Results are only given for those centres which had more than 20 patients with a measurement and for which at least 50% of the relevant patients had a measurement available. This performanace indicator is published in our Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. Date 2010 Version History There is currently no information for this item. Update Frequency Annual. Data are submitted to the UK Renal Registry on a quarterly basis. However, at present, the UK Renal Registry only prepare reports on this and other clinical performance indicators on an annual basis. Accessibility Results available for England, Wales and NI by renal centre Latest report: http://www.renalreg.com Publisher / Owner UK Renal Registry Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Percentage of prevalent haemodialysis (HD) patients with URR >65%

Library Reference Number/Identifier LT15 Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor Dialysis adequacy: percentage of haemodialysis or haemofiltration patients on thrice weekly dialysis achieving a urea reduction ratio of more than 65%, by renal centre. Rationale Dialysis dose, or 'adequacy', is an accepted marker of the quality of dialysis treatment. Achievement of a urea reduction ratio of >65% is associated with a reduced risk of complications, hospitalisation, and death. This indicator, and the detailed clinical rationale supporting it, is included in the Renal Association's clinical practice guidelines at http://www.renal.org/Clinical/GuidelinesSection/Haemodialysis.aspx#s5 Definition The Urea Reduction Ratio (URR) is derived solely from the percentage fall in serum urea during a dialysis treatment. This entails a blood sample at the start(PreD) and end(PostD) of a dialysis session usually performed monthly as routine care in haemodialysis patients. PreD-postD/preD gives the urea reduction ratio. The denominator is patients receiving thrice-weekly HD (and not at home) on the last day of the year (31st December) who have been on HD in the same centre for at least 3 months and have a URR measurement available. The numerator is patients with URR>65%. The last available measurement of URR from each patient from the last two quarters of the year is used. The higher the proportion of patients whose urea reduction ratio is >65%, the better the quality of care. Units Percentage Coverage England

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Anonymous

Source The data item is included in the National Renal Dataset and is routinely collected by the UK Renal Registry Calculations/Formula/Methodology Results are only given for those centres which had more than 20 patients with a URR value and for which at least 50% of the relevant patients had a URR value available. This performanace indicator is published in the UK Renal Registry Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. Creator / Producer UK Renal Registry Status In use Quality Urea Reduction Ratio is internationally recognised as a valid marker of the 'dose' of dialysis. Its relationship to long-term outcome may depend on other variables, including gender and body size, but there are no currently accepted gender- or size-specific targets. The indicator is not valid in patients receiving twice weekly dialysis (in whom a higher sessional dialysis dose is usually desirable) or in those receiving dialysis more than three times per week. The indicator does not take residual renal function into account and for that reason is not a perfect measure of overall small molecule clearance. Results are only given for those centres which had more than 20 patients with a measurement and for which at least 50% of the relevant patients had a measurement available. This performanace indicator is published in our Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. Date 2010 Version History There is currently no information for this item. Update Frequency Annual. Data are submitted to the UK Renal Registry on a quarterly basis. However, at present, the UK Renal Registry only prepare reports on this and other clinical performance indicators on an annual basis.

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Anonymous

Accessibility Available for England,Wales, Scotland and NI by renal centre Latest report: http://www.renalreg.com Publisher / Owner UK Renal Registry Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Percentage of prevalent haemodialysis patients with bicarbonate between 20 26 mmol/L

Library Reference Number/Identifier LT21 Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor Percentage of prevalent haemodialysis patients with bicarbonate between 20 - 26 mmol/L Rationale Acidosis (detected by low serum bicarbonate) contributes to bone and muscle damage in patients receiving renal replacement therapy. Over-correction of acidosis (detected by high serum bicarbonate) could contribute to vascular calcification. This indicator is based on the Renal Association Clinical Practice guidelines and is consistent with other national and international guidelines. See http://www.renal.org/pages/pages/guidelines/current/haemodialysis.php#Full_S6 Definition Each renal centre in England and Wales maintains a database that holds, amongst other items, laboratory values, and electronically submits an extract of these data on a quarterly basis to the UK Renal Registry. After validation and data cleaning, analyses are performed by the UK Renal Registry. The denominator is 'all patients currently receiving haemodialysis (HD) under the supervision of each renal centre who have been on HD in the same centre for at least 3 months and have a measurement available'; the numerator is 'the number of these patients whose serum phosphate value is between 20 and 26 mmol/L'. The last available measurement from each patient from the last two quarters of the year is used. Good clinical performance is indicated by a high proportion. Units Percentage Coverage England

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Anonymous

Source The data item is included in the National Renal Dataset and is routinely collected by the UK Renal Registry Calculations/Formula/Methodology Results are only given for those centres which had more than 20 patients with a value and for which at least 50% of the relevant patients had a value available. This performanace indicator is published in the UK Renal Registry Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. In the Registry Annual Report funnel plots are used to show the distribution of the percentage meeting the target over centres and to give an indication of which centres may be outlying. Creator / Producer UK Renal Registry, www.renalreg.org Status In use Quality The measurement of serum bicarbonate concentration is subject to analytical imprecision, and delays in processing of blood samples may contribute further to imprecision. Results are only given for those centres which had more than 20 patients with a measurement and for which at least 50% of the relevant patients had a measurement available. This performanace indicator is published in our Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. Date 2010 Version History There is currently no information for this item. Update Frequency Annual. Data are submitted to the UK Renal Registry on a quarterly basis. However, at present, the UK Renal Registry only prepare reports on this and other clinical performance indicators on an annual basis. Accessibility

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Anonymous

Results available for England, Wales and NI by renal centre Latest report: http://www.renalreg.com Publisher / Owner UK Renal Registry www.renalreg.com Other related PI's (relation) There is currently no information for this item. Additional Information Data from each participating renal centre should be displayed on a funnel plot (as can be seen in the Renal Registry Annual Report)

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Anonymous

Percentage of prevalent haemodialysis patients with haemoglobin between 10.5 - 12.5 g/dl
Library Reference Number/Identifier LT14a Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor Percentage of prevalent haemodialysis patients with haemoglobin between 10.5 - 12.5 g/dl Rationale The renal National Service Framework (NSF) part one and the RA minimum standards document 3rd edition state that individuals with chronic kidney disease (CKD) should achieve a Hb of at least 10 g/dl within 6 months of being seen by a nephrologist, unless there is a specific reason why it could not be achieved. The European Best Practice Guidelines (EBPG) set a minimum target of 11 g/dl but suggest not to go higher than 12 g/dl in severe cardiovascular disease. The NICE guidelines published in 2006 and the 4th edition of the RA Clinical Practice Guidelines 2006 recommended an outcome Hb of between 10.5 and 12.5 g/dl (with ESA dose changes considered at 11 and 12 g/dl) which allows for the difficulty in consistently narrowing the distribution to between 11 and 12 g/dl. The 2008 UKRR Annual Report reported how the attempt to comply with both the 10.512.5 g/dl range and the minimum standard of Hb>10.0 g/dl impacted on performance against a combination of measures. The risks associated with low (<10 g/dl) and high (>13 g/dl) Hb are not necessarily equivalent. Definition The denominator is patients receiving HD on the last day of the year (31st December) who have been on HD in the same centre for at least 3 months and have an Hb measurement available. The numerator is patients with Hb between 10.5 and 12.5 g/dl inclusive. The last available measurement of Hb from each patient from the last two quarters of the year is used. Subject to the caveats in the Rationale, a high value for this indicator is generally good. Units Percentage

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Anonymous

Coverage England Source The UKRR extract quarterly data electronically from renal centres in England, Wales and Northern Ireland, and quarterly data are sent in a single annual extract from the Scottish Renal Registry. Calculations/Formula/Methodology Results are only given for those centres which had more than 20 patients with a haemoglobin measurement and for which at least 50% of the relevant patients had an Hb measurement available. This performanace indicator is published in the UK Renal Registry Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. In the Registry Annual Report funnel plots are used to show the distribution of the percentage meeting the target over centres and to give an indication of which centres may be outlying. Creator / Producer UK Renal Registry Status In Use Quality Good. Results are only given for those centres which had more than 20 patients with a haemoglobin measurement and for which at least 50% of the relevant patients had an Hb measurement available. This performanace indicator is published in the UK Renal Registry Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. Date 2010 Version History There is currently no information for this item. Update Frequency Annual. Data are submitted to the UK Renal Registry on a quarterly basis. However, at present, the UK Renal Registry only prepare reports on this and other clinical performance indicators on an annual basis.

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Anonymous

Accessibility Available for England,Wales, Scotland and NI by renal centre Latest report: http://www.renalreg.com Publisher / Owner UK Renal Registry Other related PI's (relation) The 2007 Renal Association (RA) Clinical Practice Guidelines Document, revised European Best Practice Guidelines (EBPGII),Dialysis Outcomes Quality Initiative (DOQI) guidelines and UK NICE anaemia guidelines all recommend a target serum ferritin greater than 100 mg/L and percentage transferrin saturation (TSAT) of more than 20% in patients with CKD. EBPGII comments that a serum ferritin target for the treatment population of 200 500 mg/L ensures that 8590% of patients attain a serum ferritin of 100 mg/L. All guidelines advise that serum ferritin levels should not exceed 800 mg/L since the potential risk of toxicity increases without conferring additional benefit. The KDOQI and NICE guidelines advise against intravenous iron administration to patients with a ferritin >500 mg/L. Additional Information Department of Health Renal Team National Service Framework for Renal Services: Part One Dialysis and transplantation. Department of Health, London, 2004. Renal Association. Treatment of adults and children with renal failure: standards and audit measures. 3rd Edition. Royal College of Physicians of London and the Renal Association, London, 2002. Revised European Best Practice Guidelines for the Management of Anaemia in Patients with Chronic Renal Failure. Nephrol Dial Transplant 2004;19:ii1ii47. NKF-K/DOQI Clinical Practice Guidelines for Anemia of Chronic Kidney Disease: Update 2000. American journal of kidney diseases 2001;37:S182S238. National Collaborating Centre for Chronic Conditions. Anaemia management in chronic kidney disease: national clinical guideline for management in adults and children. Royal College of Physicians, London, 2006. Renal Association Clinical Practice Guidelines, 4th Edition, 2007 http://www.renal.org/pages/pages/clinical-affairs/guidelines.php

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Anonymous

Percentage of prevalent haemodialysis patients with phosphate between 1.1 1.8 mmol/L
Library Reference Number/Identifier LT17 Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor Percentage of prevalent haemodialysis patients with phosphate between 1.1 - 1.8 mmol/L Rationale Low serum phosphate is a marker of possible malnutrition, which contributes to poor outcomes amongst dialysis patients. High serum phosphate is associated with an increased risk of vascular calcification and death, and can usually be prevented by a combination of dietary restriction and use of medicines taken with meals that reduce absorption of phosphate from food. The indicator is based on the Renal Association clinical practice guidelines, and is consistent with other national and international guidelines. See http://www.renal.org/pages/pages/guidelines/current/complications.php#Summary_S2 Definition Each renal centre in England and Wales maintains a database that holds, amongst other items, laboratory values, and electronically submits an extract of these data on a quarterly basis to the UK Renal Registry. After validation and data cleaning, analyses are performed by the UK Renal Registry. The denominator is 'all patients currently receiving haemodialysis (HD) under the supervision of each renal centre who have been on HD in the same centre for at least 3 months and have a measurement available'; the numerator is 'the number of these patients whose serum phosphate value is between 1.1 and 1.8 mmol/L'. The last available measurement from each patient from the last two quarters of the year is used. Good clinical performance is indicated by a high proportion. Units Percentage

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Anonymous

Coverage England Source The data item is routinely collected by the UK Renal Registry Calculations/Formula/Methodology Results are only given for those centres which had more than 20 patients with a value and for which at least 50% of the relevant patients had a value available. This performanace indicator is published in the UK Renal Registry Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. In the Registry Annual Report funnel plots are used to show the distribution of the percentage meeting the target over centres and to give an indication of which centres may be outlying. Creator / Producer UK Renal Registry www.renalreg.com Status In use Quality Results are only given for those centres which had more than 20 patients with a measurement and for which at least 50% of the relevant patients had a measurement available. This performanace indicator is published in our Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. Date 2010 Version History There is currently no information for this item. Update Frequency Annual. Data are submitted to the UK Renal Registry on a quarterly basis. However, at present, the UK Renal Registry only prepare reports on this and other clinical performance indicators on an annual basis. Accessibility Results available for England, Wales and NI by renal centre Latest report: http://www.renalreg.com

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Anonymous

Publisher / Owner UK Renal Registry www.renalreg.com Other related PI's (relation) There is currently no information for this item. Additional Information Data from each participating renal centre should be displayed on a funnel plot (as can be seen in the Renal Registry Annual Report)

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Anonymous

Percentage of prevalent peritoneal dialysis (PD) patients with haemoglobin between 10.5 - 12.5 g/dl
Library Reference Number/Identifier LT14b Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor Percentage of peritoneal dialysis patients with haemoglobin (Hb) between 10.5 - 12.5 g/dl, by renal centre Rationale The renal National Service Framework (NSF) part one and the RA minimum standards document 3rd edition state that individuals with chronic kidney disease (CKD) should achieve a Hb of at least 10 g/dl within 6 months of being seen by a nephrologist, unless there is a specific reason why it could not be achieved. The European Best Practice Guidelines (EBPG) set a minimum target of 11 g/dl but suggest not to go higher than 12 g/dl in severe cardiovascular disease. The NICE guidelines published in 2006 and the 4th edition of the RA Clinical Practice Guidelines 2006 recommended an outcome Hb of between 10.5 and 12.5 g/dl (with ESA dose changes considered at 11 and 12 g/dl) which allows for the difficulty in consistently narrowing the distribution to between 11 and 12 g/dl. The 2008 UKRR Annual Report reported how the attempt to comply with both the 10.512.5 g/dl range and the minimum standard of Hb>10.0 g/dl impacted on performance against a combination of measures. The risks associated with low (<10 g/dl) and high (>13 g/dl) Hb are not necessarily equivalent. Definition The denominator is patients receiving PD on the last day of the year (31st December) who have been on PD in the same centre for at least 3 months and have an Hb measurement available. The numerator is patients with Hb between 10.5 and 12.5 g/dl inclusive. The last available measurement of Hb from each patient from the last two quarters of the year is used. Subject to the caveats in the Rationale, a high value for this indicator is generally good. Units

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Anonymous

Percentage Coverage England Source The UKRR extract quarterly data electronically from renal centres in England, Wales and Northern Ireland, and quarterly data are sent in a single annual extract from the Scottish Renal Registry. Calculations/Formula/Methodology Results are only given for those centres which had more than 20 patients with a haemoglobin measurement and for which at least 50% of the relevant patients had an Hb measurement available. This performanace indicator is published in the UK Renal Registry Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. In the Registry Annual Report funnel plots are used to show the distribution of the percentage meeting the target over centres and to give an indication of which centres may be outlying. Creator / Producer UK Renal Registry Status In use Quality Good. Results are only given for those centres which had more than 20 patients with a haemoglobin measurement and for which at least 50% of the relevant patients had an Hb measurement available. This performanace indicator is published in our Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. Date 2010 Version History There is currently no information for this item. Update Frequency Annual. Data are submitted to the UK Renal Registry on a quarterly basis. However, at present, the UK Renal Registry only prepare reports on this and other clinical performance indicators on an annual basis.

21/09/2013 07:36

Anonymous

Accessibility Available for England,Wales, Scotland and NI by renal centre Latest report: http://www.renalreg.com Publisher / Owner UK Renal Registry Other related PI's (relation) The 2007 Renal Association (RA) Clinical Practice Guidelines Document, revised European Best Practice Guidelines (EBPGII),Dialysis Outcomes Quality Initiative (DOQI) guidelines and UK NICE anaemia guidelines all recommend a target serum ferritin greater than 100 mg/L and percentage transferrin saturation (TSAT) of more than 20% in patients with CKD. EBPGII comments that a serum ferritin target for the treatment population of 200 500 mg/L ensures that 8590% of patients attain a serum ferritin of 100 mg/L. All guidelines advise that serum ferritin levels should not exceed 800 mg/L since the potential risk of toxicity increases without conferring additional benefit. The KDOQI and NICE guidelines advise against intravenous iron administration to patients with a ferritin >500 mg/L. Additional Information Department of Health Renal Team National Service Framework for Renal Services: Part One Dialysis and transplantation. Department of Health, London, 2004. Renal Association. Treatment of adults and children with renal failure: standards and audit measures. 3rd Edition. Royal College of Physicians of London and the Renal Association, London, 2002. Revised European Best Practice Guidelines for the Management of Anaemia in Patients with Chronic Renal Failure. Nephrol Dial Transplant 2004;19:ii1ii47. NKF-K/DOQI Clinical Practice Guidelines for Anemia of Chronic Kidney Disease: Update 2000. American journal of kidney diseases 2001;37:S182S238. National Collaborating Centre for Chronic Conditions. Anaemia management in chronic kidney disease: national clinical guideline for management in adults and children. Royal College of Physicians, London, 2006. Renal Association Clinical Practice Guidelines, 4th Edition, 2007 http://www.renal.org/pages/pages/clinical-affairs/guidelines.php

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Anonymous

Percentage of prevalent peritoneal dialysis patients with bicarbonate between 22 - 30 mmol/L

Library Reference Number/Identifier LT22 Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor Percentage of prevalent peritoneal dialysis (PD) patients with serum bicarbonate of between 22-30 mmol/L by renal centre Rationale Acidosis (detected by low serum bicarbonate) contributes to bone and muscle damage in patients receiving renal replacement therapy. Over-correction of acidosis (detected by high serum bicarbonate) could contribute to vascular calcification. This indicator is based on the Renal Association Clinical Practice guidelines and is consistent with other national and international guidelines. See http://www.renal.org/pages/pages/guidelines/current/peritonealdialysis.php#full_s6 Definition Each renal centre in England and Wales maintains a database that holds, amongst other items, laboratory values, and electronically submits an extract of these data on a quarterly basis to the UK Renal Registry. After validation and data cleaning, analyses are performed by the UK Renal Registry. The denominator is 'all patients currently receiving peritoneal dialysis (PD) under the supervision of each renal centre who have been on PD in the same centre for at least 3 months and have a measurement available'; the numerator is 'the number of these patients whose serum phosphate value is between 22 and 30 mmol/L'. The last available measurement from each patient from the last two quarters of the year is used. Good clinical performance is indicated by a high proportion. Units Percentage

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Anonymous

Coverage England Source The data item is included in the National Renal Dataset and is routinely collected by the UK Renal Registry Calculations/Formula/Methodology Results are only given for those centres which had more than 20 patients with a value and for which at least 50% of the relevant patients had a value available. This performanace indicator is published in the UK Renal Registry Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. In the Registry Annual Report funnel plots are used to show the distribution of the percentage meeting the target over centres and to give an indication of which centres may be outlying. Creator / Producer UK Renal Registry, www.renalreg.org Status In use Quality The measurement of serum bicarbonate concentration is subject to analytical imprecision, and delays in processing of blood samples may contribute further to imprecision. Results are only given for those centres which had more than 20 patients with a measurement and for which at least 50% of the relevant patients had a measurement available. This performanace indicator is published in the UK Renal Registry Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. Date 2010 Version History There is currently no information for this item. Update Frequency Annual. Data are submitted to the UK Renal Registry on a quarterly basis. However, at present, the UK Renal Registry only prepare reports on this and other clinical performance indicators on an annual basis.

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Anonymous

Accessibility Results available for England, Wales and NI by renal centre Latest report: http://www.renalreg.com Publisher / Owner UK Renal Registry www.renalreg.com Other related PI's (relation) There is currently no information for this item. Additional Information Data from each participating renal centre should be displayed on a funnel plot (as can be seen in the Renal Registry Annual Report)

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Anonymous

Percentage of prevalent peritoneal dialysis patients with phosphate between 1.1 - 1.8 mmol/L
Library Reference Number/Identifier LT18 Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor Percentage of peritoneal dialysis patients achieving serum phosphate maintained between 1.1 and 1.8 mmol/L by renal centre Rationale Low serum phosphate is a marker of possible malnutrition, which contributes to poor outcomes amongst dialysis patients. High serum phosphate is associated with an increased risk of vascular calcification and death, and can usually be prevented by a combination of dietary restriction and use of medicines taken with meals that reduce absorption of phosphate from food. The indicator is based on the Renal Association clinical practice guidelines, and is consistent with other national and international guidelines. See http://www.renal.org/pages/pages/guidelines/current/complications.php#Summary_S2 Definition Each renal centre in England and Wales maintains a database that holds, amongst other items, laboratory values, and electronically submits an extract of these data on a quarterly basis to the UK Renal Registry. After validation and data cleaning, analyses are performed by the UK Renal Registry. The denominator is 'all patients currently receiving peritoneal dialysis (PD) under the supervision of each renal centre who have been on PD in the same centre for at least 3 months and have a measurement available'; the numerator is 'the number of these patients whose serum phosphate value is between 1.1 and 1.8 mmol/L'. The last available measurement from each patient from the last two quarters of the year is used. Good clinical performance is indicated by a high proportion. Units Percentage

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Anonymous

Coverage England Source The data item is included in the National Renal Dataset and is routinely collected by the UK Renal Registry Calculations/Formula/Methodology Results are only given for those centres which had more than 20 patients with a value and for which at least 50% of the relevant patients had a value available. This performanace indicator is published in the UK Renal Registry Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. In the Registry Annual Report funnel plots are used to show the distribution of the percentage meeting the target over centres and to give an indication of which centres may be outlying. Creator / Producer UK Renal Registry www.renalreg.com Status In use Quality Results are only given for those centres which had more than 20 patients with a measurement and for which at least 50% of the relevant patients had a measurement available. This performanace indicator is published in our Annual Report (available at www.renalreg.com) and undergoes validation checks before publication therein. Date 2010 Version History There is currently no information for this item. Update Frequency Annual. Data are submitted to the UK Renal Registry on a quarterly basis. However, at present, the UK Renal Registry only prepare reports on this and other clinical performance indicators on an annual basis.

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Anonymous

Accessibility Results available for England, Wales and NI by renal centre Latest report: http://www.renalreg.com Publisher / Owner UK Renal Registry www.renalreg.com Other related PI's (relation) There is currently no information for this item. Additional Information Data from each participating renal centre should be displayed on a funnel plot (as can be seen in the Renal Registry Annual Report)

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Anonymous

Percentage of women receiving results of cervical screening tests within two weeks and within 2-3 weeks
Library Reference Number/Identifier VSA15 Subject Vital Signs Category National Requirement Tier 1 Detailed Descriptor Percentage of women who receive the results of their cervical screening test within 2 weeks and within 2-3 weeks of it being taken Rationale In May 2004, the International Agency for Research on Cancer (IARC), part of the World Health Organisation, concluded that organised and quality controlled cervical screening can achieve an 80% reduction in the mortality of cervical cancer In July 2004, Professor Julian Peto and colleagues published a paper in The Lancet, The cervical cancer epidemic that screening has prevented in the UK. The paper concluded that cervical screening has prevented an epidemic that would have killed about one in 65 of all British women born since 1950 and culminated in about 6,000 deaths per year in this country. 80% or more of these deaths, up to 5,000 per year, are likely to be prevented by screening. This means that about 100,000 women will have been saved from premature death by the cervical screening programme by 2030 In 2006-07, 79.2% of eligible women had a test result in the last 5 years. 3.4 million women were screened and laboratories examined 3.7 million tests In 2006-07, only 48% of women received their cervical screening results within four weeks. 13% of women had to wait over 8 weeks. This is not acceptable in a modern NHS. Waiting so long for results, especially for a test for abnormalities which may lead to cancer, causes anxiety in women. It may also deter women from being screened next time they are invited. NHS Improvement: Cancer are providing focused service improvement resources across the cervical screening pathway to support the delivery of faster turnaround times. Advice to the NHS on achieving the two week turnaround time standard was issued in The Week in April 2008. A further invite for SHAs to bid to receive NHS Improvement: Cancer support will be issued in March 2009. All women should receive the results of their cervical screening tests within two weeks by 2010.

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Anonymous

The percentage of women receiving the results of their cervical screening test within two weeks should increase with time Definition Percentage of women who receive the results of their cervical screening test within two weeks of it being taken Numerator: The number of eligible women receiving the results of their cervical screening tests within two weeks Denominator: The number of test results sent by each PCO There is further work to be done to develop detailed definitions for this plan line. It is likely that: Day 0 will be date of test Target date will be date of expected delivery of results by post Monitoring will be based on a calendar week, not working days UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: The percentage of women receiving the results of their cervical screening test within two weeks of the test being taken should increase to 100% by 2010 Units % Performance Coverage England Source Screening statistics - Cervical Calculations/Formula/Methodology UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off:

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Anonymous

The percentage of women receiving the results of their cervical screening test within two weeks of the test being taken should increase to 100% by 2010 There is further work to be done to develop detailed definitions for this plan line. It is likely that: Day 0 will be date of test Target date will be date of expected delivery of results by post Monitoring will be based on a calendar week, not working days Creator / Producer NHS Cancer Screening Programme / NHS Information Centre for Health and Social Care Status In use Quality Baseline: From 2009. An indication of current NHS performance on waiting times for the results of cervical screening is in Table 9 of ONS/IC Cervical Screening Programme England 2006-07 statistical bulletin, although definitions in the table do not reflect the new standard and will change to reflect the new standard: http://www.ic.nhs.uk/statistics-and-data-collections/screening/cervical-cancer/cervical-screeningprogramme-2006-07-%5Bns%5D Date 2011-12 Version History There is currently no information for this item. Update Frequency Annually Accessibility Available at: https://www.hub.info4local.gov.uk/DIHWEB/Logon/default.aspx?Timeout=True and http://www.ic.nhs.uk/statistics-and-data-collections/screening/cervical-cancer/cervical-screeningprogramme-2006-07-%5Bns%5D Disaggregated by: Commissioner General information available from

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Anonymous

http://www.cancerscreening.nhs.uk/cervical/index.html Publisher / Owner Department of Health (DH) Other related PI's (relation) VSA15 Additional Information NHS Cancer Screening Programmes: 0114 2711060 www.cancerscreening.nhs.uk

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Anonymous

Proportion of sites with a community stroke team for longer term management attached to the stroke multidisciplinary team
Library Reference Number/Identifier CV09 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale Hyperacute service is defined as a service which is able to see and investigate stroke patients within 3 hours of stroke to assess suitability for thrombolysis. Acute Service is defined as a service which is able to see and investigate stroke patients urgently after stroke to provide a full range of care to patients from admission but does not offer thrombolysis Rehabilitation service is defined as a service which is able to see patients for rehabilitation. There is a specific question asking about this service and so see help booklet for Question 4.2 Definition If you provide rehabilitation services only we need to know which is the main site that you link with where patients are seen acutely see comments in adjacent cell Units There is currently no information for this item. Coverage England, Wales and Northern Ireland Source Sentinel Stroke Audit - Organisational Audit

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Anonymous

Calculations/Formula/Methodology Question 4.2 See full wording of questions for exceptions in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Creator / Producer Royal College of Physicians Status In use Quality It is in the public domain Date 2010 Version History There is currently no information for this item. Update Frequency Usually every 2 years. Exceptionally 2008 and 2009. The interim data collection for the NAO report Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf Publisher / Owner Royal College of Physicians

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Anonymous

Other related PI's (relation) There is currently no information for this item. Additional Information *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Anonymous

Proportion of sites with formal links to patient/carer groups

Library Reference Number/Identifier CV21 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale To promote a service that is responsive to the needs of patients and their families (Kelson 1995; 2001; Department of Health 2000; Guidelines 2004) Definition Structures which enable regular consultation with representatives from any of the following: a special group for stroke from the Community Health Council or Patient Advocacy Liaison Service; or local groups which represent the views of people affected by stroke eg Stroke Association or Different Strokes. This is asked as Q9.5 see help text accordingly Units There is currently no information for this item. Coverage England, Wales and Northern Ireland Source Sentinel Stroke Audit - Organisational Audit Calculations/Formula/Methodology Question 9.5 See full wording of questions for exceptions in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc

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Anonymous

Creator / Producer Royal College of Physicians Status Not included in public report Quality Not in the public domain Date 2010 Version History There is currently no information for this item. Update Frequency Usually every 2 years. Exceptionally 2008 and 2009. The interim data collection for the NAO report Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf Publisher / Owner Royal College of Physicians Other related PI's (relation) There is currently no information for this item. Additional Information

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Anonymous

*Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Anonymous

Proportion of women aged 25-49 and 50-64 screened for cervical cancer
Library Reference Number/Identifier WCC 2.23 Subject NHS Screening Programme Category 2 Coverage of NHS Cervical Screening Programme, England Detailed Descriptor Coverage of women aged 25-64 screened for cervical cancer (less than 3.5 years since last adequate test for 25-49 and less than 5 years since last adequate test for 50-64) Rationale This is used to monitor the effectiveness of the programme in monitoring the target population (i.e. women eligible for screening aged 25-64 in England) Definition Coverage is defined as the percentage of women in a population eligible for screening at a given point in time who were less than a specified period since their last test producing an adequate test result. Women ineligible for screening, and thus not included in the numerator or denominator of the coverage calculation, are those whose recall has been ceased for clinical reasons (most commonly due to hysterectomy). This indicator is presented by the following age group breakdowns due to the frequency of invitation due to age. Coverage of women aged 25-49 screened for cervical cancer less than 3.5 years since last adequate test. Coverage of women aged 50-64 screened for cervical cancer less than 5 years since last adequate test. In both cases the numerator is defined as: number of women within stated age group screened for cervical cancer within the time frame since last adequate test. The denominator is defined as number of eligible women registered in each PCT. The populations used are not those of women resident within the PCO boundaries. Instead the

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Anonymous

populations of women for whom each PCO is responsible are used. Responsible populations include women on the list of GPs who comprise the PCO, regardless of which geographical PCO they live in; where women on the call/recall register are not under the care of a GP at the time coverage is calculated, they are allocated to a PCO on a geographical basis. Units % Coverage England Source Screening statistics - Cervical Calculations/Formula/Methodology http://www.connectingforhealth.nhs.uk/systemsandservices/ssd/downloads/cytology/contents/kc53 Creator / Producer NHS Information Centre for Health and Social Care, Workforce Status In use Quality This indicator is derived from a national statistic certified dataset. Date 2011-12 Version History Prior to 2003 women aged 20-24 were also eligible for Screening as part of the programme. Prior to 2005-06 production of this data was the responsibility of the Department of Health (DH) Update Frequency Annually in October Accessibility Recommended breakdown not currently on web. Will be for future publications which will be on the following website http://www.ic.nhs.uk/statistics-and-data-collections/screening . To obtain current data contact cancer.screeningh@ic.nhs.uk

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Anonymous

Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) NHS Choices, Care Quality Commission, WCC 2.23 Additional Information Figures showing the coverage combining both age ranges can be found in the publication. This is a legacy of earlier publication practices and the age breakdown recommendations for the 25-49 and 50-64 age group should be used which would be consistent with how it will be presented as indicators by other bodies. KC53 Information Centre Return information from the call and recall system collected from all PCOs. Annual extract taken from CfH Exeter system

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Anonymous

The percentage of patients on the CKD register in whom the last blood pressure reading, measured in the previous 15 months, is 140/85 or less
Library Reference Number/Identifier QOF CKD 3 Subject QOF Clinical domain : Chronic kidney disease (CKD) Category Ongoing management Detailed Descriptor The percentage of patients on the CKD register in whom the last blood pressure reading, measured in the previous 15 months, is 140/85 or less Rationale Studies have shown that in people over 65 years and in people with diabetes, normal blood pressure is hard to achieve but is important (Anderson et al. American Journal of Kidney Disease 2005; 45(6): 994-1001). See also the latest British Hypertension Society guidelines 200467: This suggests an optimal BP target in CKD of 130/80 mm Hg or 127/75 mm Hg if >1 g proteinuria. These targets in turn are derived from the Modification of Diet in Renal Disease study. In practice, these targets are often hard to achieve and the indicators 40% to 70% audit standard reflects this. The lower the blood pressure achieved the better for patient care; 140/85 mm Hg is used here as an audit standard for this indicator. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage

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Anonymous

England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF CKD 3 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients on the CKD register whose notes have a record of blood pressure in the previous 15 months
Library Reference Number/Identifier QOF CKD 2 Subject QOF Clinical domain : Chronic kidney disease (CKD) Category Initial management Detailed Descriptor The percentage of patients on the CKD register whose notes have a record of blood pressure in the previous 15 months Rationale Studies show that reducing blood pressure in people with CKD reduces the rate of deterioration of their kidney function whether or not they have hypertension or diabetes. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF CKD 2 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients on the CKD register with hypertension and proteinuria who are treated with an angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) (unless a contraindication or side effects are recorded)
Library Reference Number/Identifier QOF CKD 5 Subject QOF Clinical domain : Chronic kidney disease (CKD) Category Ongoing management Detailed Descriptor The percentage of patients on the CKD register with hypertension and proteinuria who are treated with an angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) (unless a contraindication or side effects are recorded) Rationale ACE inhibitors and ARBs are generally more effective than other anti-hypertensives in minimising deterioration in kidney function and this effect is most marked where there is significant proteinuria. Such treatment is both clinically and cost effective. The gold standard test for measuring proteinuria is a 24-hour urine collection; though problems with timing and completeness make this an impractical test to use in general practice. The alternatives are to test the albumin-creatinine ratio (ACR) or protein-creatinine ratio (PCR) in the urine or to use a stick test. SIGN Guidance also recommends measuring proteinuria with ACR in patients with diabetes and TPCR in non-diabetic patients, reflecting the differing evidence base for theses two patient populations whereas recent NICE guidance has suggested that the ACR should be used in all patients. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available.

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Anonymous

Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History New indicator for 2011-12 Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care

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Anonymous

Other related PI's (relation) QOF CKD 5 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with atrial fibrillation diagnosed after 1 April 2009 with ECG or specialist confirmed diagnosis
Library Reference Number/Identifier QOF AF 4 Subject QOF Clinical domain : Atrial fibrillation Category Initial diagnosis Detailed Descriptor The percentage of patients with atrial fibrillation diagnosed after 1 April 2009 with ECG or specialist confirmed diagnosis Rationale AF is historically too often inaccurately coded. Patients with an irregular pulse have been given an AF code even though the accuracy of AF diagnosed in this way is only approximately 30 per cent. The introduction of this indicator will enable the compilation of a more accurate register and help to ensure that treatments are targeted more appropriately. The act of referral for a specialist opinion (e.g. cardiology out patient or ECG technician report) is insufficient to achieve this indicator. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology

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Anonymous

http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status 2011-12 Quality QOF indicators are based on best available clinical evidence Date There is currently no information for this item. Version History There is currently no information for this item. Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF AF 4 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with atrial fibrillation who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy
Library Reference Number/Identifier QOF AF 3 Subject QOF Clinical domain : Atrial fibrillation Category Ongoing management Detailed Descriptor The percentage of patients with atrial fibrillation who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy Rationale There is strong evidence that stroke risk can be substantially reduced by warfarin (approximately 66 per cent risk reduction) and less so by aspirin (approximately 22 per cent risk reduction). Warfarin in particular is under-used for stroke prevention in AF. A NICE costing report accompanying the recommendations for AF treatment in 2006 estimated that nationally 355,312 patients with AF should be on warfarin (i.e. all of those assessed as high risk, half of those at moderate risk, and none of those at low risk, using the NICE stroke risk stratification algorithm, and if not contraindicated), or an additional 165,946 patients who were not receiving this treatment almost 50% of those estimated as requiring warfarin. Thus there is clearly a need to encourage the use of this treatment for AF patients at high risk of stroke. Furthermore, recent evidence from the BAFTA trial and the ACTIVE-W study suggests not only is warfarin much more effective than aspirin, but that it is not as unsafe in terms of risk of serious haemorrhage as previously thought (though it would be useful to ascertain if these findings are replicated elsewhere using an appropriate meta-analysis). Nevertheless, a significant proportion of AF patients depending on the particular risk stratification scheme selected this can be the majority of people with AF are not considered to be at high risk of stroke, though clearly this does not mean their risk of stroke is non-existent. Therefore, any treatment indicator (or set of indicators) should not focus solely on the high risk group, if that means the large group considered at moderate risk (or even those at low risk) are then excluded from their treatment being monitored. The NICE atrial fibrillation guidelines suggest that for those at moderate risk, anticoagulation or antiplatelet therapy should be prescribed depending upon

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Anonymous

patient preference after discussion of risks and benefits. This guidance therefore enables the clinician and patient to decide on the preferred regime, taking risks and benefits of both treatments (i.e. anticoagulant and antiplatelet therapy) into account, for all AF patients, whatever their category of stroke risk. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency

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Anonymous

Annual publication (October in 2011) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF AF 3 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with cancer, diagnosed within the last 18 months who have a patient review recorded as occurring within 6 months of the practice receiving confirmation of the diagnosis
Library Reference Number/Identifier QOF CANCER 3 Subject QOF Clinical domain : Cancer Category Ongoing management Detailed Descriptor The percentage of patients with cancer, diagnosed within the last 18 months who have a patient review recorded as occurring within 6 months of the practice receiving confirmation of the diagnosis Rationale Most general practitioners will see patients with a new cancer diagnosis following assessment and management in a secondary or tertiary care setting. A cancer review is an opportunity to cover the following issues: the patients individual health and support needs (this will vary with e.g. the diagnosis, staging, age and pre-morbid health of the patient and their social support networks) the co-ordination of care between sectors. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage

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Anonymous

England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF CANCER 3 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with coronary heart disease whose notes have a record of blood pressure in the previous 15 months
Library Reference Number/Identifier QOF CHD 5 Subject QOF Clinical domain : Secondary prevention of coronary heart disease Category Ongoing management Detailed Descriptor The percentage of patients with coronary heart disease whose notes have a record of blood pressure in the previous 15 months Rationale Epidemiological data indicate that continued hypertension following the onset of CHD increases the risk of a cardiac event and that the reduction of blood pressure reduces risk. Patients with known CHD should have their blood pressure measured at least annually. Definition ***DROPPED This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (October in 2010) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF CHD 5 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with newly diagnosed angina (diagnosed after 1 April 2003) who are referred for exercise testing and/or specialist assessment
Library Reference Number/Identifier QOF CHD 2 Subject QOF Clinical domain : Secondary prevention of coronary heart disease Category Diagnosis and initial management Detailed Descriptor ***DROPPED - REPLACED BY QOF CHD 13. The percentage of patients with newly diagnosed angina (diagnosed after 1 April 2003) who are referred for exercise testing and/or specialist assessment Rationale Diagnosis of coronary heart disease. The QOF does not specify how the diagnosis of angina is made or confirmed. This will vary from patient to patient, e.g. clinical history, response to medication, results of investigations, hospital letters etc. In general, angina is a clinical diagnosis. Patients with suspected angina should have a 12 lead ECG performed. The presence of an abnormal ECG supports a clinical diagnosis of coronary heart disease. An abnormal ECG also identifies a patient at higher risk of suffering new cardiac events in the subsequent year. However, a normal ECG does not exclude coronary artery disease. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units

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Anonymous

Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED - REPLACED BY QOF CHD 13. Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (published in October in 2011) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) REPLACED BY QOF CHD 13

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Anonymous

Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of all cancer patients defined as a register of patients with a diagnosis of cancer excluding non-melanotic skin cancers from 1 April 2003
Library Reference Number/Identifier QOF CANCER 1 Subject QOF Clinical domain : Cancer Category Records Detailed Descriptor The practice can produce a register of all cancer patients defined as a register of patients with a diagnosis of cancer excluding non-melanotic skin cancers from 1 April 2003 Rationale A register is a prerequisite for ensuring follow-up of patients with cancer. The register can be developed prospectively as the intention is to ensure appropriate care and follow-up for patients with a diagnosis of cancer. For the purposes of the register all cancers should be included except non-melanomatous skin lesions. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF CANCER 1 Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients aged 18 years and over with CKD (US National Kidney Foundation: Stage 3 to 5 CKD)
Library Reference Number/Identifier QOF CKD 1 Subject QOF Clinical domain : Chronic kidney disease (CKD) Category Records Detailed Descriptor The practice can produce a register of patients aged 18 years and over with CKD (US National Kidney Foundation: Stage 3 to 5 CKD) Rationale Patients aged18 years and over with a persistent estimated GFR or GFR of <60ml/min/1.73m2 should be included in the register. From 2006, eGFR has been reported automatically when serum creatinine concentration is measured. Studies of general practice computerised medical records show that it is feasible to identify people with CKD64 and that computer records are a valid source of data. The compilation of a register of people with CKD will enable appropriate advice, treatment and support for the patient to preserve kidney function and to reduce the risk of cardiovascular disease. Eating a protein containing meal can elevate creatinine; therefore it is recommended that patients do not eat meat in the 12 hours before their creatinine is measured and eGFR estimated. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage

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Anonymous

England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF CKD 1 Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients with atrial fibrillation

Library Reference Number/Identifier QOF AF 1 Subject QOF Clinical domain : Atrial fibrillation Category Records Detailed Descriptor The practice can produce a register of patients with atrial fibrillation Rationale This is good professional practice and is consistent with other clinical domains within the QOF as a building block for further evidence based interventions. A register makes it possible to call and recall patients effectively to provide systematic care and to audit care. A register should include all people with an initial event; paroxysmal; persistent and permanent AF. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH)

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Anonymous

Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF AF 1 Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients with coronary heart disease
Library Reference Number/Identifier QOF CHD 1 Subject QOF Clinical domain : Secondary prevention of coronary heart disease Category Records Detailed Descriptor The practice can produce a register of patients with coronary heart disease Rationale In order to call and recall patients effectively in any disease category and in order to be able to report on indicators for coronary heart disease, practices must be able to identify their patient population with CHD. This will include all patients who have had coronary artery revascularisation procedures such as coronary artery bypass grafting (CABG). Patients with Cardiac Syndrome X should generally not be included in the CHD register. Practices should record those with a past history of myocardial infarction as well as those with a history of CHD. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF CHD 1 Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients with established hypertension

Library Reference Number/Identifier QOF BP 1 Subject QOF Clinical domain : Hypertension Category Records Detailed Descriptor The practice can produce a register of patients with established hypertension Rationale In order to call and recall patients effectively and in order to be able to report on indicators for hypertension, practices must be able to identify their population of patients who have established hypertension. A number of patients may be wrongly coded in this group, for example patients who have had one-off high blood pressure readings or women who have been hypertensive in pregnancy. The British Hypertension Society recommends that drug therapy should be started in all patients with sustained systolic blood pressures of greater than or equal to 160 mmHg or sustained diastolic blood pressures of greater than or equal to 100 mmHg despite non-pharmacological measures. Drug treatment is also indicated in patients with sustained systolic blood pressures of 140-159 mmHg or diastolic pressures of 90-99 mmHg if target organ damage is present or there is evidence of established cardiovascular disease or diabetes or the 10 year risk of CHD is raised. Elevated blood pressure readings on three separate occasions are generally taken to confirm sustained high blood pressure. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical

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Anonymous

Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF BP 1

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Anonymous

Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients with heart failure

Library Reference Number/Identifier QOF HF 1 Subject QOF Clinical domain : Heart failure Category Records Detailed Descriptor The practice can produce a register of patients with heart failure Rationale From April 2006, all patients with heart failure should be included in the register. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use

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Anonymous

Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF HF 1 Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients with stroke or TIA

Library Reference Number/Identifier QOF STROKE 1 Subject QOF Clinical domain : Stroke and Transient Ischaemic Attack (TIA) Category Records Detailed Descriptor The practice can produce a register of patients with stroke or TIA Rationale A register is a prerequisite for monitoring patients with stroke or TIA. For patients diagnosed prior to April 2003 it is accepted that various diagnostic criteria may have been used. For this reason the presence of the diagnosis of stroke or TIA in the records will be acceptable. Generally patients with a diagnosis of Transient Global Amnesia or Vertebro-basilar insufficiency should not be included in the retrospective register. However, practices may wish to review patients previously diagnosed and if appropriate attempt to confirm the diagnosis. As with other conditions, it is up to the practice to decide, on clinical grounds, when to include a patient, for example when a dizzy spell becomes a TIA. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF STROKE 1 Additional Information There is currently no information for this item.

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Anonymous

Percentage of women in the relevant PCT population who have seen a midwife or a maternity healthcare professional, for health and social care assessment of needs, risks and choices by 12 weeks and 6 days of pregnancy
Library Reference Number/Identifier VSB06 Subject Vital Signs Category National Priority Tier 2 Detailed Descriptor Increasing early access for women to maternity services % women in the relevant PCT population who have seen a midwife or a maternity healthcare professional, for health and social care assessment of needs, risks and choices by 12 weeks and 6 days of pregnancy. Rationale All women should access maternity services for a full health and social care assessment of needs, risks and choices by 12 weeks and 6 days of their pregnancy to give them the full benefit of personalised maternity care and improve outcomes and experience for mother and baby. Reducing the percentage of women who access maternity services late through targeted outreach work for vulnerable and socially excluded groups will provide a focus on reducing the health inequalities these groups face whilst also guaranteeing choice to all pregnant women. Completion of the assessment empowers women, supporting them in making well informed decisions about their care throughout pregnancy, birth and postnatally. The national choice guarantees: choice of how to access maternity care; choice of type of antenatal care; choice of place of birth; choice of place of postnatal care. The aim is an increase in the percentage of women who have seen a midwife or a maternity healthcare professional for assessment of health and social care needs, risks and choices by 12 weeks and 6 days of pregnancy. This indicator promotes provision of accessible services. Definition

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Anonymous

Increasing Early Access for Women to Maternity Services % women in the relevant PCT population who have seen a midwife or a maternity healthcare professional, for health and social care assessment of needs, risks and choices by 12 weeks and 6 days of pregnancy.

The percentage of women in the relevant PCT population who have seen a midwife or a maternity healthcare professional, for health and social care assessment of needs, risks and choices by 12 weeks and 6 days of pregnancy. This indicator was introduced in April 2008 and the April 2008 version is superseded by this current version, which is revised for Q3 2008-09. Pregnancy Pregnancy is defined as all maternities regardless of outcome, excluding those where care is provided outside an NHS setting. In the relevant PCT population - This refers to the PCT of the GP the woman is registered with. Where a woman is not registered with a GP, the woman's postcode of residence should be used Seen This means completion of a full assessment, this may occur over multiple sessions but will be measured by the completion of the final session not the initiation of the first. Midwife To qualify as a midwife in this definition the person must hold current registration with the nursing and midwifery council and being in active employment as a midwife with the NHS. Maternity healthcare professional This is a description which covers obstetricians and general practitioners with current registration with the General Medical Council and working for the NHS providing maternity services. 12 weeks and 6 days this relates to the measured gestation of the pregnancy and is the cut-off point for measurement against the Indicator. The most valid approach is to use gestational age as calculated by ultrasound assessment, but it is recognised that the ultrasound calculation of gestation is not always available at the time of assessment of needs, risk and choices. The gestational age at completion of assessment may therefore be estimated from the date of completed assessment and the Estimated Date of Delivery (from clinical estimation/LMP or scan). Health and Social Care assessment of needs, risks and choices is defined as an antenatal care booking visit where the hand held maternity record is completed. This must include: Information provided on the choice of type of antenatal care as in 'Maternity Matters'; Antenatal information, checks and tests described in the NICE antenatal care guidance of March 2008 including - vitamin D supplements - screening for risk factors of gestational diabetes - maternal height and weight; body mass index calculated - screening questions for depression and other mental disorders - offer of screening for anaemia - offer of early ultrasound scan for gestational age assessment Assessment of incidence of domestic abuse.

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Anonymous

Direction: Increasing. Note that more than 100% may potentially be achieved if women who are assessed go on to miscarry or terminate, causing them to be captured in the numerator but not the denominator

Criteria for Plan Sign-off: By the end of 2008/09 would expect all PCTs to be achieving 80% with a year on year increase aiming to achieve at least 90% by 2010/11. Units % Performance Coverage England Source DH - Maternity Calculations/Formula/Methodology Numerator: Number of women in the relevant PCT population who have seen a midwife or a maternity healthcare professional, for health and social care assessment of needs, risks and choices by 12 weeks and 6 days of pregnancy (VSMR Line 2001 within the quarter.) Denominator: The number of women in the relevant PCT population who give birth to one or more live or stillborn babies of at least 24 weeks gestation where the baby is delivered by either midwife or a doctor and the place of delivery is either at home or in an NHS hospital (including GP units). Exclude all maternities that occur in either psychiatric or private beds/hospitals. (VSMR Line 7101)

Note: The denominator is already collected as line 7101 for the breastfeeding and smoking during pregnancy indicators. The data used as this denominator will relate to two quarters after the quarter of collection to ensure that both numerator and denominator broadly relate to the same cohort of women. For example, if the quarter of collection is Q3, then assessments in that quarter (the numerator) will be subsequently compared to births (the denominator) in Q1 of the following year. This relationship between numerator and denominator is to be followed when completing the

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Anonymous

maternity reporting template on Unify. Q1 of the numerator will be assessed against future Q3 of the denominator; and Q2 versus Q4 and so on. Therefore, in 2009-10 the Q1 column entry on the template will be Q1 2009-10 data for VSB06_01 (numerator) and Q3 2009-10 data for VSB06_04 (denominator).

Note that this denominator will be used by the Healthcare Commission to formally assess delivery, and should be used when setting plans. Q1 2009-10 denominator data will be estimated by DH using uplifted Q1 2008-09 data to account for seasonal patterns and the increasing birth rate. DH will provide uplifted Q1 2008-09 data for each PCT. DH will collect monitoring data only on a second denominator as an informal measure to enable a timely interim assessment of progress: Second Denominator (no plan to be collected): Number of women in the relevant PCT population who have seen a midwife or a maternity healthcare professional for health and social care assessment of needs, risk and choices at any time during pregnancy (VSMR Line 2002 within the quarter). Note that the definition of line 2002 is different from the original definition of line 2002 and now refers to the total number of assessments within the quarter. NB: Population Lines: Please note that standard population data will be used to populate these lines within Unify. DH will use 2006 based ONS projections for the relevant planning years. UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: By the end of 2008/09 would expect all PCTs to be achieving 80% with a year on year increase aiming to achieve at least 90% by 2010/11. Formula: N = Numerator/Denominator x 100 Creator / Producer NHS Information Centre

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Anonymous

Status In use Quality There is currently no information for this item. Date Q3_2012-13 Version History There is currently no information for this item. Update Frequency Quarterly Accessibility Available at: http://transparency.dh.gov.uk/?p=20285 Publisher / Owner Department of Health (DH) Other related PI's (relation) Included in National Indicator Set: NI 126 and VSB06 Additional Information Consult NICE guideline at www.nice.org.uk The data return must represent actual numbers of women from across the whole PCT. PCTs will need to focus on locating three key variables to provide information for this Indicator: NHS number, date of assessment, and Estimated Date of Delivery. Note that denominator 1 is the nearest possible approximation to all women who have been pregnant and could/should have had an assessment by 12 weeks and 6 days. It will exclude any pregnant women who go on to lose their babies before viability (24 weeks). This is a pragmatic approach to assessing early assessment rather than having a denominator referring to the population of pregnant women, or women who reach a certain gestational age. These alternative denominators would have implications in terms of data collection burden or require linkage to birth data. It will however be necessary to wait six months to obtain data on all births that relate to earlier assessments.

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Anonymous

For the purpose of benchmarking for the Local Area Agreement refresh in November 2008, Q3 data will be used for the numerator; Q1 2009-10 denominator data (line 7101) will be estimated using uplifted Q1 2008-09 data to account for seasonal patterns and the increasing birth rate. DH will provide uplifted Q1 2008-09 data for each PCT that has this indicator in its Local Area Agreement and publish its method on Unify2. Q3 08/09 assessment data will be compared with Q1 09/10 birth data to provide the first full assessment of Q3 performance. The first full assessment of performance improvement will be made in Q2 09/10, when Q4 08/09 assessment data is compared with Q2 09/10 birth data and performance in Q3 and Q4 08/09 can be compared. We will publish a spreadsheet on Unify2 that provides a schedule of matching numerators and denominators for the purpose of assessing quarterly and annual performance. To enable a more timely, informal assessment of performance in the interim, two indicative measures can be used as follows: 1) Line 2002 collects data on total number of assessments, so that it will be possible to calculate the proportion of assessments in each quarter that are undertaken in 12 competed weeks. 2) Line 2001 can be compared to estimated denominator data using the relevant quarters data from line 7101 the previous year, uplifted to account for seasonal patterns and the increasing birth rate. These measures are meant for use as an informal guide to performance in the interim period before full denominator data is available two quarters later. It is intended that the information will be collected by the NHS Information Centre in 2009-10 and will be provided through Hospital Episode Statistics collection. As this is a new collection, 2008-09 data will be collected from the Department of Health (DH) Vital Sign Monitoring Return (VSMR).

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Anonymous

Prevalence of Breastfeeding at 6-8 weeks

Library Reference Number/Identifier VSB11 Subject Vital Signs Category National Priority Tier 2 Detailed Descriptor Prevalence of breastfeeding at 6-8 weeks after birth Rationale There is clear evidence that breastfeeding has positive health benefits for both mother and baby in the short- and longer-term (beyond the period of breastfeeding). Breastmilk is the best form of nutrition for infants and exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant's life. For infants, it reduces the incidence of gastrointestinal and respiratory infections, otitis media and recurrent otitis media and reduces the risk of allergies. There is also some evidence that it protects against neonatal necrotizing enterocolitis, respiratory and urinary tract infection, and that it reduces the risk of auto-immune disease, such as diabetes mellitus type I, and of adiposity later in childhood. For mothers, it promotes maternal recovery from childbirth, reduces the risk of pre-menopausal breast cancer and possibly of ovarian cancer, accelerates weight loss and a return to prepregnancy body weight and prolongs the period of postpartum infertility. (See WHO Regional Publications, European Series, No.87 on Feeding and Nutrition of Infants and Young Children.) There is evidence indicating that the longer the duration of breastfeeding, the greater the health benefits in later life. Breastfeeding initiation rates have been improving over the last 10 years and, in 2005 , 78% of mothers in England initiated breastfeeding. However, only 50% of all mothers who initiated breastfeeding were continuing to breastfeed at 6 weeks and 26% continued some breastfeeding at six months. There is clear evidence that adequate support to breastfeeding mothers in the first few weeks is likely to increase the duration of breastfeeding. Breastfeeding has an important contribution to make towards reducing infant mortality, childhood obesity and health inequalities Definition

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Anonymous

Prevalence of breastfeeding at 6-8 weeks after birth Totally breastfed is defined as infants who are exclusively receiving breast milk at 6-8 weeks of age - that is, they are NOT receiving formula milk, any other liquids or food. Partially breastfed is defined as infants who are currently receiving breast milk at 6-8 weeks of age and who are also receiving formula milk or any other liquids or food. Not at all breastfed is defined as infants who are not currently receiving any breast milk at 6-8 weeks of age Numerator is Line 2 + Line 3 = [Number of infants recorded as being totally breastfed at 6-8 weeks + Number of infants recorded as being partially breastfed] Denominator is Line 1 = Total number of infants due for 6-8 weeks checks Prevalence is defined as the percentage of infants being breastfed at the 6-8 week check. From 2009/10, it is calculated using the following data lines: 1. The number of infants due a 68 week check during the quarter. 2. The number of infants recorded as being totally breastfed at 6-8 week check during the quarter. 3. The number of infants recorded as being partially breastfed at 6-8 week check during the quarter. 4. The number of infants being recorded as not being breastfed at 68 week check during the quarter. Prevalence = (Line 2 + Line 3) / Line 1 x 100 (Line 2 + Line 3 + Line 4) MUST BE LESS THAN OR EQUAL TO Line 1 The following additional validation checks will also be applied to the data: The number of infants due a 68 week check in each quarter must be greater than 90 per cent of the minimum quarterly number of registered live births in the PCT over the last 5 years. The number of infants due a 68 week check in each quarter must be less than 110 per cent of the maximum quarterly number of registered live births in the PCT over the last 5 years. The number of Infants whose breastfeeding status is not known at 6-8 weeks is defined as the number of infants who did not attend their 6-8 week review plus the number of infants where the breastfeeding status was not recorded even though they attended their 6-8 week review (Line 1-(Line 2 + Line 3 + Line 4) Direction: For 2009/10 and 2010/11, plans need to be on a quarterly basis, rather than just Quarter 4 as in 08/09. Good performance is typified by an increase in the percentage coverage and prevalence year on year. For sufficient confidence to be placed on the figures, coverage should be at least 85% and ideally 95% or more. DH will be applying the following standards when using the data for its own purposes:

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Anonymous

85% coverage by 2008/09 quarter 4 90% coverage by 2009/10 quarter 4 95% coverage by 2010/11 quarter 4 Where coverage is defined as follows ((Line 2 + Line 3 + Line 4) / Line 1)) * 100 Criteria for Plan Sign-off: SHAs should ensure that there is an increase in prevalence year on year and that the coverage and validation criteria are met. Units % Prevalence Coverage England Source DH - Maternity Calculations/Formula/Methodology Percentage of infants being breastfed at 6-8 week by PCTs and SHAs in England Where the percentage of infants being breastfed at 6-8 weeks is defined as follows: (Number of infants totally breastfed + number of infants partially breastfed) / Number of infants due a 6-8 week check Numerator is Line 2 + Line 3 = [Number of infants recorded as being totally breastfed at 6-8 weeks + Number of infants recorded as being partially breastfed] Denominator is Line 1 = Total number of infants due for 6-8 weeks checks Prevalence is defined as the percentage of infants being breastfed at the 6-8 week check. From 2009/10, it is calculated using the following data lines: 1. The number of infants due a 68 week check during the quarter. 2. The number of infants recorded as being totally breastfed at 6-8 week check during the quarter. 3. The number of infants recorded as being partially breastfed at 6-8 week check during the quarter. 4. The number of infants being recorded as not being breastfed at 68 week check during the quarter. Prevalence = (Line 2 + Line 3) / Line 1 x 100 (Line 2 + Line 3 + Line 4) MUST BE LESS THAN OR EQUAL TO Line 1 The following additional validation checks will also be applied to the data:

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Anonymous

The number of infants due a 68 week check in each quarter must be greater than 90 per cent of the minimum quarterly number of registered live births in the PCT over the last 5 years. The number of infants due a 68 week check in each quarter must be less than 110 per cent of the maximum quarterly number of registered live births in the PCT over the last 5 years. The number of Infants whose breastfeeding status is not known at 6-8 weeks is defined as the number of infants who did not attend their 6-8 week review plus the number of infants where the breastfeeding status was not recorded even though they attended their 6-8 week review (Line 1-(Line 2 + Line 3 + Line 4) UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: SHAs should ensure that there is an increase in prevalence year on year and that the coverage and validation criteria are met. Prevalence = Numerator/Denominator x 100 Creator / Producer Health Improvement Analytical Team (HIAT), Department of Health (DH). Status In use Quality Baseline: The Department of Health (DH) will publish baselines in November 2008. The timetable for negotiation of plans for 2009/10 and 2010/11 mean these baselines will make use of data up to Q2 2008/09. Where a PCT has not achieved 85% data coverage at Q2, Department of Health (DH) will advise whether the baseline is best generated by scaling up the Q2 figures or using the most recent breastfeeding initiation data and the regional continuation rate from the Infant Feeding Survey. Department of Health (DH) will repeat this exercise at Q3 and make the data available in February 2009. It is recognised that these Q3 data may be too late to inform some negotiations. Use of Q3 data will therefore be at local discretion, although we would encourage its use where it offers a significant improvement in quality over Q2. Date Q3 2012-13

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Anonymous

Version History There is currently no information for this item. Update Frequency Quarterly Accessibility Available at: http://www.dh.gov.uk/en/Healthcare/Children/Maternity/Maternalandinfantnutrition/Breastfeedinginf antfeeding/DH_085657 Publisher / Owner Department of Health (DH) Other related PI's (relation) Included in National Indicator Set: NI 53 and VSB11 Additional Information Primary Care Trust (PCT) Child Health Information records, which are reported to the Department of Health (DH) at quarterly intervals via VSMR using Unify2

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Anonymous

Smoking during pregnancy

Library Reference Number/Identifier WCC 2.06 Subject World Class Commissioning (WCC) Category 2 - Health Outcomes and Targets 1 - This chapter encompasses health outcomes and national targets which are broken down into the Darzi service model, four of which are covered here Detailed Descriptor Actual percentage of women known to be smokers at the time of delivery Rationale There is currently no information for this item. Definition There is currently no information for this item. Units There is currently no information for this item. Coverage There is currently no information for this item. Source Maternity Services Review Calculations/Formula/Methodology 09/10 data published October 2010 Creator / Producer There is currently no information for this item. Status There is currently no information for this item.

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Anonymous

Quality There is currently no information for this item. Date 2009-10 Version History There is currently no information for this item. Update Frequency Annually Accessibility http://www.cqc.org.uk/guidanceforprofessionals/nhstrusts/annualassessments/periodicreview2009/ 10/existingcommitmentsandnationalpriorities2009/10.cfm Publisher / Owner Care Quality Commission Other related PI's (relation) WCC 2.06 Additional Information Can be found on HCC indicator spreadsheet new indicators dataset sheet number 4210. Maternity Services Review.

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Anonymous

In those patients with a new diagnosis of depression, recorded between the preceding 1 April to 31 March, the percentage of patients who have had an assessment of severity at the outset of treatment using an assessment tool validated for use in primary care
Library Reference Number/Identifier QOF DEP 2 Subject QOF Clinical domain : Depression Category Diagnosis and initial management Detailed Descriptor In those patients with a new diagnosis of depression, recorded between the preceding 1 April to 31 March, the percentage of patients who have had an assessment of severity at the outset of treatment using an assessment tool validated for use in primary care Rationale This indicator applies to adults aged 18 years and over with a new diagnosis of depression in the preceding 1 April to 31 March. It does not include women with postnatal depression. Assessment of severity is essential to decide on appropriate interventions and improve the quality of care. A measure of severity at the outset of treatment enables a discussion with the patient about relevant treatment interventions and options, guided by the stepped care model of depression described in NICE guidance. The guidance states, for example, that antidepressants are not recommended for the initial treatment of mild depression but should be routinely considered for all patients with moderate or severe depression. The British Association of Psychopharmacology Guidelines state that antidepressants are a first-line treatment for moderate to severe major depression irrespective of environmental factors, and that antidepressants are not indicated for milder depression unless it has persisted for two years or more (dysthymia). The three suggested severity measures validated for use in a primary care setting are the Patient Health Questionnaire (PHQ-9), the Beck Depression Inventory Second Edition (BDI-II) and the Hospital Anxiety and Depression Scale (HADS). It is advisable for a practice to choose one of these three measures and become familiar with its questions and scoring systems.

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Anonymous

Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (October 2010) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level

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Anonymous

Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DEP 2 Additional Information There is currently no information for this item.

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Anonymous

In those patients with a new diagnosis of depression, recorded between the preceding 1 April to 31 March, the percentage of patients who have had an assessment of severity at the time of diagnosis using an assessment tool validated for use in primary care
Library Reference Number/Identifier QOF DEP 4 Subject QOF Clinical domain : Depression Category Diagnosis and initial management Detailed Descriptor Replaces QOF DEP 2. In those patients with a new diagnosis of depression, recorded between the preceding 1 April to 31 March, the percentage of patients who have had an assessment of severity at the time of diagnosis using an assessment tool validated for use in primary care Rationale This indicator applies to adults aged 18 years and over with a new diagnosis of depression in the preceding 1 April to 31 March. This indicator does not include women with postnatal depression. Assessment of severity in patients with depression is essential to decide on appropriate interventions and improve the quality of care. An assessment of severity as close as possible to the time of diagnosis enables a discussion with the patient about relevant treatment and options, guided by the stepped care model of depression described in the NICE clinical guideline 90. The guideline states, for example, that antidepressants are not recommended for the initial treatment of mild depression but should be routinely considered for all patients with moderate or severe depression. The British Association of Psychopharmacology guideline on treating depressive disorders with antidepressants state that antidepressants are a first-line treatment for moderate to severe major depression irrespective of environmental factors and that antidepressants are not indicated for milder depression unless it has persisted for two years or more (dysthymia). The three suggested severity measures validated for use in a primary care setting are the nine item Patient Health Questionnaire (PHQ-9), the Beck Depression Inventory, second edition

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Anonymous

(BDIII)and the Hospital Anxiety and Depression Scale (HADS). It is advisable for a practice to choose one of these measures and become familiar with its questions and scoring systems. Patient Health Questionnaire The PHQ-9 is a nine-question self-report measure of severity that takes approximately three minutes to complete. It uses the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for depression and scores are categorised as minimal (14), mild (59), moderate (1014), moderately severe (1519) and severe depression (2027). It was developed and validated in the United States and can be downloaded free of charge: http://www.depression-primarycare.org/clinicians/toolkits/materials/forms/phq9/ Hospital Anxiety and Depression Scale Despite its name, the HADS has been validated for use in community and primary care settings. It is self-administered and takes up to five minutes to complete. It comprises seven questions rated from a score of zero to three depending on the severity of the problem described in each question. The two subscales can also be aggregated to provide an overall anxiety and depression score. The anxiety and depression scores are categorised as normal (07), mild (8 10), moderate (1114) and severe (1521). The HADS allows the severity of both anxiety and depression to be established simultaneously. Separate scores are given for anxiety and depression, which are independent measures. The HADS can be ordered from: http://shop.glassessment. co.uk/home.php?cat=417&gclid=CPPr3fjJhpkCFQ6wQwodI2Krlw The HADS depression subscale (HAD-D) has 90 per cent sensitivity and 86 per cent specificity for depression compared to the gold standard of a structured diagnostic interview104 105. Beck Depression Inventory, second edition The BDI-II is a 21 item self-report instrument that uses DSM-IV criteria. It takes approximately five minutes to complete. A total score of 0 13 is considered minimal range, 14 19 is mild, 20 28 is moderate and 29 63 is severe. The instruments and manuals can be ordered online from: www.pearsonuk.com/product.aspx?n=1316&s=1322&cat=1426&skey=2646&gclid=CIuxq5CioZMCFQ6KMAodj 16TrQ Not all severity assessment measures map directly onto NICE guidance, which uses ICD-10 symptoms in defining mild, moderate, severe and severe depression with psychotic symptoms. However, the underlying principle of all three suggested measures is that a higher score indicates greater severity requiring different types of intervention.

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Anonymous

Recent research has shown that the use of severity measures is valued by patients and that doctors intervention and referral rates are related to the scores on the measures. Qualitative interviews with patients who had been assessed with the measures revealed that they saw them as evidence that GPs were carrying out a full assessment which helped them to receive intervention in line with the severity of their depression. The measures also helped some patients to understand how their different symptoms made sense when considered together as the syndrome of depression. Prior to the introduction of the questionnaire measures into the QOF, an audit was carried out of the use of the HAD-D by volunteer GPs in Southampton. The likelihood of being prescribed an antidepressant increased significantly with severity on the HAD-D measure and was associated with improved targeting of antidepressant treatment when compared to a study carried out in the same area prior to the introduction of the HAD-D measure107. A more recent analysis of the use of the two most commonly used measures (the PHQ-9 and HAD-D) in 38 practices in three centres also found that rates of intervention and referral increased in line with higher scores. However, it was found that overall rates of intervention and referral were very similar for patients assessed with either measure, despite the fact that the PHQ-9 classified significantly more patients as moderately to severely depressed and in need of intervention, compared to the HAD-D. These results suggest practitioners do not decide on drug treatment or referral on the basis of the severity questionnaire scores alone108. They also suggest that the two most commonly used measures are inconsistent, the PHQ-9 rating more people above the recommended threshold for intervention than the HAD-D. This is consistent with other new evidence suggesting the thresholds for intervention for these instruments should be revised. Revised thresholds for intervention A study in which the PHQ-9 and HAD-D were administered together to a single sample of patients also found that a greater proportion of the sample was classified as depressed according to the PHQ-9 compared with the HAD-D109. Validation studies against more extensive gold standard diagnostic assessments have suggested that the validity of the measures in terms of identifying major depressive disorder could be improved by using a more conservative cut-off score of 12 rather than ten on the PHQ-9 and a less conservative cut-off of ten rather than 11 on the HAD-D 110, 111. Changing the recommended threshold scores for intervention would therefore make these measures more valid against longer assessments, more consistent with each other, and more consistent with practitioners clinical judgment. The revised recommended thresholds for considering intervention are therefore: - PHQ-9 score: 12 - HAD-D score: 10 - BDI-II score: 20

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Anonymous

However, it is important to stress that symptom scores alone should not be used to determine the presence of depression which needs treatment. It is also important for clinicians to consider family and previous history as well as the degree of associated disability and patient preference in making an assessment of the need for treatment, rather than relying completely on a single symptom count at one point in time. Decisions about treatment and referral should take into account the: - severity of symptoms (assessed clinically as well as with a measure) - functional impairment (significant effects on work and daily activities) - duration (watchful waiting for around eight weeks for mild symptoms) - course (trajectory of scores, past history). In addition, the PHQ-9 and the BDI-II have not been validated in terms of their cultural sensitivity and it is important to bear this in mind if using them with black and minority ethnic populations. Definition The practice reports the percentage of patients with a new diagnosis of depression whose notes record that they have had an assessment of severity at the time of diagnosis, defined as within 28 days of the initial diagnosis. New diagnoses are those which have been made between the preceding 1 April to 31 March. The practice should also report in each patient record which of the three assessment tools they used. Verification may require randomly selecting a number of case records of patients with a new diagnosis of depression to verify that their notes record an assessment of severity. Timeframe The original DEP2 indicator was introduced to QOF in April 2006. From April 2009 the associated business rules were revised to deal with a cross-year indicator where workload spans more than one QOF year, to: - ensure fair and consistent payments to all practices - ensure that patients who were diagnosed in the last three months of the QOF year are identified The QOF is set up to support annual activity that is completed in one QOF calendar year, which runs from 1 April to 31 March. Prior to the business rule change in April 2009, any patient newly diagnosed with depression between January and February would have been removed from the denominator, due to the new diagnosis exception criteria. Furthermore, because the indicator specifically relates to a new diagnosis, the same patient would not be picked up in the following QOF year.

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Anonymous

The depression indicator business rules were therefore revised, from 1 April 2009, to cover 15 months so as to address this issue. DEP2 was reviewed and updated through the NICE process and replaced by DEP4 in April 2011. The above explanation for the timeframe and the business rules still applies. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility

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Anonymous

NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Replaces QOF DEP 2 Additional Information There is currently no information for this item.

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Anonymous

The number of people who are moving to recovery as a proportion of those who have completed a course of psychological treatment
Library Reference Number/Identifier MH12 Subject Improving Access to Psychological Therapies - Recovery Category Extending Access to NICE-compliant Services Detailed Descriptor The number of people who are moving to recovery as a proportion of those who have completed a course of psychological treatment Rationale IAPT services conduct routine clinical outcome monitoring to monitor the effectiveness of psychological therapies NICE guidance indicates the delivery of evidence based psychological therapies or depression and anxiety disorders should support recovery for at least 50% of patients completing treatment Definition This indicator has a numerator and denominator which gives a measure of the proportion of patients moving to recovery. Units % Coverage England Source Improving Access to Psychological Therapies Calculations/Formula/Methodology IAPT Key Performance Indicator Technican Guidance http://www.iapt.nhs.uk/silo/files/iapt-keyperformance-indicator-kpi-guidance-201112v21.pdf

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Anonymous

Creator / Producer Department of Health (DH), IAPT section Status In use Quality Data is validated via SHA Performance Management Date Q2 2012-13 Version History There is currently no information for this item. Update Frequency Quarterly Accessibility Data is provided by PCT - this is the lowest level available Publisher / Owner Department of Health (DH), IAPT section Other related PI's (relation) Related to Vital Signs Indicator Tier 3 Improve Access to Psychological Therapies , PSA 18 Indicator 5 : Improve Access to Psychological Therapies Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients (aged from 25 to 64 in England and Northern Ireland, from 20 to 60 in Scotland and from 20 to 64 in Wales) with schizophrenia, bipolar affective disorder and other psychoses whose notes record that a cervical screening test has been performed in the preceding 5 years
Library Reference Number/Identifier QOF MH 16 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor Along with QOF MH 11, QOF MH 12, QOF MH 13, QOF MH 14 and QOF MH 15, replaces QOF MH 9. The percentage of patients (aged from 25 to 64 in England and Northern Ireland, from 20 to 60 in Scotland and from 20 to 64 in Wales) with schizophrenia, bipolar affective disorder and other psychoses whose notes record that a cervical screening test has been performed in the preceding 5 years Rationale A recent report by the Disability Rights Commission based on the primary care records of 1.7 million primary care patients found that women with schizophrenia were less likely to have had a cervical sample taken in the previous five years (63 per cent) compared with the general population (73 per cent). This did not apply to patients with bipolar affective disorder. This finding may reflect an underlying attitude that such screening is less appropriate for women with schizophrenia. This indicator therefore encourages practices to ensure that women with schizophrenia, bipolar affective disorder or other psychoses are given cervical screening according to devolved national guidelines. Definition The practice reports the percentage of women (aged from 25 to 64 in England and Northern Ireland, from 20 to 60 in Scotland and from 20 to 64 in Wales) with schizophrenia, bipolar affective disorder and other psychoses whose notes record that a cervical screening test has been performed in the preceding five years.

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Anonymous

Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care

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Anonymous

Other related PI's (relation) Along with QOF MH 11, QOF MH 12, QOF MH 13, QOF MH 14 and QOF MH 15, replaces QOF MH 9. Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients aged 40 years and over with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood glucose level in the preceding 15 months
Library Reference Number/Identifier QOF MH 15 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor Along with QOF MH 11, QOF MH 12, QOF MH 13, QOF MH 14 and QOF MH 16, replaces QOF MH 9 The percentage of patients aged 40 years and over with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood glucose level in the preceding 15 months Rationale A cross-sectional study of 4310 patients diagnosed with bipolar disorder in 2001 receiving care at veterans administration facilities found a prevalence of diabetes of 17 per cent. The relative risk of developing diabetes mellitus is two to three times higher in people with schizophrenia than in the general population. The NICE QOF Advisory Committee noted that there was lack of evidence to support the use of blood glucose testing in all people with schizophrenia, bipolar affective disorder and other psychoses and therefore recommended that an age limit of 40 years or above should be applied to this indicator. This indicator is intended to encourage case finding of diabetes in those with a serious mental illness through the use of random or fasting blood glucose measurements. Patients in whom diabetes has already been diagnosed will be excluded from the denominator of this indicator. They should be managed according to the diabetes indicator set. Definition The practice reports the percentage of patients on its mental health register for schizophrenia, bipolar affective disorder and other psychoses, aged 40 years and over who have had a test for

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Anonymous

blood glucose levels in the preceding 15 months. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care

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Anonymous

Other related PI's (relation) Along with QOF MH 11, QOF MH 12, QOF MH 13, QOF MH 14 and QOF MH 16, replaces QOF MH 9. Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients aged 40 years and over with schizophrenia, bipolar affective disorder and other psychoses who have a record of total cholesterol:hdl ratio in the preceding 15 months
Library Reference Number/Identifier QOF MH 14 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor Along with QOF MH 11, QOF MH 12, QOF MH 13, QOF MH 15 and QOF MH 16, replaces QOF MH 9. The percentage of patients aged 40 years and over with schizophrenia, bipolar affective disorder and other psychoses who have a record of total cholesterol:hdl ratio in the preceding 15 months Rationale A cross-sectional study of 4310 patients diagnosed with bipolar disorder in 2001 receiving care at veterans administration facilities found a prevalence of hyperlipidaemia of 23 per cent. People with schizophrenia also have a much higher risk of raised total cholesterol:hdl ratio than the general population. Definition The practice reports the percentage of patients aged 40 years and over on its mental health register for schizophrenia, bipolar affective disorder and other psychoses that have had their total cholesterol:hdl ratio measured in the preceding 15 months. Units Numerical Coverage England Source

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Anonymous

Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Along with QOF MH 11, QOF MH 12, QOF MH 14, QOF MH 15 and QOF MH 16, replaces QOF MH 9. Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients diagnosed with dementia whose care has been reviewed in the previous 15 months
Library Reference Number/Identifier QOF DEM 2 Subject QOF Clinical domain : Dementia Category Ongoing management Detailed Descriptor The percentage of patients diagnosed with dementia whose care has been reviewed in the previous 15 months Rationale The face to face review should focus on support needs of the patient and their carer. In particular the review should address four key issues: i. An appropriate physical and mental health review for the patient. ii. If applicable, the carers needs for information commensurate with the stage of the illness and his or her and the patients health and social care needs. iii. If applicable, the impact of caring on the care-giver. iv. Communication and co-ordination arrangements with secondary care (if applicable). A series of well-designed cohort and case control studies have demonstrated that people with Alzheimer-type dementia do not complain of common physical symptoms, but experience them to the same degree as the general population. Patient assessments should therefore include the assessment of any behavioural changes caused by: concurrent physical conditions (e.g. joint pain or intercurrent infections) new appearance of features intrinsic to the disorder (e.g. wandering) and delusions or hallucinations due to the dementia or as a result of caring behaviour (e.g. being dressed by a carer). Depression should also be considered since it is more common in people with dementia than those without. Definition

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Anonymous

The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level

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Anonymous

Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DEM 2 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range within the preceding 4 months
Library Reference Number/Identifier QOF MH 18 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor Replaces QOF MH 5. The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range within the preceding 4 months Rationale Lithium monitoring is essential due to the narrow therapeutic range of serum lithium and the potential toxicity from intercurrent illness, declining renal function or co-prescription of drugs, for example thiazide diuretics or non-steroidal anti-inflammatory drugs (NSAIDS), which may reduce lithium excretion. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Replaces QOF MH 5 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range within the previous 6 months
Library Reference Number/Identifier QOF MH 5 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor ****DROPPED - REPLACED BY QOF MH 18. The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range within the previous 6 months Rationale Lithium monitoring is essential due to the narrow therapeutic range of serum lithium and the potential toxicity from intercurrent illness, declining renal function or co-prescription of drugs e.g. thiazide diuretics or NSAIDs which may reduce lithium excretion. However, there is no definitive evidence on the frequency of lithium level checks. Most practitioners would monitor lithium levels when stable every three to six months. Where a practice is prescribing, it has responsibility for checking that routine blood tests have been done (not necessarily by the practice) and for following up patients who default where responsibility has been accepted for administering treatment. The therapeutic range for patients on lithium therapy is normally 0.4 -1.0mmol/l (see the British National Formulary). If the range differs locally, the PCO will be required to allow for this. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage

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Anonymous

England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ****DROPPED - REPLACED BY QOF MH 18. Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (October in 2011) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) ****DROPPED - REPLACED BY QOF MH 18. Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 15 months
Library Reference Number/Identifier QOF MH 4 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 15 months Rationale The number of points and indicators for Lithium have been reduced in recognition of the relatively small number of people this indicator applies to and the importance of the intermediate outcome of the lithium level being within the therapeutic range. It is important to check thyroid and renal function on an annual basis since there is a much higher than normal incidence of hypercalcaemia and hypothyroidism in patients on lithium, and of abnormal renal function tests. Overt hypothyroidism has been found in between 8 per cent and 15 per cent of people on lithium. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England Source

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Anonymous

Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF MH 4 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 9 months
Library Reference Number/Identifier QOF MH 17 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor Replaces QOF MH 4. The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 9 months Rationale It is important to check thyroid and renal function regularly in patients taking lithium, since there is a much higher than normal incidence of hypothyroidism and hypercalcaemia, and of abnormal renal function tests in patients on lithium. Overt hypothyroidism has been found in between eight per cent and 15 per cent of people on lithium. The NICE clinical guideline on bipolar disorder recommends that practitioners should check thyroid function every six months together with levels of thyroid antibodies if clinically indicated (for example, by the thyroid function tests). It also recommends that renal function tests should be carried out every six months and more often if there is evidence of impaired renal function. Definition The practice reports the percentage of patients on lithium therapy with a record of TSH in the preceding nine months. Practices should report the percentage of patients on lithium therapy with a record of serum creatinine in the preceding nine months. In verifying that this information has been correctly recorded, a number of approaches could be taken: 1. inspection of the output from a computer search that has been used to provide information on this indicator 2. inspection of a sample of records of patients on lithium therapy to look at the proportion with

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Anonymous

recorded TSH and creatinine in the last nine months 3. inspection of a sample of records of patients on lithium therapy for whom a record of TSH and creatinine is claimed, to see if there is evidence of this in the medical records. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level

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Anonymous

Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Replaces QOF MH 4 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients on the diabetes register and/or the CHD register for whom case finding for depression has been undertaken on one occasion during the previous 15 months using two standard screening questions
Library Reference Number/Identifier QOF DEP 1 Subject QOF Clinical domain : Depression Category Diagnosis and initial management Detailed Descriptor The percentage of patients on the diabetes register and /or the CHD register for whom case finding for depression has been undertaken on one occasion during the previous 15 months using two standard screening questions Rationale Depression is more common in people with coronary heart disease and presence of depression is associated with poorer outcomes. Up to 33 per cent of patients develop depression after a myocardial infarction. The presence of depression in people with coronary heart disease is associated with reduced compliance with treatment, increased use of health resources, increased social isolation, and poorer outcomes. A meta-analysis of 20 trials found that depressive symptoms and clinical depression in people with CHD increased mortality for all follow up eriods even after adjustment for other risk factors. In other words, depression was an independent risk factor for mortality in people with CHD. There is Grade A evidence from two randomised controlled trials that SSRI antidepressant treatment in people with coronary heart disease is safe and effective in reducing depression, at least among those with a prior history of depression and more severe symptoms. Patients treated with an SSRI were also found to have a 42% reduction in death or recurrent MI in a sub-group analysis of outcomes in a trial of cognitive behavioural therapy (CBT), although this was a post-hoc observation, and assignment to antidepressants was not randomised. There is a 24% lifetime prevalence of co-morbid depression in individuals with diabetes mellitus a prevalence rate three times higher than the general population. A recent meta-analysis of 42

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Anonymous

studies found that depression is clinically relevant in nearly one in three patients with diabetes. People with both diabetes and depression are less physically and socially active and less likely to comply with diet and treatment than people with diabetes alone, leading to worse long term complications and higher mortality. It may also be that practitioners provide poorer care to patients with co-morbid depression and diabetes because depression impairs communication with patients. There is good evidence from five randomised controlled trials that effective treatment with either antidepressants or CBT improves the outcome of depression in patients with diabetes. While treatment has not been shown consistently to improve glycaemic control, psychological well-being has been identified as an important goal of diabetes management in its own right by the St Vincent Declaration. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date

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Anonymous

2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DEP 1 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients on the register who have a comprehensive care plan documented in the records agreed between individuals, their family and/or careers as appropriate
Library Reference Number/Identifier QOF MH 10 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor Replaces QOF MH 6. The percentage of patients on the register who have a comprehensive care plan documented in the records agreed between individuals, their family and/or careers as appropriate Rationale This indicator reflects good professional practice and supported by NICE clinical guidelines. Patients on the mental health register should have a documented primary care consultation that acknowledges, especially in the event of a relapse, a plan for care. This consultation may include the views of their relatives or carers where appropriate. Up to half of people who have a serious mental illness are seen only in a primary care setting. For these patients, it is important that the primary care team takes responsibility for discussing and documenting a care plan in their primary care record. When constructing the primary care record research supports the inclusion of the following information: 1. Patients current health status and social care needs including how needs are to be met, by whom, and the patients expectations. 2. How socially supported the individual is: e.g. friendships/family contacts/voluntary sector organisation involvement. 3. People with mental health problems have fewer social networks than average, with many of their contacts related to health services rather than sports, family, faith, employment, education or arts and culture. One survey found that 40 per cent of people with ongoing mental health problems

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Anonymous

had no social contacts outside mental health services. 4. Coordination arrangements with secondary care and/or mental health services and a summary of what services are actually being received. 5. Occupational status. 6. In England, only 24 per cent of people with mental health problems are currently in work, the lowest employment rate of any group of people (ONS Labour Force Survey, Autumn 2003). People with mental health problems also earn only two thirds of the national average hourly rate (ONS, 2002). Studies show a clear interest in work and employment activities amongst users of mental health services with up to 90 per cent wishing to go into or back to work. 7. Early Warning Signs. 8. Early warning signs from the patients perspective that may indicate a possible relapse. Many patients may already be aware of their early warning signs (or relapse signature) but it is important for the primary care team to also be aware of noticeable changes in thoughts, perceptions, feelings and behaviours leading up to their most recent episode of illness as well as any events the person thinks may have acted as triggers. 9. The patients preferred course of action (discussed when well) in the event of a clinical relapse, including who to contact and wishes around medication. A care plan should be accurate, easily understood, reviewed annually and discussed with the patient, their family and/or carers. If a patient is treated under the care programme approach (CPA), then they should have a documented care plan discussed with their community key worker available. This is acceptable for the purposes of the QOF. Where a patient has relapsed after being recorded as being in remission their care plan should be updated subsequent to the relapse. Care plans dated prior to the date of the relapse will not be acceptable for QOF purposes. Further information The Mental Health (Care and Treatment) (Scotland) Act 2003. www.opsi.gov.uk/legislation/scotland/acts2003/asp_20030013_en_1 Definition The practice reports the percentage of patients on the mental health register for schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan recorded. Verification may require randomly selecting a number of care plans to ensure that they are being maintained annually. Units

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Anonymous

Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Replaces QOF MH 6.

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Anonymous

Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients on the register who have a comprehensive care plan documented in the records agreed between individuals, their family and/or carers as appropriate
Library Reference Number/Identifier QOF MH 6 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor The percentage of patients on the register who have a comprehensive care plan documented in the records agreed between individuals, their family and/or carers as appropriate Rationale This indicator reflects good professional practice and supported by national Clinical Guidelines: Patients on the mental health register should have a documented primary care consultation that acknowledges, especially in the event of a relapse, a plan for care. This consultation may include the views of their relatives or carers where appropriate. Up to one half of people who have a serious mental illness are seen only in a primary care setting. For these patients, it is important that the primary care team takes responsibility for discussing and documenting a care plan in their primary care record. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England

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Anonymous

Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF MH 6 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who do not attend the practice for their annual review who are identified and followed up by the practice team within 14 days of nonattendance
Library Reference Number/Identifier QOF MH 7 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who do not attend the practice for their annual review who are identified and followed up by the practice team within 14 days of non-attendance Rationale Poor compliance with medication is well recognised, and it is estimated that around 50 per cent of people with schizophrenia do not always take their medication regularly. This may lead to relapse, hospitalisation and poorer outcome. There is also evidence to suggest that non-attendance at appointments may be interpreted by some practices as irrationality, as part of having a serious mental illness, rather than recognising that not turning up for an appointment may be a sign of relapse. This indicator requires proactive intervention from the practice to contact the patient and enquire about their health status. This may be through telephone contact, letter (only if there is no phone number recorded) or visit where appropriate. If the person is in contact with secondary care, it will be appropriate to contact their key worker to discuss any concerns. Evidence will be required as to how this contact has been made. Definition ***DROPPED The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available.

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Anonymous

Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (October in 2010) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care

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Anonymous

Other related PI's (relation) QOF MH 7 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of alcohol consumption in the preceding 15 months
Library Reference Number/Identifier QOF MH 11 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor Along with QOF MH 12, QOF MH 13, QOF MH 14, QOF MH 15 and QOF MH 16, replaces QOF MH 9. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of alcohol consumption in the preceding 15 months Rationale Substance misuse by people with schizophrenia is increasingly recognised as a major problem, both in terms of its prevalence and its clinical and social effects. The National Psychiatric Morbidity Survey in England found that 16 per cent of people with schizophrenia were drinking over the recommended limits of 21 units of alcohol for men and 14 units or alcohol for women a week. Bipolar affective disorder is also highly comorbid with alcohol and other substance abuse. Definition The practice reports the percentage of patients on its mental health register for schizophrenia, bipolar affective disorder and other psychoses that have a record of alcohol consumption in the preceding 15 months Units Numerical Coverage England

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Anonymous

Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Along with QOF MH 12, QOF MH 13, QOF MH 14, QOF MH 15 and QOF MH 16, replaces QOF MH 9. Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood pressure in the preceding 15 months
Library Reference Number/Identifier QOF MH 13 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor Along with QOF MH 11, QOF MH 12, QOF MH 14, QOF MH 15 and QOF MH 16, replaces QOF MH 9. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood pressure in the preceding 15 months Rationale People with schizophrenia have a mortality of between two and three times that of the general population and most of the excess deaths are from diseases that are the major causes of death in the general population. A recent prospective record linkage study of the mortality of a community cohort of 370 people with schizophrenia found that the increased mortality risk is probably lifelong, and it suggested that the cardiovascular mortality of schizophrenia has increased over the past 25 years relative to the general population66. The NICE clinical guideline on bipolar disorder also states that the standardised mortality ratio for cardiovascular death may be twice that of the general population but appears to be reduced if patients adhere to long term medication. Hypertension in people with schizophrenia is estimated at 19 per cent compared with 15 per cent in the general population. A cross-sectional study of 4310 patients diagnosed with bipolar disorder in 2001 receiving care at veterans administration facilities found a prevalence of hypertension of 35 per cent. There is evidence to suggest that physical conditions such as cardiovascular disorders go unrecognised in psychiatric patients. A direct comparison of cardiovascular screening (blood pressure, lipid levels and smoking status) of people with asthma, people with schizophrenia and other attendees indicated that practices were less likely to screen people with schizophrenia for

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Anonymous

cardiovascular risk compared with the other two groups. Recording (and treating) cardiovascular risk factors are therefore very important for people with a serious mental illness. Definition The practice reports the percentage of patients on its mental health register for schizophrenia, bipolar affective disorder and other psychoses that have had their blood pressure measured in the preceding 15 months. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency

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Anonymous

Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Along with QOF MH 11, QOF MH 12, QOF MH 14, QOF MH 15 and QOF MH 16, replaces QOF MH 9. Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of BMI in the preceding 15 months
Library Reference Number/Identifier QOF MH 12 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor Along with QOF MH 11, QOF MH 13, QOF MH 14, QOF MH 15 and QOF MH 16, replaces QOF MH 9. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of BMI in the preceding 15 months Rationale The general population in developed countries is experiencing an escalation in cardiovascular risk factors, such as obesity and lack of exercise, and increased rates of type 2 diabetes mellitus. Superimposed on this are lifestyle issues (not all actively chosen) for people with psychosis, generating an escalation of cardiovascular risks. In particular, people with psychosis may lead more sedentary lives, eat less fruit and vegetables, be much more likely to be obese, are two to three times more likely to smoke cigarettes, and five times more likely to smoke heavily. In addition to lifestyle factors, antipsychotic drugs vary in their liability for metabolic side effects, such as weight gain, lipid abnormalities and disturbance of glucose regulation. Specifically, they increase the risk of the metabolic syndrome, a recognised cluster of features (hypertension, central obesity, glucose intolerance or insulin resistance, and dyslipidaemia), which is a predictor of Type 2 diabetes and CHD. Approximately 40 per cent of people with schizophrenia are obese and obesity is also common in people with bipolar disorders. NICE clinical guideline 43 (2006). Obesity. The prevention, identification, assessment and management of overweight and obesity in adults and children. http://guidance.nice.org.uk/CG43

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Anonymous

SIGN guideline 115 (2010). Management of obesity. http://www.sign.ac.uk/guidelines/fulltext/115/index.html Definition The practice reports the percentage of patients on its mental health register for schizophrenia, bipolar affective disorder and other psychoses that have had their BMI calculated in the preceding 15 months. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end

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Anonymous

Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Along with QOF MH 11, QOF MH 13, QOF MH 14, QOF MH 15 and QOF MH 16, replaces QOF MH 9. Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses with a review recorded in the preceding 15 months. In the review there should be evidence that the patient has been offered routine health promotion and prevention advice appropriate to their age, gender and health status
Library Reference Number/Identifier QOF MH 9 Subject QOF Clinical domain : Mental health Category Ongoing management Detailed Descriptor The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses with a review recorded in the preceding 15 months. In the review there should be evidence that the patient has been offered routine health promotion and prevention advice appropriate to their age, gender and health status Rationale Patients with serious mental health problems are at considerably increased risk of physical illhealth than the general population. It is therefore good practice for a member of the practice team to review each patients physical health on an annual basis. Health promotion and health prevention advice is particularly important for people with serious mental illness however there is good evidence that they are much less likely than other members of the general population to be offered, for example, blood pressure checks and cholesterol checks if they have concurrent coronary heart disease, and cervical screening. People with serious mental illness are also far more likely to smoke than the general population (61% of people with schizophrenia and 46% of people with bipolar disorder smoke compared to 33% of the general population). Premature death and smoking-related diseases, such as respiratory disorders and heart disease, are, however, more common among people with serious mental illness who smoke, than in the general population of smokers.

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Anonymous

People with schizophrenia appear to be at increased risk of impaired glucose tolerance and diabetes, and this is independent of treatment with the newer atypical antipsychotic drugs. The NICE clinical guideline on schizophrenia (2002) recommended physical health checks for diabetes, blood pressure, lipids, and smoking (Good Practice Point). The NICE clinical guideline on bipolar disorder (2006) has recommended that people with bipolar disorder should have an annual physical health review, normally in primary care, to ensure that the following are assessed each year: lipid levels, including cholesterol in all patients over 40 even if there is no other indication of risk, plasma glucose levels, weight, smoking status, alcohol use, and blood pressure. See also the Disability Rights Commission Equal Treatment: Closing the Gap One year on. Definition ***DROPPED - REPLACED BY QOF MH 11, QOF MH 12, QOF MH 13, QOF MH 14, QOF MH 15, QOF MH 16. The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED - REPLACED BY QOF MH 11, QOF MH 12, QOF MH 13, QOF MH 14, QOF MH 15, QOF MH 16.

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Anonymous

Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (October in 2011) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) REPLACED IN 2011-12 BY QOF MH 11, QOF MH 12, QOF MH 13, QOF MH 14, QOF MH 15, QOF MH 16. Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients diagnosed with dementia

Library Reference Number/Identifier QOF DEM 1 Subject QOF Clinical domain : Dementia Category Records Detailed Descriptor The practice can produce a register of patients diagnosed with dementia Rationale A register is a pre-requisite for the organisation of good primary care for a particular patient group. There is little evidence to support screening for dementia and it is expected that the diagnosis will largely be recorded from correspondence when patients are referred to secondary care with suspected dementia or as an additional diagnosis when a patient is seen in secondary care. However it is also important to include patients where it is inappropriate or not possible to refer to a secondary care provider for a diagnosis and where the GP has made a diagnosis based on their clinical judgement and knowledge of the patient. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DEM 1 Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of people with schizophrenia, bipolar disorder and other psychoses
Library Reference Number/Identifier QOF MH 8 Subject QOF Clinical domain : Mental health Category Records Detailed Descriptor The practice can produce a register of people with schizophrenia, bipolar disorder and other psychoses Rationale The register now includes all people with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses rather than a generic phrase that is open to variations in interpretation. This brings mental health in line with other areas of the QOF. The notion of agreeing to regular follow up has also been removed to acknowledge the variation in interpretation of this clause and to bring the indicator in line with the rest of the QOF. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology

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Anonymous

http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF MH 8 Additional Information There is currently no information for this item.

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Anonymous

Approach rate - The percentage of potential donors for whom solid organ donation was considered, whose family were approached for consent to donation
Library Reference Number/Identifier LT25 Subject Organ Donation Category Potential for donation Detailed Descriptor The percentage of potential donors for whom solid organ donation was considered, whose family were approached for consent to donation (Donation after Brain Death (DBD) (formerly Heartbeating); Donation after Circulatory Death (DCD) (formerly Non-Heartbeating) Rationale To identify opportunities to increase the number of organs available for transplantation from deceased donors Definition Numerator - number of families approached/made approach for consent to donation. Denominator - number of potential donors for whom solid organ donation was considered. Potential DBD donor is patient confirmed brain stem dead with no absolute medical contraindications (known HIV or known /suspected CJD). Potential DCD donor is patient where DCD donation is possible, no absolute contraindications and active treatment of the patient was withdrawn. Units % Coverage UK - patients in intensive care units (ICUs) excluding cardiothoracic ICU. Patients aged 75 or under Source

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Anonymous

Potential Donor Audit Calculations/Formula/Methodology Ratio of numerator to denominator http://www.bmj.com/cgi/content/full/332/7550/1124?maxtoshow=&HITS=10&hits=10&RESULTFO RMAT=&author1=Barber+K&fulltext=donation&andorexactfulltext=and&searchid=1&FIRSTINDEX =0&sortspec=relevance&resourcetype=HWCIT Creator / Producer NHS Blood and Transplant (NHSBT) Status In use Quality There is currently no information for this item. Date 2011-12 Version History None Update Frequency Next update due June 2013 when data covering financial year 2012/13 will be available. This data will then be subsequently updated on an annual basis. Accessibility Available to clinical donation champions for Trusts. National information available annually on http://www.organdonation.nhs.uk/ukt/statistics/potential_donor_audit/potential_donor_audit.jsp Publisher / Owner NHS Blood and Transplant (NHSBT) Other related PI's (relation) There is currently no information for this item. Additional Information

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Anonymous

There is currently no information for this item.

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Anonymous

Consent rate - The percentage of potential donors whose families were approached or made the approach for consent to donation who gave consent
Library Reference Number/Identifier LT26 Subject Organ Donation Category Potential for donation Detailed Descriptor The percentage of potential donors whose families were approached or made the approach for consent to donation who gave consent (Donation after Brain Death (DBD) (formerly Heartbeating); Donation after Circulatory Death (DCD) (formerly Non-Heartbeating) ) Rationale To identify opportunities to increase the number of organs available for transplantation from deceased donors Definition Numerator - number of families gave consent to donation. Denominator - number of potential donors for whom solid organ donation was considered and whose family was approached/made approach. Potential DBD donor is patient confirmed brain stem dead with no absolute medical contraindications (known HIV or known /suspected CJD). Potential DCD donor is patient where DCD donation is possible, no absolute contraindications and active treatment of the patient was withdrawn. Units % Coverage UK - patients in intensive care units (ICUs) excluding cardiothoracic ICU. Patients aged 75 or under Source Potential Donor Audit

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Anonymous

Calculations/Formula/Methodology Ratio of numerator to denominator http://www.bmj.com/cgi/content/full/332/7550/1124?maxtoshow=&HITS=10&hits=10&RESULTFO RMAT=&author1=Barber+K&fulltext=donation&andorexactfulltext=and&searchid=1&FIRSTINDEX =0&sortspec=relevance&resourcetype=HWCIT Creator / Producer NHS Blood and Transplant (NHSBT) Status In use Quality There is currently no information for this item. Date 2011/12 Version History None Update Frequency Next update due June 2013 when data covering financial year 2012/13 will be available. This data will then be subsequently updated on an annual basis. Accessibility Available to clinical donation champions for Trusts. National information available annually on http://www.organdonation.nhs.uk/ukt/statistics/potential_donor_audit/potential_donor_audit.jsp Publisher / Owner NHS Blood and Transplant (NHSBT) Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Conversion rate - The percentage of potential donors who became actual donors
Library Reference Number/Identifier LT27 Subject Organ Donation Category Potential for donation Detailed Descriptor The percentage of potential donors referred to a Specialist Nurse - Organ Donation (SN-OD) Donation after Brain Death (DBD) (formerly Heartbeating); Donation after Circulatory Death (DCD) (formerly Non-Heartbeating). Rationale To identify opportunities to increase the number of organs available for transplantation from deceased donors Definition Numerator - number of actual donors (at least one organ retrieved with the intention to transplant). Denominator - number of potential donors. Potential DBD donor is patient confirmed brain stem dead with no absolute medical contraindications (known HIV or known /suspected CJD). Potential DCD donor is patient where DCD donation is possible, no absolute contraindications and active treatment of the patient was withdrawn. Units % Coverage UK - patients in intensive care units (ICUs) excluding cardiothoracic ICU. Patients aged 75 or under Source Potential Donor Audit

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Anonymous

Calculations/Formula/Methodology Ratio of numerator to denominator http://www.bmj.com/cgi/content/full/332/7550/1124?maxtoshow=&HITS=10&hits=10&RESULTFO RMAT=&author1=Barber+K&fulltext=donation&andorexactfulltext=and&searchid=1&FIRSTINDEX =0&sortspec=relevance&resourcetype=HWCIT Creator / Producer NHS Blood and Transplant (NHSBT) Status In use Quality There is currently no information for this item. Date 2011-12 Version History None Update Frequency Next update due 2013 when data covering financial year 2012/13 will be available. This data will then be subsequently updated on an annual basis. Accessibility Available to clinical donation champions for Trusts. National information available annually on http://www.organdonation.nhs.uk/ukt/statistics/potential_donor_audit/potential_donor_audit.jsp Publisher / Owner NHS Blood and Transplant (NHSBT) Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Referral rate - The percentage of potential donors referred to a Specialist Nurse - Organ Donation (SN-OD)
Library Reference Number/Identifier LT24 Subject Organ Donation Category Potential for donation Detailed Descriptor The percentage of potential donors referred to a SN-OD - Donation after Brain Death (DBD) (formerly Heartbeating); Donation after Circulatory Death (DCD) (formerly Non-Heartbeating). Rationale To identify opportunities to increase the number of organs available for transplantation from deceased donors Definition Numerator - number of potential donors referred to a Specialist Nurse Denominator - number of potential donors. Potential DBD donor is patient confirmed brain stem dead with no absolute medical contraindications (known HIV or known /suspected CJD). Potential DCD donor is patient where DCD donation is possible, no absolute contraindications and active treatment of the patient was withdrawn. Units % Coverage UK - patients in intensive care units (ICUs) excluding cardiothoracic ICU. Patients aged 75 or under Source Potential Donor Audit Calculations/Formula/Methodology

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Anonymous

Ratio of numerator to denominator http://www.bmj.com/cgi/content/full/332/7550/1124?maxtoshow=&HITS=10&hits=10&RESULTFO RMAT=&author1=Barber+K&fulltext=donation&andorexactfulltext=and&searchid=1&FIRSTINDEX =0&sortspec=relevance&resourcetype=HWCIT Creator / Producer NHS Blood and Transplant (NHSBT) Status In use Quality There is currently no information for this item. Date 2011-12 Version History None Update Frequency Next update due June 2013 when data covering financial year 2012/13 will be available. This data will then be subsequently updated on an annual basis. Accessibility Available to clinical donation champions for Trusts. National information available annually on http://www.organdonation.nhs.uk/ukt/statistics/potential_donor_audit/potential_donor_audit.jsp Publisher / Owner NHS Blood and Transplant (NHSBT) Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Compliance with 3C-100 to 3C-500 measures (chemotherapy services)

Library Reference Number/Identifier CA51 Subject CQUINS Category There is currently no information for this item. Detailed Descriptor Percentage compliance taken from CQUINS (Cancer Quality Information Network System), presently for the first round of Peer Review (March 2004 - March 2007). Reviewed against the Manual for Cancer Services 2004, Section 3C-100 to 3C-500, Chemotherapy Services. Rationale The Cancer Reform Strategy (2007) sets out key priorities for improving treatment to patients. This metric gives an indication of the performance of Chemotherapy services, against measures contained within the Manual for Cancer Services 2004. It considers governance arrangements for the chemotherapy service, the local chemotherapy group, guidelines and protocols, patient centred care, safe delivery of chemotherapy, safe workload arrangements, 24-hour telephone advice, staff training and service improvement. Definition Percentages are obtained from compliance against the relevant Measures in the Manual for Cancer Services 2004. Units % compliance Coverage England Source Cancer Quality Improvement Network System (CQUINS) Calculations/Formula/Methodology The percentage of measures met by teams reviewed against the Manual for Cancer Services 2004 http://www.v3.cquins.nhs.uk/manual.php during the National Cancer Peer Review process

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Anonymous

http://www.cquins.nhs.uk Creator / Producer National Cancer Peer Review (NCPR) Status In use Quality Approved Date 2004-8 (pooled) Version History v.01 Update Frequency This has been calculated for 2004-2007 Peer Review, and will be calculated on a yearly basis for new Peer Review Programme Accessibility Original data on http://www.cquins.nhs.uk; will also be available from NHS Information Centre for Health and Social Care beyond summer 2009 Users will need to register and follow host organisations access procedures. Publisher / Owner National Cancer Action Team Other related PI's (relation) There is currently no information for this item. Additional Information Please note that the data reflects reviews of Cancer Services undertaken from 2004 to 2008, and as such is not a snapshot of current service provision. Data will now be updated on an annual basis, although the data will be at different levels of verification (Peer Reviewed, Internally validated, Externally Verified)

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Anonymous

Imaging services: percentage compliance with 3B measures

Library Reference Number/Identifier CA28 Subject CQUINS Category There is currently no information for this item. Detailed Descriptor Percentage compliance taken from CQUINS (Cancer Quality Information Network System), presently for the first round of Peer Review (March 2004 - March 2007). Reviewed against the Manual for Cancer Services 2004, Section 3B, Imaging Rationale An effective Imaging Service is one of the underpinning factors in delivering timely diagnosis and monitoring treatment as highlighted in the Cancer Reform Strategy (2007). The metric considers performance of Imaging Services against the Manual for Cancer Services 2004, considering the scope and leadership of the service, the provision of Imaging support to MDTs and policy for Rapid Notification of an Unsuspected Diagnosis of Cancer. Definition Percentages are obtained from compliance against the relevant Measures in the Manual for Cancer Services 2004. Units % compliance Coverage England Source Cancer Quality Improvement Network System (CQUINS) Calculations/Formula/Methodology The percentage of measures met by teams reviewed against the Manual for Cancer Services 2004 http://www.v3.cquins.nhs.uk/manual.php during the National Cancer Peer Review process http://www.cquins.nhs.uk

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Anonymous

Creator / Producer National Cancer Peer Review (NCPR) Status DROPPED - These measures are no longer active Quality Approved Date 2004-8 (pooled) Version History v.01 Update Frequency This has been calculated for 2004-2007 Peer Review, and will be calculated on a yearly basis for new Peer Review Programme Accessibility Original data on http://www.cquins.nhs.uk; will also be available from NHS Information Centre for Health and Social Care beyond summer 2009 Users will need to register and follow host organisations access procedures. Publisher / Owner National Cancer Action Team Other related PI's (relation) There is currently no information for this item. Additional Information Please note that the data reflects reviews of Cancer Services undertaken from 2004 to 2008, and as such is not a snapshot of current service provision. Data will now be updated on an annual basis, although the data will be at different levels of verification (Peer Reviewed, Internally validated, Externally Verified)

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Anonymous

Pathology services: percentage compliance with 3D measures

Library Reference Number/Identifier CA27 Subject CQUINS Category There is currently no information for this item. Detailed Descriptor Percentage compliance taken from CQUINS (Cancer Quality Information Network System), presently for the first round of Peer Review (March 2004 - March 2007). Reviewed against the Manual for Cancer Services 2004, Section 3D, Pathology Rationale An effective Pathology Service is one of the underpinning factors in delivering timely diagnosis and monitoring treatment as highlighted in the Cancer Reform Strategy (2007). The metric considers performance of Pathology Services against the Manual for Cancer Services 2004, considering accreditation of Services, referral of specimens, minimum data set requirements, the provision of Pathology support to MDTs and arrangements for referring specimens outside the service. It also measures the response of the service to guidelines with regard testing for Prostate Specific Antigen (PSA). Definition Percentages are obtained from compliance against the relevant Measures in the Manual for Cancer Services 2004. Units % compliance Coverage England Source Cancer Quality Improvement Network System (CQUINS) Calculations/Formula/Methodology

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Anonymous

The percentage of measures met by teams reviewed against the Manual for Cancer Services 2004 http://www.v3.cquins.nhs.uk/manual.php during the National Cancer Peer Review process http://www.cquins.nhs.uk Creator / Producer National Cancer Peer Review (NCPR) Status DROPPED - These measures are no longer active Quality Approved Date 2004-8 (pooled) Version History v.01 Update Frequency This has been calculated for 2004-2007 Peer Review, and will be calculated on a yearly basis for new Peer Review Programme Accessibility Original data on http://www.cquins.nhs.uk; will also be available from NHS Information Centre for Health and Social Care beyond summer 2009 Users will need to register and follow host organisations access procedures. Publisher / Owner National Cancer Action Team Other related PI's (relation) There is currently no information for this item. Additional Information Please note that the data reflects reviews of Cancer Services undertaken from 2004 to 2008, and as such is not a snapshot of current service provision. Data will now be updated on an annual basis, although the data will be at different levels of verification (Peer Reviewed, Internally validated, Externally Verified)

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Anonymous

Percentage compliance with Peer Review by team (breast, lung, colorectal, local and specialist gynaecology, local and specialist urology (including supranetwork testicular and penile, haematology and head & neck)
Library Reference Number/Identifier CA01 Subject CQUINS Category There is currently no information for this item. Detailed Descriptor Percentage compliance taken from CQUINS (Cancer Quality Information Network System), presently for the first round of Peer Review (March 2004 - March 2007). Reviewed against the Manual for Cancer Services 2004, Sections 2B, 2C, 2D, 2E, 2F, 2G and 2I. Oesophageal, gastric and pancreatic services are contained within the 2F Measures (for Upper GI Cancer); Ovarian within the 2E Measures (for Gynaecological Cancer) and bladder within the 2G Measures (for Urological Cancer). Rationale The NHS Cancer Plan (2000) gave a commitment that all patients with cancer have the right to have their care and treatment discussed at a multidisciplinary team meeting. It is important that the MDT operates effectively. The Cancer Reform Strategy (2007) emphasises that MDT working, as specified by NICE guidance, will remain the core model for cancer service delivery in the future. This metric assesses the position of each local and speciality MDTs based on the latest peer review against measures contained within the Manual for Cancer Services 2004. Definition Percentages are obtained from compliance against the relevant Measures in the Manual for Cancer Services 2004. Units % compliance Coverage England

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Anonymous

Source Cancer Quality Improvement Network System (CQUINS) Calculations/Formula/Methodology The percentage of measures met by teams reviewed against the Manual for Cancer Services 2004 http://www.v3.cquins.nhs.uk/manual.php during the National Cancer Peer Review process http://www.cquins.nhs.uk Creator / Producer National Cancer Peer Review (NCPR) Status In use Quality Approved Date 2004-8 (pooled) Version History v.01 Update Frequency This has been calculated for 2004-2007 Peer Review, and will be calculated on a yearly basis for new Peer Review Programme Accessibility Original data on http://www.cquins.nhs.uk; will also be available from NHS Information Centre for Health and Social Care beyond summer 2009 Users will need to register and follow host organisations access procedures. Publisher / Owner National Cancer Action Team Other related PI's (relation) There is currently no information for this item.

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Anonymous

Additional Information Please note that the data reflects reviews of Cancer Services undertaken from 2004 to 2008, and as such is not a snapshot of current service provision. Data will now be updated on an annual basis, although the data will be at different levels of verification (Peer Reviewed, Internally validated, Externally Verified) *Pancreatic - Additional Measures for Specialist Pancreatic MDT which is being put forward for review also as a liver resection MDT

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Anonymous

Percentage of cases staged at presentation

Library Reference Number/Identifier CA42a Subject NCASP Cancer Category Bowel Cancer Detailed Descriptor Percentage of cases reported to the audit with modified Dukes staging recorded Rationale Proxy marker for standard of care Definition Percentage of cases reported to the audit with modified Dukes staging recorded Units Percent Coverage England Wales Scotland N. Ireland Source National Bowel Cancer Audit Calculations/Formula/Methodology Percentage of cases reported to the audit with modified Dukes staging recorded Creator / Producer There is currently no information for this item. Status The data for this indicator is no longer supplied by NCASP, so the results have been taken down from the website.

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Anonymous

Quality NCASP standard Date 2009 Annual Report Data Version History There is currently no information for this item. Update Frequency Annually Accessibility Annual Reports Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) No Additional Information There is currently no information for this item.

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Anonymous

Percentage of cases staged at presentation

Library Reference Number/Identifier CA42b Subject NCASP Cancer Category Head & Neck Cancer Detailed Descriptor Percentage of cases reported to the audit with pre-treatment T Stage and N Stage recorded Rationale For risk adjusted outcomes Definition Percentage of cases reported to the audit with pre-treatment T Stage and N Stage recorded Units Percent Coverage England Wales Source National Head and Neck Cancer Audit Calculations/Formula/Methodology Percentage of cases reported to the audit with pre-treatment T Stage and N Stage recorded Creator / Producer There is currently no information for this item. Status Live Quality

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Anonymous

NCASP standard Date 2007/08 Version History There is currently no information for this item. Update Frequency Annually Accessibility Available in the annual report and on iView Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) No Additional Information There is currently no information for this item.

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Anonymous

Percentage of cases staged at presentation

Library Reference Number/Identifier CA42c Subject NCASP Cancer Category Lung Cancer Detailed Descriptor Percentage of patients reported to the audit that have stage recorded for their lung cancer Rationale Proxy marker for standard of care Definition Percentage of patients reported to the audit that have stage recorded for their lung cancer Units Percent Coverage England Wales Source National Lung Cancer Audit Calculations/Formula/Methodology Denominator is all patients submitted to the audit for 2008. Numerator is patients submitted to the audit that have stage recorded for their lung cancer Creator / Producer There is currently no information for this item. Status Live

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Anonymous

Quality NLCA standard Date 2008 Version History There is currently no information for this item. Update Frequency Annually Accessibility NLCA report and related data Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) No Additional Information There is currently no information for this item.

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Anonymous

Proportion of incident cases reviewed by Multi-Disciplinary Team (MDT) for all cancers
Library Reference Number/Identifier CA45 Subject National Clinical Audit Support Programme (NCASP) Category Cancer Detailed Descriptor Those cases reported to the audit as having been reviewed at an MDT as a proportion of all of the total cases reported to the audit. Rationale Conformance with NICE Guideline that patients should be discussed at an MDT Definition Those cases reported to the audit as having been reviewed at an MDT as a proportion of all of the total cases reported to the audit. Units % Coverage England Source Cancer Quality Improvement Network System (CQUINS) Calculations/Formula/Methodology % of patients reported to the audit that are indicated as having been discussed at an MDT Creator / Producer National Clinical Audit Support Programme (NCASP)

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Anonymous

Status DROPPED - These measures are no longer active Quality Good Date 2004-8 (pooled) Version History There is currently no information for this item. Update Frequency Annual Accessibility Cancer Audit Annual reports - http://www.ic.nhs.uk/canceraudits Publisher / Owner National Clinical Audit Support Programme (NCASP) Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Radiotherapy: percentage compliance with 3E measures

Library Reference Number/Identifier CA29 Subject CQUINS Category There is currently no information for this item. Detailed Descriptor Percentage compliance taken from CQUINS (Cancer Quality Information Network System), presently for the first round of Peer Review (March 2004 - March 2007). Reviewed against the Manual for Cancer Services 2004, Section 3E, Radiotherapy Rationale The Cancer Reform Strategy (2007) sets out key priorities for improving treatment to patients. One of these priorities is the development of world class radiotherapy services. This metric looks at the performance of radiotherapy services against measures contained within the Manual for Cancer Services 2004 which seeks to ensure that radiotherapy services are of a high quality through clearly defined leadership and organisational arrangements; provision of adequate professional staffing and equipment; minimising delays for treatment and breaks in treatment; use of standardised processes for prescribing and checking radiotherapy treatments; use of standard principles for the delivery of radiotherapy; clear documentation and quality assurance processes. Definition Percentages are obtained from compliance against the relevant Measures in the Manual for Cancer Services 2004. Units % compliance Coverage England Source Cancer Quality Improvement Network System (CQUINS)

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Anonymous

Calculations/Formula/Methodology The percentage of measures met by teams reviewed against the Manual for Cancer Services 2004 http://www.v3.cquins.nhs.uk/manual.php during the National Cancer Peer Review process http://www.cquins.nhs.uk Creator / Producer National Cancer Peer Review (NCPR) Status In use Quality Approved Date 2004-8 (pooled) Version History v.01 Update Frequency This has been calculated for 2004-2007 Peer Review, and will be calculated on a yearly basis for new Peer Review Programme Accessibility Original data on http://www.cquins.nhs.uk; will also be available from NHS Information Centre for Health and Social Care beyond summer 2009 Users will need to register and follow host organisations access procedures. Publisher / Owner National Cancer Action Team Other related PI's (relation) There is currently no information for this item. Additional Information Please note that the data reflects reviews of Cancer Services undertaken from 2004 to 2008, and as such is not a snapshot of current service provision. Data will now be updated on an annual basis, although the data will be at different levels of verification (Peer Reviewed, Internally

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Anonymous

validated, Externally Verified)

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Anonymous

30 day mortality after first time aortic valve replacement

Library Reference Number/Identifier CV49 Subject Central Cardiac Audit Database (Future Indicator) Category Heart Disease Detailed Descriptor 30 day mortality after first time aortic valve replacement (Also in Mortality section) Rationale Future Indicator Definition Risk adjusted mortality for Isolated Aortic Valve surgery as derived from the CCAD database Units Number of procedures and survival percentage rates. Coverage UK Source Central Cardiac Audit Database (CCAD) Calculations/Formula/Methodology http://heartsurgery.cqc.org.uk/about-aortic-valve.aspx Creator / Producer National Clinical Audit Support Programme (NCASP) Status Data available for 2000 to 2005 at National and provider level. Quality

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Anonymous

Good Date 2006-2009 Version History There is currently no information for this item. Update Frequency No Accessibility General Audit site at: http://www.ic.nhs.uk/services/national-clinical-audit-support-programmencasp/heart-disease Specific CCAD site on heart surgery available at http://heartsurgery.cqc.org.uk/about-aorticvalve.aspx Publisher / Owner National Clinical Audit Support Programme (NCASP) Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

30 day mortality after first time CABG (Future Indicator)

Library Reference Number/Identifier CV48 Subject Central Cardiac Audit Database Category Heart Disease Detailed Descriptor 30 day mortality after first time CABG (Also in Mortality section) Rationale Future Indicator Definition Risk adjusted mortality for Isolated Coronary Artery Surgery as derived from the CCAD database Units Number of procedures and survival percentage rates. Coverage UK Source Central Cardiac Audit Database (CCAD) Calculations/Formula/Methodology CCAD website for Contributing hospitals www.ccad.org.uk Creator / Producer National Clinical Audit Support Programme (NCASP) Status Data available for 2000 to 2005 at National and provider level. Quality

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Anonymous

Good Date 2006-2009 Version History There is currently no information for this item. Update Frequency No Accessibility Data can be viewed at http://heartsurgery.cqc.org.uk/ General Audit site at: http://www.ic.nhs.uk/services/national-clinical-audit-support-programmencasp/heart-disease Publisher / Owner National Clinical Audit Support Programme (NCASP) Other related PI's (relation) There is currently no information for this item. Additional Information Future Indicator

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Anonymous

30 day mortality following congenital heart disease surgery (Future Indicator)

Library Reference Number/Identifier CV52 Subject Central Cardiac Audit Database Category Heart Disease Detailed Descriptor 30 day mortality following congenital heart disease surgery (Also in Mortality section) Rationale http://www.ccad.org.uk/002/congenital.nsf/vwContent/Information%20for%20Patients?Opendocum ent Definition All causes of mortality within 30 days or 1 year providing the patient has not had further procedures (reoperation) during that period. Units Number of procedures and survival percentage rates. Coverage UK Source Central Cardiac Audit Database (CCAD) Calculations/Formula/Methodology http://www.ccad.org.uk/002/congenital.nsf/9791867eff401e0d8025716f004bb8f2/c2d858b7c2e64f d9802574810039c9a4/$FILE/SpecificProcedureCoding_20080520.xls Creator / Producer National Clinical Audit Support Programme (NCASP) Status

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Anonymous

Data available for 2000 to 2005 at National and provider level. Quality Good Date Data available for 2000 to 2005 at National and provider level. Version History There is currently no information for this item. Update Frequency Yes - Annually Accessibility General Audit site at: http://www.ic.nhs.uk/services/national-clinical-audit-support-programmencasp/heart-disease Specific CCAD site on congenital heart disease available at http://www.ccad.org.uk/002/congenital.nsf/vwContent/home?Opendocument Publisher / Owner National Clinical Audit Support Programme (NCASP) Other related PI's (relation) There is currently no information for this item. Additional Information Future Indicator

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Anonymous

In those patients with a new diagnosis of hypertension (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) recorded between the preceding 1 April to 31 March: the percentage of patients aged 30 to 74 years who have had a face to face cardiovascular risk assessment at the outset of diagnosis (within 3 months of the initial diagnosis) using an agreed risk assessment tool
Library Reference Number/Identifier QOF PP 1 Subject QOF Clinical domain : Primary Prevention Category On-going management Detailed Descriptor In those patients with a new diagnosis of hypertension (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) recorded between the preceding 1 April to 31 March: the percentage of patients aged 30 to 74 years who have had a face to face cardiovascular risk assessment at the outset of diagnosis (within 3 months of the initial diagnosis) using an agreed risk assessment tool Rationale To deliver primary prevention of CVD requires that patients at risk are identified before disease has become established and that requires screening. Current NICE Guidance (May 2008) recommends that the Framingham 1991 10 year risk equations should be used to assess CVD risk. The variables required for this estimation are: Age Sex Systolic blood pressure (mean of previous two systolic readings) Total cholesterol HDL cholesterol Smoking status Presence of left ventricular hypertrophy. Key to this assessment however, is that it should be an assessment of actual as opposed to estimated risk. The values used should have been recorded no longer than 6 months before the

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Anonymous

date of the risk assessment and prior to any treatment for hypertension. Definition In those patients with a new diagnosis of hypertension (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) recorded between the preceding 1 April to 31 March: the percentage of patients aged 30 to 74 years who have had a face to face cardiovascular risk assessment at the outset of diagnosis (within 3 months of the initial diagnosis) using an agreed risk assessment tool. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History New indicator for 2011-12 Update Frequency Annual publication based on previous financial year end

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Anonymous

Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) There is currently no information for this item. Additional Information Further information: Lipid Modification: Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. Clinical Guideline 67. NICE: London 2008.

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Anonymous

Percentage of patients following myocardial infarction discharged on ACE inhibitors

Library Reference Number/Identifier CV32 Subject Myocardial Ischaemia National Audit Project/ British Cardiovascular Intervention Society Category Heart Disease Detailed Descriptor Percentage of patients discharged on ACE inhibitors following myocardial infarction Rationale Good evidence that secondary prevention medication reduces risk of heart failure following heart attack Definition % of eligible patients (with discharge diagnosis of troponin positive ACS who survived to leave hospital that were not contra-indicated, declined treatment, not indicated or transferred to another hospital) that were discharged on an ACE inhibitor/ARB Units % of eligible patients Coverage England and Wales Source Myocardial Ischaemia National Audit Project (MINAP) Calculations/Formula/Methodology % of patients with discharge diagnosis of troponin positive ACS who survived to leave hospital where there was no contraindication to use, and where it was appropriate to record discharge therapy (ie not dying in hospital and not transferred elsewhere) that were discharged on ACE inhibitors.

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Anonymous

Creator / Producer Myocardial Ischaemia National Audit Project (MINAP) Status In use Quality Good Date 2010-11 Version History First report produced in 2002 with updates annually. Update Frequency Annual NB continuous collection Accessibility Figures available for England and Wales and national and provider level. Percentages are not shown for less than 20 cases for thrombolytic treatment and analysis is not performed on less than 10 cases for primary angioplasty. General website: http://www.rcplondon.ac.uk/CLINICALSTANDARDS/ORGANISATION/PARTNERSHIP/Pages/MINAP-.aspx Latest report: http://www.rcplondon.ac.uk/clinicalstandards/organisation/partnership/Documents/Minap-2008.pdf Please note that the linked report contains details similar to that of the indicator, however there were differences, e.g. report does not state STEMI. Publisher / Owner Myocardial Ischaemia National Audit Project (MINAP) Other related PI's (relation) There is currently no information for this item. Additional Information

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Anonymous

NB ACE inhibitor /ARB

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Anonymous

Percentage of patients following myocardial infarction discharged on aspirin

Library Reference Number/Identifier CV29 Subject Myocardial Ischaemia National Audit Project/ British Cardiovascular Intervention Society Category Heart Disease Detailed Descriptor Percentage of patients discharged on aspirin following myocardial infarction Rationale Good evidence that secondary prevention treatment with aspirin reduces risk of another heart attack. This indicator will provide evidence that the organisation is prescribing aspirin appropriately on discharge for patients with acute coronary syndromes. Definition % of eligible patients (with discharge diagnosis of troponin positive ACS who survived to leave hospital that were not contra-indicated, declined treatment, not indicated or transferred to another hospital) that were discharged on aspirin Units % of eligible patients Coverage England and Wales Source Myocardial Ischaemia National Audit Project (MINAP) Calculations/Formula/Methodology % of patients with discharge diagnosis of troponin positive ACS who survived to leave hospital where there was no contraindication to use, and where it was appropriate to record discharge therapy (ie not dying in hospital and not transferred elsewhere) that were discharged on aspirin. Creator / Producer

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Anonymous

Myocardial Ischaemia National Audit Project (MINAP) Status In use Quality Good Date 2010-11 Version History First report produced in 2002 with updates annually. Update Frequency Annual NB continuous collection Accessibility Figures available for England and Wales and national and provider level. Percentages are not shown for less than 20 cases for thrombolytic treatment and analysis is not performed on less than 10 cases for primary angioplasty. General website: http://www.rcplondon.ac.uk/CLINICALSTANDARDS/ORGANISATION/PARTNERSHIP/Pages/MINAP-.aspx Latest report: http://www.rcplondon.ac.uk/clinicalstandards/organisation/partnership/Documents/Minap-2008.pdf Please note that the linked report contains details similar to that of the indicator, however there were differences, e.g. report does not state STEMI. Publisher / Owner Myocardial Ischaemia National Audit Project (MINAP) Other related PI's (relation) There is currently no information for this item. Additional Information From 01/04/09 aspirin, previously aspirin/other anti platelet

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Anonymous

Percentage of patients following myocardial infarction discharged on betablockers

Library Reference Number/Identifier CV30 Subject Myocardial Ischaemia National Audit Project/ British Cardiovascular Intervention Society Category Heart Disease Detailed Descriptor Percentage of patients discharged on beta-blockers following myocardial infarction Rationale Good evidence that secondary prevention treatment with betablockers reduces risk of another heart attack. This indicator will provide evidence that the organisation is prescribing betablockers appropriately on discharge for patients with acute coronary syndromes. Definition % of eligible patients (with discharge diagnosis of troponin positive ACS who survived to leave hospital that were not contra-indicated, declined treatment, not indicated or transferred to another hospital) that were discharged on beta blockers Units % of eligible patients Coverage England and Wales Source Myocardial Ischaemia National Audit Project (MINAP) Calculations/Formula/Methodology % of patients with discharge diagnosis of troponin positive ACS who survived to leave hospital where there was no contraindication to use, and where it was appropriate to record discharge therapy (ie not dying in hospital and not transferred elsewhere) that were discharged on betablockers.

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Anonymous

Creator / Producer Myocardial Ischaemia National Audit Project (MINAP) Status In use Quality Good Date 2010-11 Version History First report produced in 2002 with updates annually. Update Frequency Annual NB continuous collection Accessibility Figures available for England and Wales and national and provider level. Percentages are not shown for less than 20 cases for thrombolytic treatment and analysis is not performed on less than 10 cases for primary angioplasty. General website: http://www.rcplondon.ac.uk/CLINICALSTANDARDS/ORGANISATION/PARTNERSHIP/Pages/MINAP-.aspx Latest report: http://www.rcplondon.ac.uk/clinicalstandards/organisation/partnership/Documents/Minap-2008.pdf Please note that the linked report contains details similar to that of the indicator, however there were differences, e.g. report does not state STEMI. Publisher / Owner Myocardial Ischaemia National Audit Project (MINAP) Other related PI's (relation) There is currently no information for this item. Additional Information

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Anonymous

There is currently no information for this item.

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Anonymous

Percentage of patients following myocardial infarction discharged on statins

Library Reference Number/Identifier CV31 Subject Myocardial Ischaemia National Audit Project/ British Cardiovascular Intervention Society Category Heart Disease Detailed Descriptor Percentage of patients discharged on statins following myocardial infarction Rationale Good evidence that secondary prevention with statin drugs reduces risk of another heart attack. This indicator will provide evidence that the organisation is prescribing statins appropriately on discharge for patients with acute coronary syndromes. Definition % of eligible patients (with discharge diagnosis of troponin positive ACS who survived to leave hospital that were not contra-indicated, declined treatment, not indicated or transferred to another hospital) that were discharged on a statin Units % of eligible patients Coverage England and Wales Source Myocardial Ischaemia National Audit Project (MINAP) Calculations/Formula/Methodology % of patients with discharge diagnosis of troponin positive ACS who survived to leave hospital where there was no contraindication to use, and where it was appropriate to record discharge therapy (ie not dying in hospital and not transferred elsewhere) that were discharged on statins. Creator / Producer

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Anonymous

Myocardial Ischaemia National Audit Project (MINAP) Status In use Quality Good Date 2010-11 Version History First report produced in 2002 with updates annually. Update Frequency Annual NB continuous collection Accessibility Figures available for England and Wales and national and provider level. Percentages are not shown for less than 20 cases for thrombolytic treatment and analysis is not performed on less than 10 cases for primary angioplasty. General website: http://www.rcplondon.ac.uk/CLINICALSTANDARDS/ORGANISATION/PARTNERSHIP/Pages/MINAP-.aspx Latest report: http://www.rcplondon.ac.uk/clinicalstandards/organisation/partnership/Documents/Minap-2008.pdf Please note that the linked report contains details similar to that of the indicator, however there were differences, e.g. report does not state STEMI. Publisher / Owner Myocardial Ischaemia National Audit Project (MINAP) Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Percentage of patients following myocardial infarction discharged on theinopyridine (clopidogrel)

Library Reference Number/Identifier CV33 Subject Myocardial Ischaemia National Audit Project/ British Cardiovascular Intervention Society Category Heart Disease Detailed Descriptor Percentage of patients discharged on clopidogrel following myocardial infarction Rationale Good evidence that secondary prevention treatment with clopidogrel reduces risk of another heart attack Definition % of eligible patients (with discharge diagnosis of troponin positive ACS who survived to leave hospital that were not contra-indicated, declined treatment, not indicated or transferred to another hospital) that were discharged on clopidogrel Units % of eligible patients Coverage England and Wales Source Myocardial Ischaemia National Audit Project (MINAP) Calculations/Formula/Methodology % of patients with discharge diagnosis of troponin positive ACS who survived to leave hospital where there was no contraindication to use, and where it was appropriate to record discharge therapy (ie not dying in hospital and not transferred elsewhere) that were discharged on clopidrogel.

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Anonymous

Creator / Producer Myocardial Ischaemia National Audit Project (MINAP) Status In use Quality Good Date 2010-11 Version History First report produced in 2002 with updates annually. Update Frequency Annual NB continuous collection Accessibility Figures available for England and Wales and national and provider level. Percentages are not shown for less than 20 cases for thrombolytic treatment and analysis is not performed on less than 10 cases for primary angioplasty. General website: http://www.rcplondon.ac.uk/CLINICALSTANDARDS/ORGANISATION/PARTNERSHIP/Pages/MINAP-.aspx Latest report: http://www.rcplondon.ac.uk/clinicalstandards/organisation/partnership/Documents/Minap-2008.pdf Please note that the linked report contains details similar to that of the indicator, however there were differences, e.g. report does not state STEMI. Publisher / Owner Myocardial Ischaemia National Audit Project (MINAP) Other related PI's (relation) There is currently no information for this item. Additional Information

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Anonymous

From 01/04/09 thienopyridine inhibitor, previously clopidogrel

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Anonymous

The percentage of patients with a current diagnosis of heart failure due to LVD who are currently treated with an ACE inhibitor or Angiotensin Receptor Blocker (ARB), who are additionally treated with a betablocker licensed for heart failure, or recorded as intolerant to or having a contraindication to betablockers
Library Reference Number/Identifier QOF HF 4 Subject QOF Clinical domain : Heart failure Category Ongoing management Detailed Descriptor The percentage of patients with a current diagnosis of heart failure due to LVD who are currently treated with an ACE inhibitor or Angiotensin Receptor Blocker (ARB), who are additionally treated with a betablocker licensed for heart failure, or recorded as intolerant to or having a contraindication to betablockers Rationale There is currently no information for this item. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF HF 4 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with a current diagnosis of heart failure due to LVD who are currently treated with an ACE inhibitor or Angiotensin Receptor Blocker, who can tolerate therapy and for whom there is no contra-indication
Library Reference Number/Identifier QOF HF 3 Subject QOF Clinical domain : Heart failure Category Ongoing management Detailed Descriptor The percentage of patients with a current diagnosis of heart failure due to LVD who are currently treated with an ACE inhibitor or Angiotensin Receptor Blocker, who can tolerate therapy and for whom there is no contra-indication Rationale The evidence base for treating patients with LVD heart failure with ARBs is strong, however, this should only be after first attempting to initiate ACE inhibitors. It should also be noted that it is possible to have a diagnosis of LVD without heart failure, for example, asymptomatic people who might be identified coincidentally but who are at high risk of developing subsequent heart failure. In such cases ACE inhibitors delay the onset of symptomatic heart failure, reduce cardiovascular events and improve long-term survival. This indicator only concerns patients with heart failure and thus excludes this other group of patients who should nevertheless be considered for treatment with ACE inhibitors. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical

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Anonymous

Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF HF 3 Additional Information

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Anonymous

There is currently no information for this item.

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Anonymous

The percentage of patients with a diagnosis of heart failure (diagnosed after 1 April 2006) which has been confirmed by an echocardiogram or by specialist assessment
Library Reference Number/Identifier QOF HF 2 Subject QOF Clinical domain : Heart failure Category Initial diagnosis Detailed Descriptor The percentage of patients with a diagnosis of heart failure (diagnosed after 1 April 2006) which has been confirmed by an echocardiogram or by specialist assessment Rationale From April 2006, all patients with suspected heart failure should be investigated and this is expected to involve, as a minimum, specialist investigation (such as echocardiography or natiuretic peptide assay) and often specialist opinion. Specialists may include GPs identified by their PCO as having a special clinical interest in heart failure. Many heart failure patients will be diagnosed following specialist referral or during hospital admission and some will also have their diagnosis confirmed by tests such as cardiac scintography or angiography rather than echocardiography. Current guidance requires either echocardiography or specialist assessment for all patients with suspected heart failure, regardless of presumed aetiology. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England

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Anonymous

Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF HF 2 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with a history of myocardial infarction (diagnosed after 1 April 2003) who are currently treated with an ACE inhibitor or Angiotensin II antagonist
Library Reference Number/Identifier QOF CHD 11 Subject QOF Clinical domain : Secondary prevention of coronary heart disease Category Ongoing management Detailed Descriptor The percentage of patients with a history of myocardial infarction (diagnosed after 1 April 2003) who are currently treated with an ACE inhibitor or Angiotensin II antagonist Rationale A number of trials have shown reduced mortality following myocardial infarction with the use of ACE inhibitors. The Heart Outcome Prevention Evaluation (HOPE) showed that ACE inhibitors are also of benefit in reducing coronary events and progression of coronary arteriosclerosis in patients without left ventricular systolic dysfunction. There is evidence that Angiotensin II antagonists have a similar effect. Definition ***DROPPED - REPLACED BY QOF CHD 14 This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England

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Anonymous

Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED - REPLACED BY QOF CHD 14 Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (published in October in 2011) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) REPLACED BY QOF CHD 14 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with a history of myocardial infarction (from 1 April 2011) currently treated with an ACE inhibitor (or ARB if ACE intolerant), aspirin or an alternative anti-platelet therapy, beta blocker and statin (unless a contraindication or side effects are recorded)
Library Reference Number/Identifier QOF CHD 14 Subject QOF Clinical domain : Secondary prevention of coronary heart disease Category Ongoing management Detailed Descriptor Replaces QOF CHD 11. The percentage of patients with a history of myocardial infarction (from 1 April 2011) currently treated with an ACE inhibitor (or ARB if ACE intolerant), aspirin or an alternative anti-platelet therapy, beta blocker and statin (unless a contraindication or side effects are recorded) Rationale There is evidence from meta-analyses and randomised controlled trials (level 1 evidence) for a range of relevant health outcomes, including mortality, to support all patients who have had an acute myocardial infarction (MI) being offered treatment with a combination of the following drugs: - ACE (angiotensin-converting enzyme) inhibitor (or ARB if ACE intolerant) - aspirin - beta-blocker - statin There is also health economic evidence to suggest that these drug interventions are costeffective. ACE inhibitor (ACE-I) In the studies reviewed, short-term treatment with an ACE-I in unselected patients immediately after an MI was associated with a small reduction in mortality. Long term treatment with an ACE-I in patients with signs of heart failure and/or left ventricular systolic dysfunction who have recently experienced an MI was associated with a substantial reduction in all-cause mortality, recurrent MI and re-admission for heart failure.

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Anonymous

Where patients are intolerant of an ACE-I (for example because of a cough or allergy) it is recommended that an ARB (angiotensin receptor blocker) is substituted.

Aspirin and alternative antiplatelet therapy In the studies reviewed, treatment with aspirin after an MI reduced the risk of death and cardiovascular events. In a subgroup of patients with recent MI, aspirin and clopidogrel (an alternative antiplatelet therapy) have similar cardiovascular benefits. Warfarin Patients may be treated with anticoagulants when they are intolerant of aspirin and clopidogrel or for the management of co-morbid conditions such as atrial fibrillation and heart failure. Where a patient is treated with anticoagulant therapy, anti-platelet therapy may not be clinically appropriate. For the purpose of this indicator, anticoagulant therapy will be included in the aspirin or an alternative anti-platelet therapy component of this indicator to cover this cohort of patients. Beta-blocker In the studies reviewed, in unselected patients after acute MI, long term treatment with betablockers was associated with reduced mortality compared with placebo.

Statins In a meta-analysis of primary and secondary prevention studies, treatment with a statin was associated with a reduction in all-cause mortality and cardiovascular mortality. Further information NICE clinical guideline 48 (2007). MI secondary prevention in primary and secondary care for patients following a myocardial infarction. www.nice.org.uk/guidance/CG48 NICE technology appraisal 94 (2006). Statins for the prevention of cardiovascular events in patients at increased risk of developing CVD or those with established CVD. www.nice.org.uk/guidance/TA94 NICE clinical guideline 67 (2007). Lipid modification. www.nice.org.uk/guidance/CG67 Definition This indicator requires a patient to be on four drugs, one from each of the following categories: - an ACE inhibitor OR (if contraindicated) an ARB; and - either aspirin OR an alternative anti-platelet or anticoagulant therapy; and

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Anonymous

- a beta-blocker; and - a statin. A patient will be counted towards the target if they are: a. receiving an ACE AND receiving either aspirin or alternative anti-platelet or anticoagulant therapy AND receiving a beta-blocker AND receiving a statin b. the patient is contraindicated for an ACE BUT receiving an ARB AND receiving either aspirin or an alternative anti-platelet or anticoagulant therapy AND receiving a betablockerAND receiving a statin. A patient will not be counted towards the target if they are: a. exception reported using one of the nine QOF exception reporting criteria (apart from if they have a contraindication as per b above but receiving the other drugs) b. receiving a drug from the last three groups but contraindicated for both an ACE and ARB. A patient will count towards the target (included in the denominator but not the numerator) if they are: a. not appropriately exception coded b. not receiving the medicines described above. The practice reports the percentage of patients who have had a myocardial infarction (from 1 April 2011) currently treated with an ACE-I (or ARB if ACE intolerant), aspirin or an alternative antiplatelet or anticoagulant therapy, beta-blocker and statin (unless a contraindication or side effects are recorded). Units Numerical Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Replaces QOF CHD 11 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with coronary heart disease in whom the last blood pressure reading (measured in the previous 15 months) is 150/90 or less
Library Reference Number/Identifier QOF CHD 6 Subject QOF Clinical domain : Secondary prevention of coronary heart disease Category Ongoing management Detailed Descriptor The percentage of patients with coronary heart disease in whom the last blood pressure reading (measured in the previous 15 months) is 150/90 or less Rationale The British Hypertension Society Guidelines propose an optimal blood pressure of 140 mm Hg or less systolic and 85 mm Hg or less diastolic for patients with CHD. This guideline also proposes a pragmatic audit standard of a blood pressure reading of 150/90 or less. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF CHD 6 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with coronary heart disease who are currently treated with a beta blocker (unless a contraindication or side-effects are recorded)
Library Reference Number/Identifier QOF CHD 10 Subject QOF Clinical domain : Secondary prevention of coronary heart disease Category Ongoing management Detailed Descriptor The percentage of patients with coronary heart disease who are currently treated with a beta blocker (unless a contraindication or side-effects are recorded) Rationale Long-term beta blockade remains an effective and well-tolerated treatment that reduces mortality and morbidity in patients with angina and patients after myocardial infarction. Although the trial evidence relates mainly to patients who have had a myocardial infarction, experts have generally extrapolated this evidence to all patients with CHD. Because the evidence is not based on all patients with CHD, the target levels for this indicator have been set somewhat lower than for other process indicators. Recent evidence against the use of beta blockers in hypertension should not be extrapolated to patients with CHD. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical

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Anonymous

Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF CHD 10 Additional Information

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Anonymous

There is currently no information for this item.

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Anonymous

The percentage of patients with coronary heart disease who have a record of influenza immunisation in the preceding 1 September to 31 March
Library Reference Number/Identifier QOF CHD 12 Subject QOF Clinical domain : Secondary prevention of coronary heart disease Category Ongoing management Detailed Descriptor The percentage of patients with coronary heart disease who have a record of influenza immunisation in the preceding 1 September to 31 March Rationale This is a current recommendation from the Department of Health and the Joint Committee on Vaccination and Immunisation. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF CHD 12 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with coronary heart disease whose last measured total cholesterol (measured in the previous 15 months) is 5mmol/l or less
Library Reference Number/Identifier QOF CHD 8 Subject QOF Clinical domain : Secondary prevention of coronary heart disease Category Ongoing management Detailed Descriptor The percentage of patients with coronary heart disease whose last measured total cholesterol (measured in the previous 15 months) is 5mmol/l or less Rationale A number of Randomised Controlled Trials of statin therapy in the secondary prevention of CHD have shown a reduction in relative risk of cardiac events irrespective of the starting level of cholesterol (see reference in 7.1). Recent trials have found greater relative benefit with more potent cholesterol lowering regimes. It is likely that National Guidelines relating to statin therapy in patients with CHD will change to recommend statin therapy for all patients with CHD irrespective of their starting level of total cholesterol. However, currently the Joint British Recommendations on Prevention of Coronary Heart Disease in Clinical Practice (1998) and SIGN Guidelines 93, 96 and 97 recommend that patients who have cholesterol of greater than 5mmol/l should be offered lipid lowering therapy. This should be treated as an audit target below which to aim for all eligible CHD patients. The guidance here is given in terms of total cholesterol, as this is used in national guidance and in trials. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator.

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Anonymous

Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation)

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Anonymous

QOF CHD 8 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with coronary heart disease whose notes have a record of total cholesterol in the previous 15 months
Library Reference Number/Identifier QOF CHD 7 Subject QOF Clinical domain : Secondary prevention of coronary heart disease Category Ongoing management Detailed Descriptor The percentage of patients with coronary heart disease whose notes have a record of total cholesterol in the previous 15 months Rationale A number of trials have demonstrated that cholesterol lowering with statins significantly reduces cardiovascular or all-cause mortality in patients with angina or in patients following myocardial infarction. Definition ***DROPPED This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (October in 2010) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF CHD 7 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with coronary heart disease with a record in the previous 15 months that aspirin, an alternative anti-platelet therapy, or an anticoagulant is being taken (unless a contraindication or side-effects are recorded)
Library Reference Number/Identifier QOF CHD 9 Subject QOF Clinical domain : Secondary prevention of coronary heart disease Category Ongoing management Detailed Descriptor The percentage of patients with coronary heart disease with a record in the previous 15 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken (unless a contraindication or side-effects are recorded) Rationale Aspirin (75-150mg per day) should be given routinely and continued for life in all patients with CHD unless there is a contraindication. Clopidogrel (75mg/ day) is an effective alternative in patients with contraindications to aspirin, or who are intolerant of aspirin. Aspirin should be avoided in patients who are anticoagulated. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source

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Anonymous

Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF CHD 9 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with hypertension in whom the last blood pressure (measured in the previous 9 months) is 150/90 or less
Library Reference Number/Identifier QOF BP 5 Subject QOF Clinical domain : Hypertension Category Ongoing management Detailed Descriptor The percentage of patients with hypertension in whom the last blood pressure (measured in the previous 9 months) is 150/90 or less Rationale For most patients a target of 140/85 is recommended. However, the British Hypertension Society suggests an audit standard of 150/90 which has been adopted for the QOF. For patients with diabetes mellitus, see DM 12. For patients with chronic kidney disease, see CKD 4. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF BP 5 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with hypertension in whom there is a record of the blood pressure in the previous 9 months
Library Reference Number/Identifier QOF BP 4 Subject QOF Clinical domain : Hypertension Category Ongoing management Detailed Descriptor The percentage of patients with hypertension in whom there is a record of the blood pressure in the previous 9 months Rationale The frequency of follow-up for treated patients after adequate blood pressure control is attained depends upon factors such as the severity of the hypertension, variability of blood pressure, complexity of the treatment regime, patient compliance and the need for non-pharmacological advice. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology

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Anonymous

http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF BP 4 Additional Information There is currently no information for this item.

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Anonymous

The percentage of people with hypertension diagnosed after 1 April 2009 who are given lifestyle advice in the last 15 months for: increasing physical activity, smoking cessation, safe alcohol consumption and healthy diet
Library Reference Number/Identifier QOF PP 2 Subject QOF Clinical domain : Primary Prevention Category On-going management Detailed Descriptor The percentage of people with hypertension diagnosed after 1 April 2009 who have been given lifestyle advice in the last 15 months for: increasing physical activity, smoking cessation, safe alcohol consumption and healthy diet Rationale There is considerable evidence to support the positive impact of increasing physical activity, smoking cessation, reducing unsafe alcohol consumption, and improving diet on cardiovascular health. Patients with hypertension are at increased risk of developing CVD and this risk can be reduced, not only by treating their hypertension, but by also reducing lifestyle risks. Practices should refer to recognised guidance and advice on advising patients on lifestyle risk. This advice should be reiterated on an annual basis. Definition The percentage of people with hypertension diagnosed after 1 April 2009 who have been given lifestyle advice in the last 15 months for: increasing physical activity, smoking cessation, safe alcohol consumption and healthy diet Units Numerical Coverage England Source

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Anonymous

Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History New indicator in 2011-12 Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) There is currently no information for this item. Additional Information Further information: Smoking Cessation: guidance and recent developments in smoking cessation Cessation Update 2007 (NHS Health Scotland and ASH Scotland).

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Anonymous

COPD11 - The percentage of patients with COPD receiving inhaled treatment in whom there is a record that inhaler technique has been checked in the previous 15 months
Library Reference Number/Identifier QOF COPD 11 Subject There is currently no information for this item. Category Ongoing management Detailed Descriptor There is currently no information for this item. Rationale COPD is increasingly recognised as a treatable disease with large improvements in symptoms, health status, exacerbation rates and even mortality if managed appropriately. Appropriate management should be based on NICE guideline CG12 and international GOLD guidelines in terms of both drug and non-drug therapy. In making assessments of the patients condition as part of an annual review and when considering management changes it is essential that health care professionals are aware of: current lung function exacerbation history degree of breathlessness (MRC dyspnoea scale) and A tool such as the Clinical COPD Questionnaire could be used to assess current health status. Additionally there is evidence that inhaled therapies can improve the quality of life in some patients with COPD. However, there is evidence that patients require training in inhaler technique and that such training requires reinforcement. Where a patient is prescribed an inhaled therapy their technique should be assessed during any review. Definition There is currently no information for this item.

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Anonymous

Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status The data for this indicator is no longer available, so the results have been taken down from the website. Quality QOF indicators are based on best available clinical evidence Date 2008/09 Version History There is currently no information for this item. Update Frequency Annual publication based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care

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Anonymous

Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

The percentage of all patients with COPD diagnosed after 1 April 2011 in whom the diagnosis had been confirmed by post bronchodilator spirometry
Library Reference Number/Identifier QOF COPD 15 Subject QOF Clinical domain : Chronic obstructive pulmonary disease (COPD) Category Initial diagnosis Detailed Descriptor Replaces QOF COPD 12. The percentage of all patients with COPD diagnosed after 1 April 2011 in whom the diagnosis had been confirmed by post bronchodilator spirometry Rationale A diagnosis of COPD relies on clinical judgement based on a combination of history, physical examination and confirmation of the presence of airflow obstruction using spirometry. NICE clinical guidelines provide the following definition of COPD: - airflow obstruction is defined as a reduced FEV1/FVC ratio (where FEV1 is forced expired volume in one second and FVC is forced vital capacity), such that FEV1/FVC is less than 0.7 - if FEV1 is greater than or equal to 80 per cent predicted normal a diagnosis of COPD should only be made in the presence of respiratory symptoms, for example breathlessness or cough. The NICE guidelines require post bronchodilator spirometry for diagnosis and gradation of severity of airways obstruction. Failure to use post bronchodilator readings has been shown to overestimate the prevalence of COPD by 25 per cent45. Spirometry should be performed after the administration of an adequate dose of an inhaled bronchodilator (e.g. 400mcg salbutamol). Prior to performing post-bronchodilator spirometry, patients do not need to stop any therapy, such as long acting bronchodilators or inhaled steroids. Routine reversibility testing is not recommended. However, where doubt exists as to whether the diagnosis is asthma or COPD, reversibility testing may add additional information to post bronchodilator readings alone and peak flow charts are useful. It is acknowledged that COPD and

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Anonymous

asthma can co-exist and that many patients with asthma who smoke will eventually develop irreversible airways obstruction. Where asthma is present, these patients should be managed as asthma patients as well as COPD patients. This will be evidenced by a greater than 400mls response to a reversibility test and a post bronchodilator FEV1 of less than 80 per cent of predicted normal as well as an appropriate medical history. Patients with reversible airways obstruction should be included on the asthma register. Patients with coexisting asthma and COPD should be included on the register for both conditions. Further information NICE clinical guideline 101 (2010). Chronic obstructive pulmonary disease. http://guidance.nice.org.uk/CG101/NICEGuidance/pdf/English From April 2011 the diagnostic codes for this indicator have been updated to include new codes for post bronchodilator spirometry. The previous codes for reversibility testing will no longer be acceptable for QOF purposes. Definition The practice reports the percentage of patients diagnosed after 1 April 2011 who are on their COPD register, who have a record that the diagnosis has been confirmed by post bronchodilator spirometry. For the purposes of the QOF, post bronchodilator spirometry undertaken between three months before and 12 months after a diagnosis of COPD being made would be considered as meeting the requirements of this indicator. In verifying that this information has been correctly recorded, a number of approaches could be taken: 1. inspection of the output from a computer search that has been used to provide information on this indicator 2. inspection of a sample of records of patients with COPD to look at the proportion with a record of post bronchodilator spirometry 3. inspection of a sample of records of patients for whom a record of post bronchodilator spirometry is claimed, to see if there is evidence of this in the medical records. Units Numerical Coverage

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Anonymous

England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011/12 Version History There is currently no information for this item. Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Replaces QOF COPD 12 Additional Information There is currently no information for this item.

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Anonymous

The percentage of all patients with COPD diagnosed after 1st April 2009 in whom the diagnosis has been confirmed by post bronchodilator spirometry
Library Reference Number/Identifier QOF COPD 12 Subject QOF Clinical domain : Chronic obstructive pulmonary disease (COPD) Category Initial diagnosis Detailed Descriptor The percentage of all patients with COPD diagnosed after 1st April 2009 in whom the diagnosis has been confirmed by post bronchodilator spirometry Rationale COPD is diagnosed if: the patient has an FeV1 of less than 80 per cent of predicted normal and has an FeV1/FVC ratio of less than 70 per cent and the patient has symptoms consistent with COPD. Spirometry should be performed after the administration of an adequate dose of an inhaled bronchodilator (e.g. 400mcg salbutamol). Prior to performing post-bronchodilator spirometry, patients do not need to stop any therapy, such as long acting bronchodilators or inhaled steroids. All of these elements are required to make the diagnosis of COPD. Routine reversibility testing is not recommended in NICE, and the GOLD guidelines require post bronchodilator spirometry for diagnosis and grading. Failure to use post bronchodilator readings overestimated the prevalence of COPD by 25%. This change will reduce workload in primary care and removes the conflict with evidence based guidelines. Where doubt occurs as to whether the diagnosis is asthma or COPD, reversibility testing may add additional information to post bronchodilator readings alone and peak flow charts are useful. It is acknowledged that COPD and asthma can co-exist and that many patients with asthma who smoke will eventually develop irreversible airways obstruction. However, where asthma is present, these patients should be managed as asthma patients as well as COPD patients. This will be evidenced by a greater than 400mls response to a reversibility test and a post bronchodilator

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Anonymous

FeV1 of <80% of predicted normal as well as an appropriate medical history. Patients with reversible airways obstruction should be included on the asthma register. Patients with coexisting asthma and COPD should be included on the register for both conditions. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status To be used in QOF 2009/10 Quality QOF indicators are based on best available clinical evidence Date 2010/11 Version History Future indicator, expected late 2011

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Anonymous

Update Frequency Annual publication (October in 2010) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF COPD 12 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with COPD who have had a review, undertaken by a healthcare professional, including an assessment of breathlessness using the MRC dyspnoea score in the preceding 15 months
Library Reference Number/Identifier QOF COPD 13 Subject QOF Clinical domain : Chronic obstructive pulmonary disease (COPD) Category Ongoing management Detailed Descriptor The percentage of patients with COPD who have had a review undertaken by a healthcare professional in the preceding 15 months, including an assessment of breathlessness using the MRC dyspnoea score Rationale COPD is increasingly recognised as a treatable disease with large improvements in symptoms, health status, exacerbation rates and even mortality if managed appropriately. Appropriate management should be based on NICE guideline CG12 and international GOLD guidelines in terms of both drug and non-drug therapy. In making assessments of the patients condition as part of an annual review and when considering management changes it is essential that health care professionals are aware of: current lung function exacerbation history degree of breathlessness (MRC dyspnoea scale) and A tool such as the Clinical COPD Questionnaire could be used to assess current health status. Additionally there is evidence that inhaled therapies can improve the quality of life in some patients with COPD. However, there is evidence that patients require training in inhaler technique and that such training requires reinforcement. Where a patient is prescribed an inhaled therapy their technique should be assessed during any review. Definition

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Anonymous

The percentage of patients with COPD who have had a review, undertaken by a healthcare professional, including an assessment of breathlessness using the MRC dyspnoea score in the preceding 15 months. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History New indicator in 2011-12 Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level

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Anonymous

Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) There is currently no information for this item. Additional Information www.thorax.bmj.com/content/vol59/suppl_1/ Further information on management of COPD: www.thorax.bmj.com/content/vol59/suppl_1/ www.nice.org.uk/Guidance/CG12 www.goldcopd.com www.ccq.nl

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Anonymous

The percentage of patients with COPD who have had influenza immunisation in the preceding 1 September to 31 March
Library Reference Number/Identifier QOF COPD 8 Subject QOF Clinical domain : Chronic obstructive pulmonary disease (COPD) Category Ongoing management Detailed Descriptor The percentage of patients with COPD who have had influenza immunisation in the preceding 1 September to 31 March Rationale This is a current recommendation from the Departments of Health and the Joint Committee on Vaccination and Immunisation. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF COPD 8 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with COPD with a record of FeV1 in the previous 15 months
Library Reference Number/Identifier QOF COPD 10 Subject QOF Clinical domain : Chronic obstructive pulmonary disease (COPD) Category Ongoing management Detailed Descriptor The percentage of patients with COPD with a record of FeV1 in the previous 15 months Rationale There is a gradual deterioration in lung function in patients with COPD. This deterioration accelerates with the passage of time. There are important interventions which can improve quality of life in patients with severe COPD. It is therefore important to monitor respiratory function in order to identify patients who might benefit from pulmonary rehabilitation or continuous oxygen therapy. Current guidance states that there are no clear guidelines with regard to the optimum frequency of spirometry for patients with COPD and the time interval was pragmatically set at two years. However NICE Clinical Guideline 12 (February 2004), endorsed by the British Thoracic Society, now suggests that FeV1 and inhaler technique should be assessed at least annually for people with mild/moderate COPD (and in fact at least twice a year for people with severe COPD). The purpose of regular monitoring is to identify patients with increasing severity of disease who may benefit from referral for more intensive treatments/diagnostic review. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical

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Anonymous

Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF COPD 10

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Anonymous

Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients with COPD

Library Reference Number/Identifier QOF COPD 1 Subject QOF Clinical domain : Chronic obstructive pulmonary disease (COPD) Category Records Detailed Descriptor ***DROPPED - REPLACED BY QOF COPD 14. The practice can produce a register of patients with COPD Rationale A register is a prerequisite for monitoring patients with COPD. A diagnosis of COPD should be considered in any patient who has symptoms of persistent cough, sputum production, or dyspnoea and/or a history of exposure to risk factors for the disease. The diagnosis is confirmed by post bronchodilator spirometry. Where patients have a long-standing diagnosis of COPD and the clinical picture is clear, it would not be essential to confirm the diagnosis by spirometry in order to enter the patient onto the register. However, where there is doubt about the diagnosis practices may wish to carry out post bronchodilator spirometry for confirmation. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED - REPLACED BY QOF COPD 14. Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (published in October in 2011) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) REPLACED BY QOF COPD 14 Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients with COPD

Library Reference Number/Identifier QOF COPD 14 Subject QOF Clinical domain : Chronic obstructive pulmonary disease (COPD) Category Records Detailed Descriptor Replaces QOF COPD 1. The practice can produce a register of patients with COPD Rationale A register is a prerequisite for monitoring patients with COPD. A diagnosis of COPD should be considered in any patient who has symptoms of persistent cough, sputum production, or dyspnoea and/or a history of exposure to risk factors for the disease. The diagnosis is confirmed by post bronchodilator spirometry. Where patients have a long-standing diagnosis of COPD and the clinical picture is clear, it would not be essential to confirm the diagnosis by spirometry in order to enter the patient onto the register. However, where there is doubt about the diagnosis practices may wish to carry out post bronchodilator spirometry for confirmation. NICE clinical guideline 101 recommended a change to the diagnostic threshold for COPD. As this may lead to an increase in the recorded prevalence of COPD, this indicator hasbeen renumbered from April 2011 in recognition of this. Definition The practice reports the number of patients on its COPD disease register and the number of patients on its COPD disease register as a proportion of total list size. Where patients have co-existing COPD and asthma then they should be on both disease registers. Approximately 15 per cent of patients with COPD will also have asthma. Verification may require a comparison of the expected prevalence with the reported prevalence.

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Anonymous

Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care

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Anonymous

Other related PI's (relation) Replaces QOF COPD 1 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes who have a record of retinal screening in the previous 15 months
Library Reference Number/Identifier QOF DM 21 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes who have a record of retinal screening in the previous 15 months Rationale Screening for diabetic retinal disease is effective at detecting unrecognised sight-threatening retinopathy. Systematic annual screening should be provided for all people with diabetes. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DM 21 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes with a record of the presence or absence of peripheral pulses in the previous 15 months
Library Reference Number/Identifier QOF DM 9 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes with a record of the presence or absence of peripheral pulses in the previous 15 months Rationale Patients with diabetes are at high risk of foot complications. Inspection for vasculopathy and neuropathy is needed to detect problems. These checks should be carried out at an annual review. Definition ***DROPPED - REPLACED BY QOF DM 29 This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology

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Anonymous

http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED - REPLACED BY QOF DM 29 Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (October in 2010) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) REPLACED BY QOF DM 29 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes with a record of neuropathy testing in the previous 15 months
Library Reference Number/Identifier QOF DM 10 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes with a record of neuropathy testing in the previous 15 months Rationale The measurement of foot sensation should be carried out as recommended in the SIGN Guideline 55 on the Management of Diabetes. Foot sensation should be considered abnormal if monofilament and/or vibration sensation are impaired. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DM 10 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes who have a record of the blood pressure in the previous 15 months
Library Reference Number/Identifier QOF DM 11 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes who have a record of the blood pressure in the previous 15 months Rationale Cardiovascular disease is the major cause of morbidity and mortality in people with diabetes, and coronary heart disease is the most common cause of death among people with Type 2 diabetes. Many people with Type 2 diabetes have an increased coronary event risk even if they do not have manifest cardiovascular disease. Hypertension is associated with an increased risk of many complications of diabetes including cardiovascular disease. Blood pressure should be measured at least annually in patients with diabetes. Definition ***DROPPED This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage

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Anonymous

England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (October in 2010) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DM 11 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes who have a record of microalbuminuria testing in the previous 15 months (exception reporting for patients with proteinuria)
Library Reference Number/Identifier QOF DM 13 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes who have a record of micro-albuminuria testing in the previous 15 months (exception reporting for patients with proteinuria) Rationale Diabetic patients are at risk of developing nephropathy. Measurements of urinary albumin loss and serum creatinine are the best screening tests for diabetic nephropathy. Urinary microalbuminuria has been identified as an independent risk factor for cardiovascular complications. Its presence is therefore a pointer to the need for more rigorous management of all cardiovascular risk factors. All patients with diabetes should have their urinary albumin concentration and serum creatinine measured at diagnosis and at regular intervals, usually annually. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England

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Anonymous

Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DM 13 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes who have a record of estimated glomerular filtration rate (eGFR) or serum creatinine testing in the previous 15 months
Library Reference Number/Identifier QOF DM 22 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes who have a record of estimated glomerular filtration rate (eGFR) or serum creatinine testing in the previous 15 months Rationale Estimated glomerular filtration rate (eGFR), based on serum creatinine is reported as a better means to detect and monitor early renal disease and will be routinely reported data in 2006. This has therefore now been included in indicator 22. In the long term, eGFR should be easier for patients to understand, as log transformation is not required to assess change in renal function. Diabetic patients are at risk of developing nephropathy. Measurements of urinary albumin loss and serum creatinine are the best screening tests for diabetic nephropathy. Urinary microalbuminuria has been identified as an independent risk factor for cardiovascular complications. Its presence is therefore a pointer to the need for more rigorous management of all cardiovascular risk factors. All patients with diabetes should have their urinary albumin concentration and serum creatinine measured at diagnosis and at regular intervals, usually annually. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator.

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Anonymous

Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation)

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Anonymous

QOF DM 22 Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of all patients aged 17 years and over with diabetes mellitus, which specifies whether the patient has Type 1 or Type 2 diabetes
Library Reference Number/Identifier QOF DM 19 Subject QOF Clinical domain : Diabetes mellitus Category Records Detailed Descriptor The practice can produce a register of all patients aged 17 years and over with diabetes mellitus, which specifies whether the patient has Type 1 or Type 2 diabetes Rationale It is not possible to undertake planned systematic care for patients with diabetes without a register which forms the basis of a recall system, and is needed in order to audit care. The QOF does not specify how the diagnosis should be made, and a record of the diagnosis will, for the purposes of the QOF, be regarded as sufficient evidence of diabetes. However, in addition to the substantial number of undiagnosed patients with diabetes who exist, other patients are treated for diabetes when they do not in fact have the disease. Practices are therefore encouraged to adopt a systematic approach to the diagnosis of diabetes. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England

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Anonymous

Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DM 19 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes whose notes record BMI in the previous 15 months
Library Reference Number/Identifier QOF DM 2 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes whose notes record BMI in the previous 15 months Rationale Weight control in overweight subjects with diabetes is associated with improved glycaemic control. There is little evidence to dictate the frequency of recording but it is general clinical practice that BMI is assessed at least annually. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DM 2 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes who have a record of HbA1c or equivalent in the previous 15 months
Library Reference Number/Identifier QOF DM 5 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes who have a record of HbA1c or equivalent in the previous 15 months Rationale HbA1c is a marker of long-term control of diabetes. Better control leads to fewer complications in both insulin dependent and non-insulin dependent patients with diabetes. There is no trial evidence to support the frequency of HbA1c measurement. Definition ***DROPPED This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework

21/09/2013 07:36

Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (October 2010) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DM 5 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes in whom the last blood pressure reading is 145/85 or less
Library Reference Number/Identifier QOF DM 12 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes in whom the last blood pressure is 145/85 or less Rationale Blood pressure lowering in people with diabetes reduces the risk of macrovascular and microvascular disease. Hypertension in people with diabetes should be treated aggressively with lifestyle modification and drug therapy. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DM 12 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes with a diagnosis of proteinuria or micro-albuminuria who are treated with ACE inhibitors (or A2 antagonists)
Library Reference Number/Identifier QOF DM 15 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes with a diagnosis of proteinuria or micro-albuminuria who are treated with ACE inhibitors (or A2 antagonists) Rationale The progression of renal disease in patients with diabetes is slowed by treatment with ACE inhibitors, and trial evidence suggests that these are most effective when given in the maximum dose quoted in the British National Formulary (BNF). Although trial evidence is based largely on ACE inhibitors, it is believed that similar benefits occur from treatment with Angiotensin II antagonists (A2) in patients who are intolerant of ACE inhibitors. Patients with a diagnosis of microalbuminuria or proteinuria should be commenced on an ACE inhibitor or considered for Angiotensin II antagonist therapy. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England

21/09/2013 07:36

Anonymous

Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DM 15 Additional Information There is currently no information for this item.

21/09/2013 07:36

Anonymous

The percentage of patients with diabetes who have a record of total cholesterol in the previous 15 months
Library Reference Number/Identifier QOF DM 16 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes who have a record of total cholesterol in the previous 15 months Rationale Vascular disease commonly complicates diabetes. Control of risk factors including serum cholesterol is associated with a reduction in vascular risk. Definition ***DROPPED This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology

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Anonymous

http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (October in 2010) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DM 16 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes whose last measured total cholesterol within the previous 15 months is 5mmol/l or less
Library Reference Number/Identifier QOF DM 17 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes whose last measured total cholesterol within the previous 15 months is 5mmol/l or less Rationale If total cholesterol is greater than 5.0mmol/l, statin therapy to reduce cholesterol should be initiated and titrated as necessary to reduce total cholesterol to less than 5mmol/l. There is ongoing debate concerning the intervention levels of serum cholesterol in diabetic patients who do not apparently have cardiovascular disease. Further National Guidance is awaited. The age when a statin should be initiated is unclear. It is pragmatically suggested that the prescription of a statin should be considered for all diabetic patients over the age of 40, particularly if their cholesterol is greater than 5.0mmol/l. Below the age of 40 a decision needs to be reached between the doctor and the patient and may involve assessment of other risk factors and the actual age of the patient. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage

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Anonymous

England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DM 17 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes who have had influenza immunisation in the preceding 1 September to 31 March
Library Reference Number/Identifier QOF DM 18 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes who have had influenza immunisation in the preceding 1 September to 31 March Rationale This is a current recommendation from the Departments of Health and the Joint Committee on Vaccination and Immunisation. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF DM 18 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes in whom the last HbA1c is 7 or less (or equivalent test/reference range depending on local laboratory) in the previous 15 months
Library Reference Number/Identifier QOF DM 23 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes in whom the last HbA1c was 7 or less (or equivalent test/reference range depending on local laboratory) in the previous 15 months Rationale The relationship between hyperglycaemia and cardiovascular risk is essentially linear, so for those with raised HbA1c levels, better glycaemic control should lead to reduced cardiac risk. For people with Type 1 diabetes, the finding of a 42% reduction in cardiovascular events in those treated intensively in the DCCT trial provides evidence for this (DCCT/EDICT, 2005). Similarly, 10 year follow-up data from the UKPDS trial showed significantly less cardiovascular disease in those patients with Type 2 diabetes who were intensively treated (Holman et al, 2008). The three target levels for HbA1c (7%, 8% and 9%) are designed to provide an incentive to improve glycaemic control across the distribution of HbA1c values. The lower level may not be achievable for all patients, but the payment thresholds reflect this. Also practitioners should note that in the 2008 guidance for Type 2 diabetes NICE advises against pursuing highly intensive management to levels below 6.5%. NICE Guidance for Type 2 diabetes 2008: www.nice.org.uk/Guidance/CG66 Definition ***DROPPED - REPLACED BY QOF DM 26 Units Numerical

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Anonymous

Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED - REPLACED BY QOF DM 26 Quality QOF indicators are based on best available clinical evidence Date 2010/11 Version History Future indicator, expected late 2011 Update Frequency Annual publication based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) REPLACED BY QOF DM 26 Additional Information

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Anonymous

There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes in whom the last HbA1c is 8 or less (or equivalent test/reference range depending on local laboratory) in the previous 15 months
Library Reference Number/Identifier QOF DM 24 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes in whom the last HbA1c was 8 or less (or equivalent test/reference range depending on local laboratory) in the previous 15 months Rationale Auditing the proportion of patients with an HbA1c below 8% is designed to provide an incentive to improve glycaemic control across the range of HbA1c values. The relationship between hyperglycaemia and cardiovascular risk is essentially linear, so for those with raised HbA1c levels, better glycaemic control should lead to reduced cardiac risk. For people with Type 1 diabetes, the finding of a 42% reduction in cardiovascular events in those treated intensively in the DCCT trial provides evidence for this (DCCT/EDICT, 2005). Similarly, 10 year follow-up data from the UKPDS trial showed significantly less cardiovascular disease in those patients with Type 2 diabetes who were intensively treated (Holman et al, 2008). The three target levels for HbA1c (7%, 8% and 9%) are designed to provide an incentive to improve glycaemic control across the distribution of HbA1c values. The lower level may not be achievable for all patients, but the payment thresholds reflect this. Also practitioners should note that in the 2008 guidance for Type 2 diabetes NICE advises against pursuing highly intensive management to levels below 6.5%. NICE Guidance for Type 2 diabetes 2008: www.nice.org.uk/Guidance/CG66 Definition ***DROPPED - REPLACED BY QO

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Anonymous

Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status Future indicator, expected late 2011 Quality ***DROPPED - REPLACED BY QOF DM 27 Date 2010/11 Version History Future indicator, expected late 2011 Update Frequency Annual publication based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care

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Anonymous

Other related PI's (relation) REPLACED BY QOF DM 27 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes in whom the last HbA1c is 9 or less (or equivalent test/reference range depending on local laboratory) in the previous 15 months
Library Reference Number/Identifier QOF DM 25 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor The percentage of patients with diabetes in whom the last HbA1c was 9 or less (or equivalent test/reference range depending on local laboratory) in the previous 15 months Rationale Auditing the proportion of patients with an HbA1c below 9% is designed to provide an incentive to improve glycaemic control amongst those with high levels of HbA1c who are at particular risk. The target level has been reduced in order to provide an incentive to improve the care of more people with high levels of HbA1c. The relationship between hyperglycaemia and cardiovascular risk is essentially linear, so for those with raised HbA1c levels, better glycaemic control should lead to reduced cardiac risk. For people with Type 1 diabetes, the finding of a 42% reduction in cardiovascular events in those treated intensively in the DCCT trial provides evidence for this (DCCT/EDICT, 2005). Similarly, 10 year follow-up data from the UKPDS trial showed significantly less cardiovascular disease in those patients with Type 2 diabetes who were intensively treated (Holman et al, 2008). The three target levels for HbA1c (7%, 8% and 9%) are designed to provide an incentive to improve glycaemic control across the distribution of HbA1c values. The lower level may not be achievable for all patients, but the payment thresholds reflect this. Also practitioners should note that in the 2008 guidance for Type 2 diabetes NICE advises against pursuing highly intensive management to levels below 6.5%. NICE Guidance for Type 2 diabetes 2008: www.nice.org.uk/Guidance/CG66 Definition

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Anonymous

***DROPPED - REPLACED BY QOF DM 28 Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED - REPLACED BY QOF DM 28 Quality QOF indicators are based on best available clinical evidence Date 2010/11 Version History Future indicator, expected late 2011 Update Frequency Annual publication based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care

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Anonymous

Other related PI's (relation) REPLACED BY QOF DM 28 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes in whom the last HbA1c is 10 or less (or equivalent test/reference range depending on local laboratory) in the previous 15 months
Library Reference Number/Identifier QOF DM 7 Subject QOF Clinical domain : Diabetes mellitus Category QOF Clinical domain : Diabetes mellitus Detailed Descriptor The percentage of patients with diabetes in whom the last HbA1c is 10 or less (or equivalent test/ reference range depending on local laboratory) in the previous 15 months Rationale QOF Indicators are agreed in national negotiations involving DH, NHS Employers and professional bodies, and the rationale is derived from an evidence base Definition ***DROPPED - REPLACED BY QOF DM 12 This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units % Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status THIS INDICATOR HAS BEEN REPLACED BY QOF DM 12 Quality ****DROPPED - REPLACED BY QOF DM 12 Date 2008-09 Version History N/A Update Frequency Annual publication (October in 2010) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) REPLACED BY QOF DM 12 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes in whom the last blood pressure is 150/90 or less in the preceding 15 months
Library Reference Number/Identifier QOF DM 30 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor Replaces QOF DM 12. The percentage of patients with diabetes in whom the last blood pressure is 150/90 or less in the preceding 15 months Rationale Blood pressure BP lowering in people with diabetes reduces the risk of macrovascular and microvascular disease. This indicator, along with indicator DM31 are replacements to the 2009/10 indicator DM12(The percentage of patients with diabetes in whom the last blood pressure is 145/85 or less). DM31 sets a target of 140/80 mmHg as per the target recommended by NICE40 while the target of 150/90 mmHg has been set for those people who cannot manage this, such as those with retinopathy, microalbuminuria or cerebrovascular disease. Setting a BP target at a higher level, but expecting most patients to have BP below this, is intended to encourage practitioners to address the needs of the minority of patients whose BP is hard to control and will avoid the possibility of perverse incentives to focus efforts away from those at highest absolute risk. Definition The practice reports the percentage of patients on the diabetic register in which the last blood pressure measurement was 150/90 or less. The pressure must have been measured in the preceding 15 months.

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Anonymous

Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation)

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Anonymous

Along with QOF DM 31, replaces QOF DM 12 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes in whom the last blood pressure is 140/80 or less in the preceding 15 months
Library Reference Number/Identifier QOF DM 31 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor Replaces QOF DM 12. The percentage of patients with diabetes in whom the last blood pressure is 140/80 or less in the preceding 15 months Rationale Blood pressure (BP) lowering in people with diabetes reduces the risk of macrovascular and microvascular disease. This indicator, along with indicator DM30, are replacements of the 2009/10 QOF indicator DM12 (The percentage of patients with diabetes in whom the last blood pressure is 145/85 or less). The target of 140/80 mmHg has been set as per the target recommended by NICE. Definition The practice reports the percentage of patients on the diabetic register in which the last blood pressure measurement was 140/80 or less. The pressure must have been measured in the preceding 15 months. Units Numerical Coverage England Source

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Anonymous

Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Along with QOF DM 30, replaces QOF DM 12 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes in whom the last IFCC-HbA1c is 59 mmol/mol (equivalent to HbA1c of 7.5% in DCCT values) or less (or equivalent test/reference range depending on local laboratory) in the preceding 15 months
Library Reference Number/Identifier QOF DM 26 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor Replaces QOF DM 23. The percentage of patients with diabetes in whom the last IFCC-HbA1c is 59 mmol/mol (equivalent to HbA1c of 7.5% in DCCT values) or less (or equivalent test/reference range depending on local laboratory) in the preceding 15 months Rationale This indicator has been amended (from an HbA1c level of 7.0 to 7.5 per cent in DCCT values [53 to 59 mmol/mol]) following advice from the NICE QOF Advisory Committee in response to concern that a lower level of 7.0 per cent may have unintended consequences in terms of patient care because in order to achieve an average practice target of IFCC-HbA1c of 53mmol/mol (7.0 per cent) a clinician may need to aim for a IFCC-HbA1c below this in individual patients. The three target levels for IFCC-HbA1c (59, 64 and 75 mmol/mol) in the QOF are designed to provide an incentive to improve glycaemic control across the distribution of IFCC-HbA1c values. The lower level may not be achievable or appropriate for all patients. Also practitioners should note that in the 2009 guideline for Type 2 diabetes, NICE advises against pursuing highly intensive management to levels below 48mmol/mol in certain patient subgroups. There is a near linear relationship between glycaemic control and death rate in people with type 2 diabetes. In the EPIC Norfolk population cohort, a one per cent higher HbA1c was independently associated with 28 per cent higher risk of death, an association that extended below the diagnostic cut off for diabetes. These results suggest that, as with blood pressure and cholesterol, over the

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Anonymous

longer term at least, the lower the IFCC-HbA1c the better. However, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial has highlighted the risks of adopting an aggressive treatment strategy for patients at risk of cardiovascular disease. In the trials intervention group, HbA1c fell from 8.1 per cent to 6.4 per cent, but this was associated with increased mortality. However, a recent meta-analysis did not confirm such an increase in risk and reassuringly, the ADVANCE study34 and the Veteran Affairs Diabetes Trial found no increase in all-cause mortality in their intensive treatment groups. Also, long term followup of the UK Prospective Diabetes Study demonstrated a legacy effect, with fewer deaths after ten years in those initially managed intensively. However, a newly published retrospective analysis of cohort data from the UK General Practice Research Database (GPRD) has reopened the debate about how low to aim37. The study found that, among people whose treatment had been intensified by the addition of insulin or a sulphonylurea, there was no benefit in reducing HbA1c below 7.5 per cent, although these differences were not statistically significant. The mortality rate was higher among those with the tightest control (this lowest decile of cohort had HbA1c below 6.7%; median = 6.4%). The reasons for these findings are unclear, but they raise further questions about the possibility of some groups of patients for whom a tight glycaemic target is inappropriate. The NICE clinical guideline on the management of Type 2 diabetes identifies the following key priorities for implementation to help people with Type 2 diabetes achieve better glycaemic control: - Offer structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review. Inform people and their carers that structured education is an integral part of diabetes care. - Provide individualised and ongoing nutritional advice from a healthcare professional with specific expertise and competencies in nutrition. - When setting a target glycated haemoglobin (HbA1c): 1. involve the person in decisions about their individual IFCC-HbA1c target level, which may be above that of 48mmol/mol set for people with type 2 diabetes in general 2. encourage the person to maintain their individual target unless the resulting side effects (including hypoglycaemia) or their efforts to achieve this impair their quality of life 3. offer therapy (lifestyle and medication) to help achieve and maintain the IFCCHbA1c target level 4. inform a person with a higher HbA1c that reduction in IFCC-HbA1c towards the agreed target is advantageous to future health 5. avoid pursuing highly intensive management to levels of less than 48mmol/mol The NICE and SIGN clinical guidelines are consistent. Given that there is strong evidence to support tight glycaemic control in Type 1 diabetes, which is reflected in current NICE and SIGN guidance, the revised indicator aims to balance risks and

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Anonymous

benefits for people with Type 2 diabetes. Younger people with little comorbidity are more likely to reap the benefits of tighter control, whereas less stringent goals may be more appropriate for people with established cardiovascular disease, those with a history of hypoglycaemia, or those requiring multiple medications or insulin to achieve a NICE suggested target IFCC-HbA1c of 48mmol/mol. From June 2009 the way in which HbA1c results are reported in the UK has changed. A standard specific for HbA1c was prepared by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) so that HbA1c reported by laboratories is traceable to the IFCC reference method and global comparison of HbA1c results is possible. From 1 June 2011, results will be reported only as IFCC-HbA1c mmol/mol. Definition The practice reports the percentage of patients on the diabetic register in which the last IFCCHbA1c measurement was 59mmol/mol or less (value 7.5 per cent or less). The test must have been carried out in the preceding 15 months. In verifying that this information has been correctly recorded, a number of approaches could be taken: 1. inspection of the output from a computer search that has been used to provide information on this indicator 2. inspection of a sample of records of patients with diabetes to look at the proportion with a last recorded IFCC-HbA1c of 59mmol/mol or less 3. inspection of a sample of records of patients for whom a record of IFCC-HbA1c of 59mmol/mol or less is claimed, to see if there is evidence of this in the medical records. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History In use Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Replaces QOF DM 23 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes in whom the last IFCC-HbA1c is 64 mmol/mol (equivalent to HbA1c of 8% in DCCT values) or less (or equivalent test/reference range depending on local laboratory) in the preceding 15 months
Library Reference Number/Identifier QOF DM 27 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor Replaces QOF DM 24. The percentage of patients with diabetes in whom the last IFCC-HbA1c is 64 mmol/mol (equivalent to HbA1c of 8% in DCCT values) or less (or equivalent test/reference range depending on local laboratory) in the preceding 15 months Rationale Auditing the proportion of patients with an IFCC-HbA1c below 64mmol/mol is designed to provide an incentive to improve glycaemic control across the range of IFCC-HbA1c values. Definition The practice reports the percentage of patients on the diabetic register in which the last IFCCHbA1c measurement was 59mmol/mol or less (value 7.5 per cent or less). The test must have been carried out in the preceding 15 months. In verifying that this information has been correctly recorded, a number of approaches could be taken: 1. inspection of the output from a computer search that has been used to provide information on this indicator 2. inspection of a sample of records of patients with diabetes to look at the proportion with a last recorded IFCC-HbA1c of 59mmol/mol or less 3. inspection of a sample of records of patients for whom a record of IFCC-HbA1c of 59mmol/mol or less is claimed, to see if there is evidence of this in the medical records.

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Anonymous

Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History In use Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care

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Anonymous

Other related PI's (relation) Replaces QOF DM 24 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes in whom the last IFCC-HbA1c is 75 mmol/mol (equivalent to HbA1c of 9% in DCCT values) or less (or equivalent test/reference range depending on local laboratory) in the preceding 15 months
Library Reference Number/Identifier QOF DM 28 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor Replaces QOF DM 25. The percentage of patients with diabetes in whom the last IFCC-HbA1c is 75 mmol/mol (equivalent to HbA1c of 9% in DCCT values) or less (or equivalent test/reference range depending on local laboratory) in the preceding 15 months Rationale Auditing the proportion of patients with an IFCC-HbA1c below 75mmol/mol is designed to provide an incentive to improve glycaemic control amongst those with high levels of IFCCHbA1c who are at particular risk. Definition The practice reports the percentage of patients on the diabetic register in which the last IFCCHbA1c measurement was 75mmol/mol or less. The test must have been carried out in the preceding 15 months. In verifying that this information has been correctly recorded, a number of approaches could be taken: 1. inspection of the output from a computer search that has been used to provide information on this indicator 2. inspection of a sample of records of patients with diabetes to look at the proportion with last recorded IFCC-HbA1c 75 mmol/mol or less 3. inspection of a sample of records of patients for whom a record of IFCC-HbA1c 75mmol/mol or less is claimed, to see if there is evidence of this in the medical records.

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Anonymous

Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History In use Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care

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Anonymous

Other related PI's (relation) Replaces QOF DM 25 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with diabetes with a record of a foot examination and risk classification: 1) low risk (normal sensation, palpable pulses), 2) increased risk (neuropathy or absent pulses), 3) high risk (neuropathy or absent pulses plus deformity or skin changes or previous ulcer) or 4) ulcerated foot within the preceding 15 months
Library Reference Number/Identifier QOF DM 29 Subject QOF Clinical domain : Diabetes mellitus Category Ongoing management Detailed Descriptor Replaces QOF DM 9. The percentage of patients with diabetes with a record of a foot examination and risk classification: 1) low risk (normal sensation, palpable pulses), 2) increased risk (neuropathy or absent pulses), 3) high risk (neuropathy or absent pulses plus deformity or skin changes or previous ulcer) or 4) ulcerated foot within the preceding 15 months Rationale Patients with diabetes are at high risk of foot complications. Evaluation of skin, soft tissue, musculoskeletal, vascular and neurological condition on an annual basis is important for the detection of feet at raised risk of ulceration. The foot inspection and assessment should include: - identifying the presence of sensory neuropathy (loss of the ability to feel a monofilament,vibration or sharp touch) and/or the abnormal build up of callus - identifying when the arterial supply to the foot is reduced (absent foot pulses, signs of tissue ischaemia or symptoms of intermittent claudication) - identifying deformities or problems of the foot (including bony deformities, dry skin or fungal infection), which may put it at risk - identifying other factors that may put the foot at risk (which may include reduced capacity for selfcare, impaired renal function, poor glycaemic control, cardiovascular and cerebrovascular disease, or previous amputation).

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Anonymous

The NICE guideline on Type 2 diabetes: the prevention and management of foot problems advises that foot risk should be classified as: - at low current risk: normal sensation, palpable pulses - at increased risk: neuropathy or absent pulses or other risk factor - at high risk: neuropathy or absent pulses plus deformity or skin changes or previous ulcer - ulcerated foot. The practitioner carrying out the inspection and assessment should: - discuss with the patient their individual level of risk and agree plans for future surveillance - initiate appropriate referrals for expert review of those with increased risk - give advice on action to be taken in the event of a new ulcer/lesion arising - give advice on the use of footwear which will reduce the risk of a new ulcer/lesion - give advice on other aspects of foot care which will reduce the risk of a new ulcer/lesion. For the purpose of QOF the Read codes for moderate risk are used to record the concept of increased risk. In NHS Scotland, foot risk is calculated by using the SCI-DC electronic foot risk screening tool which is based on the SIGN clinical guideline 116 foot risk algorithm and as such is recognised as best practice and encouraged for use in Scotland. Definition The practice reports the percentage of patients on the diabetic register who have had a foot examination within the preceding 15 months that classifies the level of risk as follows: 1) low risk (normal sensation, palpable pulses), 2) increased risk (neuropathy or absent pulses), 3) high risk (neuropathy or absent pulses plus deformity or skin changes or previous ulcer) or 4)ulcerated foot. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History In use Update Frequency Annual publication (published in October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Replaces QOF DM 9 Additional Information There is currently no information for this item.

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Anonymous

Diagnostics waiting times: percentage of patients waiting under 6 weeks

Library Reference Number/Identifier TC03 Subject There is currently no information for this item. Category There is currently no information for this item. Detailed Descriptor Patient waiting times for the following groups of tests and procedures should be reported: Imaging - Magnetic Resonance Imaging Imaging - Computed Tomography Imaging - Non-obstetric ultrasound Imaging - Barium Enema Imaging - DEXA Scan Physiological Measurement - Audiology Audiology Assessments Physiological Measurement - Cardiology - echocardiography Physiological Measurement - Cardiology - electrophysiology Physiological Measurement - Neurophysiology - peripheral neurophysiology Physiological Measurement - Respiratory physiology - sleep studies Physiological Measurement - Urodynamics - pressures & flows Endoscopy - Colonoscopy Endoscopy - Flexi sigmoidoscopy Endoscopy - Cystoscopy Endoscopy Gastroscopy Rationale There is currently no information for this item. Definition There is currently no information for this item. Units There is currently no information for this item. Coverage

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Anonymous

There is currently no information for this item. Source Diagnostics quarterly census. Diagnostics monthly data collection (top 15 tests) Calculations/Formula/Methodology There is currently no information for this item. Creator / Producer There is currently no information for this item. Status There is currently no information for this item. Quality Please note these are patients that are waiting and not those that have been treated Date November 2012 Version History There is currently no information for this item. Update Frequency Monthly Accessibility http://transparency.dh.gov.uk/2012/07/03/monthly-diagnostics-data-2012-13/ Publisher / Owner Department of Health (DH) Other related PI's (relation) There is currently no information for this item. Additional Information Guidance: Overview: The Diagnostics data is collected on a monthly basis from NHS providers (NHS Trusts and other providers) and signed off by commissioners (Primary Care Trusts).

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Anonymous

It records patients still waiting at the end of the month. Commissioner Based Data: Commissioner based returns reflect data on a responsible population basis, which is defined as: all those patients resident within the PCT boundary; plus all patients registered with GPs who are members of the PCT, but are resident in another PCT; minus All patients resident in the PCT, but registered with a GP who is a member of another PCT Provider Based Data: Provider based returns refer to patients waiting by NHS Hospital Trust. When does the clock start? The diagnostic waiting time clock starts when the request for a diagnostic test or procedure is made. When does the clock stop? The diagnostic waiting time clock stops when the patient receives the diagnostic test/procedure. Definitions: A Diagnostic Test: This is a test or procedure used to identify a persons disease or condition and which allows a medical diagnosis to be made. Diagnostic Activity: The Activity reports the number of tests/procedures (actual number carried out during the month in question). One unit of activity is counted for each distinct clinical test/procedure carried out. Planned tests / procedures: This is the number of planned (or surveillance) diagnostic tests or procedures carried out during the month for which the patient had waited on a planned waiting list. Unscheduled tests / procedures: This is the number of diagnostic tests or procedures carried out during the month on patients following an emergency admission, as well as any diagnostic tests/procedures on patients in A&E. Waiting list tests / procedures (excluding planned): This is the number of diagnostic tests or procedures carried out during the month for which the patient had waited on a waiting list. Commissioner Organisation: A commissioner is normally a Primary Care Trust (PCT). PCTs commission services from providers of NHS care.

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Anonymous

Provider Organisation: An organisation that provides NHS treatment or care, for example an NHS Trust, a PCT provider or an Independent Sector organisation. SHA: Strategic Health Authority. England is split into 10 SHAs. SHAs lead planning for improving health services in their local area and ensuring that national priorities are integrated into local health service plans. Further details are available under the "Definitions" section at: http://transparency.dh.gov.uk/2012/07/03/monthly-diagnostics-data-2012-13/

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Anonymous

In those patients with a new diagnosis of depression and assessment of severity recorded between the preceding 1 April to 31 March, the percentage of patients who have had a further assessment of severity 4-12 weeks (inclusive) after the initial recording of the assessment of severity. Both assessments should be completed using an assessment tool validated for use in primary care
Library Reference Number/Identifier QOF DEP 5 Subject QOF Clinical domain : Depression Category Ongoing management Detailed Descriptor Replaces QOF DEP 3 In those patients with a new diagnosis of depression and assessment of severity recorded between the preceding 1 April to 31 March, the percentage of patients who have had a further assessment of severity 4-12 weeks (inclusive) after the initial recording of the assessment of severity. Both assessments should be completed using an assessment tool validated for use in primary care Rationale The rationale for such follow-up measurement is derived from the recognition that depression is often a chronic disease, yet treatment is often episodic and short-lived. The change to the wording of this indicator, from 5 12 weeks to 4 12 weeks, recognises that in clinical practice most prescriptions or follow-up appointments are given for one, two or four weeks at this stage in the illness. If treatment with antidepressants is initiated, patients should be followed-up regularly for several months. The NICE clinical guideline 90 recommends that for people started on antidepressants who are not considered to be at increased risk of suicide, normally see them after two weeks. See them regularly thereafter, for example at intervals of two to four weeks in the first three months and then at longer intervals if the response is good. Early cessation of treatment is associated with a greater risk of relapse.

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Anonymous

The guideline also suggests that a person who has benefited from taking an antidepressant should continue medication for at least six months after remission of an episode of depression. However, one study showed that only up to one-third of patients prescribed antidepressants were still receiving medication at four to six months. Analysis of the GP Research Database for the years 1993 to 2005 has confirmed this finding: more than half of patients treated with antidepressants for a new diagnosis of depression during those years received prescriptions for only one or two months of treatment, and that this pattern had not changed over the 13 year period. If drug treatment is not started after the initial diagnosis, patients should in any case be reassessed to see whether their symptoms have resolved or worsened to the point where treatment becomes advisable. Recent research into the use of severity measures has shown that patients whose GPs used the measures for follow-up in addition to initial assessment valued having repeated scores to help monitor their progress and assess the effectiveness of treatment. Most of the GPs interviewed for the same study believed that there was value in repeating the score as a way of monitoring patients progress. The nine item Patient Health Questionnaire (PHQ-9) has been shown to be a responsive and reliable measure for gauging response to treatment in individual patient care. Definition The practice reports the percentage of patients with a new diagnosis of depression whose notes record that they have had an assessment of severity 4 12 weeks (inclusive) after the initial recording of the assessment of severity related to a new diagnosis of depression. New diagnoses are those which have been made between the preceding 1 April to 31 March. To be included in the numerator for this indicator a patient needs to have had both an initial and a subsequent severity assessment. Practices also report in each patient record which of the three assessment tools they used. Verification may require randomly selecting a number of case records of patients with a new diagnosis of depression to verify that their notes record a follow-up assessment of severity 4 12 weeks after the initial assessment of severity. Timeframe The DEP3 indicator was introduced to QOF in April 2009 and for that reason, the first line of the

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Anonymous

supporting business rules excluded patients newly diagnosed before April 2009. The business rules for DEP3, like DEP2 (now DEP4), were structured to take account of the crossyear issue which ensures fair and consistent payment to practices and good patient care. The business rules therefore look back 68 weeks to address this issue. DEP3 was reviewed and updated through the NICE process and replaced by DEP5 in April 2011. The above explanation for the timeframe and the business rules still applies. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/SiteCollectionDocuments/QOFguidanceGMScontract_2011_12_FL %2013042011.pdf Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History There is currently no information for this item. Update Frequency Annual publication (published in October 2012) based on previous financial year end

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Anonymous

Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) Replaces QOF DEP 3 Additional Information There is currently no information for this item.

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Anonymous

In those patients with a new diagnosis of depression and assessment of severity recorded between the preceding 1 April to 31 March, the percentage of patients who have had a further assessment of severity 5-12 weeks (inclusive) after the initial recording of the assessment of severity. Both assessments should be completed using an assessment tool validated for use in primary care
Library Reference Number/Identifier QOF DEP 3 Subject QOF Clinical domain : Depression Category Ongoing management Detailed Descriptor In those patients with a new diagnosis of depression and assessment of severity recorded between the preceding 1 April to 31 March, the percentage of patients who have had a further assessment of severity 5-12 weeks (inclusive) after the initial recording of the assessment of severity. Both assessments should be completed using an assessment tool validated for use in primary care Rationale The rationale for such follow-up measurement is derived from the recognition that depression is often a chronic disease, yet treatment is often episodic and short-lived. If treatment with antidepressants is initiated, then patients should be being followed up regularly for several months. Early cessation of treatment is associated with a greater risk of relapse, and the 2004 NICE guidelines on depression recommend initial treatment for six months after recovery. One study showed that only around one third or less of patients prescribed antidepressants were still receiving medication at 4-6 months. Recent analysis of the GP Research Database for the years 1993 to 2005 has confirmed this finding: more than half of the patients treated with antidepressants for a new diagnosis of depression during those years received prescriptions for only one or two months of treatment and that pattern had not changed over the 13 year period. If treatment is not started after the initial diagnosis then NICE guidance suggests patients should in any case be reassessed over one to two months, to see whether their symptoms have resolved or worsened to the point where treatment becomes advisable (watchful waiting).

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Anonymous

Recent research into the use of severity measures has shown that patients whose GPs used the measures for follow-up in addition to initial assessment valued having repeated scores to help monitor their progress and assess the effectiveness of treatment. When asked, most of the GPs interviewed for the same study also believed that there was value in repeating the score as a way of monitoring patients progress. Definition ***DROPPED - REPLACED BY QOF DEP 5 Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED - REPLACED BY QOF DEP 5 Quality QOF indicators are based on best available clinical evidence Date 2010/11 Version History Future indicator, expected late 2011 Update Frequency

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Anonymous

Annual publication based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) ***DROPPED - REPLACED BY QOF DEP 5 Additional Information There is currently no information for this item.

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Anonymous

Mortality following a hip replacement

Library Reference Number/Identifier MR31 Subject Mortality Category Hospital care Detailed Descriptor This measure is presented as a survival ratio on the NHS Choices website, full methodology is available at http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=93&OrgType=5 Rationale Many clinicians use survival rates to monitor and improve the quality of care in the services that they provide. Definition The rates are calculated from routinely collected hospital data, a full methodology is available at http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=93&OrgType=5 Units Below expected, as expected, above expected Coverage Acute non-specialist providers Source Commissioning Data Sets_36 Months Calculations/Formula/Methodology Full methodology is available at http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=93&OrgType=5 Creator / Producer Data is supplied to NHS Choices by the NHS Information Centre for health and social care

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Anonymous

Status In use Quality The indicator is derived from mandatory data sets (Hospital Episode Statistics) and the source data and the indicators themselves are validated with individual providers, there may be some variation in the way that data is recorded by hospitals or trusts and this may lead to a risk of misreporting. Data is updated monthly. Date Q1 M3 2012-13 Version History N/A Update Frequency The data will be updated monthly on a rolling three year cycle (for example, data published in June 2008 is based on the period January 2005 December 2007). Accessibility http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=93&OrgType=5 Publisher / Owner Data is published by NHS Choices and commissioned by NHS Choices from the NHS Information Centre for health and social care Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Mortality following a knee replacement

Library Reference Number/Identifier MR30 Subject Mortality Category Hospital care Detailed Descriptor This measure is presented as a survival ratio on the NHS Choices website, full methodology is available at http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=94&OrgType=5 Rationale Many clinicians use survival rates to monitor and improve the quality of care in the services that they provide. Definition The rates are calculated from routinely collected hospital data, a full methodology is available at :http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=94&OrgType=5 Units Below expected, as expected, above expected Coverage Acute non-specialist providers Source Commissioning Data Sets_36 Months Calculations/Formula/Methodology Full methodology is available at http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=94&OrgType=5 Creator / Producer Data is supplied to NHS Choices by the NHS Information Centre for health and social care

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Anonymous

Status In use Quality The indicator is derived from mandatory data sets (Hospital Episode Statistics) and the source data and the indicators themselves are validated with individual providers, there may be some variation in the way that data is recorded by hospitals or trusts and this may lead to a risk of misreporting. Data is updated monthly. Date Q1 M3 2012-13 Version History N/A Update Frequency The data will be updated monthly on a rolling three year cycle (for example, data published in June 2008 is based on the period January 2005 December 2007). Accessibility http://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=94&OrgType=5 Publisher / Owner Data is published by NHS Choices and commissioned by NHS Choices from the NHS Information Centre for health and social care Other related PI's (relation) There is currently no information for this item. Additional Information There is currently no information for this item.

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Anonymous

Percentage of BADS (British Association of Day Surgery) Directory of Procedures (including electronic assessment) carried out as a day case or within appropriate length of stay
Library Reference Number/Identifier TC05 Subject British Association of Day Surgery (BADS) Category Directory of Procedures Detailed Descriptor There is currently no information for this item. Rationale There is currently no information for this item. Definition There is currently no information for this item. Units There is currently no information for this item. Coverage There is currently no information for this item. Source Hospital Episode Statistics via British Association of Day Surgery Calculations/Formula/Methodology The methodology for use of the BADS Procedure Directory (allowing an easily comparable benchmark by procedure, surgical sub-speciality, and overall organisation performance) has been developed and piloted by the Association over the last six months. We believe we have a robust algorithm for calculation of duration of stay, and from that, the derived Efficiency Score to provide intuitively understandable information. An overview is available on the BADS website at: http://www.bads.co.uk/bads/joomla/index.php/efficiency-assessment-tool (old link is

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Anonymous

http://www.bads.co.uk/content/files/downloads/bads%20assessment%20tool.htm) Creator / Producer There is currently no information for this item. Status There is currently no information for this item. Quality There is currently no information for this item. Date 2008-09 Version History There is currently no information for this item. Update Frequency There is currently no information for this item. Accessibility Available at: http://www.bads.co.uk/bads/joomla/index.php/efficiency-assessment-tool Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) There is currently no information for this item. Additional Information For the pilot sites involved with the project, we have fed back comparative benchmarks based upon their epoch of data submitted (mostly annual), but believe that quarterly review is feasible in accord with the current dissemination provided by the Better Care, Better Values website (http://www.productivity.nhs.uk/) The indicator is already calculated with ease by the Association, though derivation on a national basis would require categorisation by duration of stay from national returns, together with derivation of the BADS Efficiency Score National reporting of Day and Short stay performance for England needs to advance beyond the

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Anonymous

Audit Commission Basket of 25 procedures. NHS Scotland have already adopted reporting by BADS Directory remits, (http://www.scotland.gov.uk/Publications/2006/11/17092115/0) with Wales, following discussions with BADS, considering similar progression.

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Anonymous

Pressure ulcer incidence per 10,000 patients

Library Reference Number/Identifier HES 1 Subject Future indicator Category Future indicator Detailed Descriptor Future indicator Rationale Measured in most care settings. Links to nursing care and the planning and preventative nature of care, the importance of the fundamentals of care such as nutrition, hydration. Included as part of the patient centred benchmarks within Essence of Care. (Pressure Ulcers) Pressure ulcers involve wider MDT such as AHPs and medical staff. 2007/8 there were 42,995 episodes of pressure ulcers, of which 3,225 were primary diagnoses, demonstrating that data are collected and coded nationally. Pressure Ulcer data are universally collected (allowing for local/regional and international benchmarking) Definition Future indicator Units Future indicator Coverage Future indicator Source Hospital Episode Statistics (HES) Calculations/Formula/Methodology Future indicator

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Anonymous

Creator / Producer Future indicator Status Future indicator Quality Future indicator Date Future indicator Version History Future indicator Update Frequency Future indicator Accessibility Future indicator Publisher / Owner Future indicator Other related PI's (relation) Future indicator Additional Information Future indicator

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Anonymous

Surgical site infections - Hip hemiarthroplasty

Library Reference Number/Identifier HC25 Subject Health Protection Agency (HPA) Category Surgical Site Infections (SSI) Detailed Descriptor Rate of surgical site infection following hip hemiarthroplasty Rationale SSIs are of public health importance given their impact on patient care and associated costs to the health service. Surveillance of SSIs enables Trusts to benchmark their rates of infection against national rates, providing a means for identifying and investigating elevated rates of SSI. Definition Numerator: number of SSIs detected during hospital stay and at readmission in each category of surgery. Denominator: number of operations within each category of surgery. Units % Coverage England Source Surgical Site Infection Surveillance Service (Health Protection Agency) Calculations/Formula/Methodology The % SSI represents the number of SSIs detected during the post-operative stay in hospital or during readmission divided by the number of operations performed in that category of surgery. Eligible procedures are defined by a set of OPCS codes for each category of surgery. Trusts must undertake surveillance for a minimum of one quarter in one of four orthopaedic categories and have the option of participating in any number of 14 other surgical categories. The surveillance must include all patients undergoing an eligible procedure during the surveillance period. Further

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Anonymous

details on the methodology including standard case definitions for SSI are described in the surveillance protocol. Creator / Producer Health Protection Agency Status Live Quality Data are submitted via a web-based data entry system with in-built data validation systems. The data are subsequently checked comprehensively for errors by HPA surveillance staff. The following limitations should be borne in mind in interpreting these data: 1) Surveillance protocols were amended in July 2008 and participating hospitals required to collect data on SSIs identified at readmission in addition to those detected in the post-operative stay previously. This increased the rate of detection of SSIs. 2) Some Trusts perform small numbers of operations and their rates of SSI may therefore be imprecise. 3) No adjustment has been made for the case mix of patients or other important risk factors that may affect Trusts' rates of SSI which should be taken into account when comparing rates. Date 2011-12 Version History v2.0 Update Frequency Annually Accessibility Data available from: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/SurgicalSiteInfectionSurveillanceSe rvice/ http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1227774003731 Publisher / Owner Health Protection Agency

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Anonymous

Other related PI's (relation) There is currently no information for this item. Additional Information *The confidence limits represent the range of rates between which the true rate of infection could feasibly lie and will be wider for those Trusts with fewer operations. Very low, or very high rates that are based on a small number of procedures should therefore not be taken at face value but should be interpreted in conjunction with the confidence limits. The conventional method of calculating confidence limits could be misleading for rates based on less than 50 operations, as they overestimate the true upper 95% limit, and for this reason they have not been included for Trusts with less than 50 operations in a particular orthopaedic category. Hammersmith NHS Trust merged with Imperial College Healthcare NHS Trust on 1st October 2007. Imperial College Healthcare NHS Trust was formed on 1st October 2007 by merging St Mary's NHS Trust and Hammersmith NHS Trust. Surrey & Sussex Healthcare NHS TrusT: Includes Redwood Diagnosis and Treatment Centre merged with Surrey & Sussex Healthcare NHS Trust after March 2008.

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Anonymous

Surgical site infections - Hip prosthesis

Library Reference Number/Identifier HC23 Subject Health Protection Agency (HPA) Category Surgical Site Infections (SSI) Detailed Descriptor Rate of surgical site infection following hip prosthesis Rationale SSIs are of public health importance given their impact on patient care and associated costs to the health service. Surveillance of SSIs enables Trusts to benchmark their rates of infection against national rates, providing a means for identifying and investigating elevated rates of SSI. Definition Numerator: number of SSIs detected during hospital stay and at readmission in each category of surgery. Denominator: number of operations within each category of surgery. Units % Coverage England Source Surgical Site Infection Surveillance Service (Health Protection Agency) Calculations/Formula/Methodology The % SSI represents the number of SSIs detected during the post-operative stay in hospital or during readmission divided by the number of operations performed in that category of surgery. Eligible procedures are defined by a set of OPCS codes for each category of surgery. Trusts must undertake surveillance for a minimum of one quarter in one of four orthopaedic categories and have the option of participating in any number of 14 other surgical categories. The surveillance must include all patients undergoing an eligible procedure during the surveillance period. Further

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Anonymous

details on the methodology including standard case definitions for SSI are described in the surveillance protocol. Creator / Producer Health Protection Agency Status Live Quality Data are submitted via a web-based data entry system with in-built data validation systems. The data are subsequently checked comprehensively for errors by HPA surveillance staff. The following limitations should be borne in mind in interpreting these data: 1) Surveillance protocols were amended in July 2008 and participating hospitals required to collect data on SSIs identified at readmission in addition to those detected in the post-operative stay previously. This increased the rate of detection of SSIs. 2) Some Trusts perform small numbers of operations and their rates of SSI may therefore be imprecise. 3) No adjustment has been made for the case mix of patients or other important risk factors that may affect Trusts' rates of SSI which should be taken into account when comparing rates. Date 2011-12 Version History v2.0 Update Frequency Annually Accessibility Data available from: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/SurgicalSiteInfectionSurveillanceSe rvice/ http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1227774003731 Publisher / Owner Health Protection Agency

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Anonymous

Other related PI's (relation) There is currently no information for this item. Additional Information *The confidence limits represent the range of rates between which the true rate of infection could feasibly lie and will be wider for those Trusts with fewer operations. Very low, or very high rates that are based on a small number of procedures should therefore not be taken at face value but should be interpreted in conjunction with the confidence limits. The conventional method of calculating confidence limits could be misleading for rates based on less than 50 operations, as they overestimate the true upper 95% limit, and for this reason they have not been included for Trusts with less than 50 operations in a particular orthopaedic category. Hammersmith NHS Trust merged with Imperial College Healthcare NHS Trust on 1st October 2007. Imperial College Healthcare NHS Trust was formed on 1st October 2007 by merging St Mary's NHS Trust and Hammersmith NHS Trust. Surrey & Sussex Healthcare NHS TrusT: Includes Redwood Diagnosis and Treatment Centre merged with Surrey & Sussex Healthcare NHS Trust after March 2008.

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Anonymous

Surgical site infections - Knee prosthesis

Library Reference Number/Identifier HC22 Subject Health Protection Agency (HPA) Category Surgical Site Infections (SSI) Detailed Descriptor Rate of surgical site infection following knee prosthesis Rationale SSIs are of public health importance given their impact on patient care and associated costs to the health service. Surveillance of SSIs enables Trusts to benchmark their rates of infection against national rates, providing a means for identifying and investigating elevated rates of SSI. Definition Numerator: number of SSIs detected during hospital stay and at readmission in each category of surgery. Denominator: number of operations within each category of surgery. Units % Coverage England Source Surgical Site Infection Surveillance Service (Health Protection Agency) Calculations/Formula/Methodology The % SSI represents the number of SSIs detected during the post-operative stay in hospital or during readmission divided by the number of operations performed in that category of surgery. Eligible procedures are defined by a set of OPCS codes for each category of surgery. Trusts must undertake surveillance for a minimum of one quarter in one of four orthopaedic categories and have the option of participating in any number of 14 other surgical categories. The surveillance must include all patients undergoing an eligible procedure during the surveillance period. Further

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Anonymous

details on the methodology including standard case definitions for SSI are described in the surveillance protocol. Creator / Producer Health Protection Agency Status Live Quality Data are submitted via a web-based data entry system with in-built data validation systems. The data are subsequently checked comprehensively for errors by HPA surveillance staff. The following limitations should be borne in mind in interpreting these data: 1) Surveillance protocols were amended in July 2008 and participating hospitals required to collect data on SSIs identified at readmission in addition to those detected in the post-operative stay previously. This increased the rate of detection of SSIs. 2) Some Trusts perform small numbers of operations and their rates of SSI may therefore be imprecise. 3) No adjustment has been made for the case mix of patients or other important risk factors that may affect Trusts' rates of SSI which should be taken into account when comparing rates. Date 2011-12 Version History v2.0 Update Frequency Annually Accessibility Data available from: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/SurgicalSiteInfectionSurveillanceSe rvice/ http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1227774003731 Publisher / Owner Health Protection Agency

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Anonymous

Other related PI's (relation) There is currently no information for this item. Additional Information *The confidence limits represent the range of rates between which the true rate of infection could feasibly lie and will be wider for those Trusts with fewer operations. Very low, or very high rates that are based on a small number of procedures should therefore not be taken at face value but should be interpreted in conjunction with the confidence limits. The conventional method of calculating confidence limits could be misleading for rates based on less than 50 operations, as they overestimate the true upper 95% limit, and for this reason they have not been included for Trusts with less than 50 operations in a particular orthopaedic category. Hammersmith NHS Trust merged with Imperial College Healthcare NHS Trust on 1st October 2007. Imperial College Healthcare NHS Trust was formed on 1st October 2007 by merging St Mary's NHS Trust and Hammersmith NHS Trust. Surrey & Sussex Healthcare NHS TrusT: Includes Redwood Diagnosis and Treatment Centre merged with Surrey & Sussex Healthcare NHS Trust after March 2008.

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Anonymous

The percentage of patients age 18 and over on drug treatment for epilepsy who have a record of seizure frequency in the previous 15 months
Library Reference Number/Identifier QOF EPILEPSY 6 Subject QOF Clinical domain : Epilepsy Category Ongoing management Detailed Descriptor The percentage of patients age 18 and over on drug treatment for epilepsy who have a record of seizure frequency in the previous 15 months Rationale It is recommended that the following information should be recorded routinely in patients notes at each review: seizure type and frequency, including date of last seizure antiepileptic drug therapy and dosage any adverse drug reactions arising from antiepileptic drug therapy key indicators of the quality of care i.e. topics discussed and plans for future review. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source

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Anonymous

Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF EPILEPSY 6 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients aged 18 and over on drug treatment for epilepsy who have a record of medication review involving the patient and/or carer in the previous 15 months
Library Reference Number/Identifier QOF EPILEPSY 7 Subject QOF Clinical domain : Epilepsy Category Ongoing management Detailed Descriptor The percentage of patients age 18 and over on drug treatment for epilepsy who have a record of medication review involving the patient and/or carer in the previous 15 months Rationale The involvement of the patient and/or carer is included to stress the importance of a face to face medication review, where clinically appropriate. It is recommended that the following information should be recorded routinely in patients notes at each review: seizure type and frequency, including date of last seizure antiepileptic drug therapy and dosage any adverse drug reactions arising from antiepileptic drug therapy key indicators of the quality of care i.e. topics discussed and plans for future review. Definition ***DROPPED This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units

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Anonymous

Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (October in 2010) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF EPILEPSY 7

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Anonymous

Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients aged 18 and over on drug treatment for epilepsy who have been seizure free for the last 12 months recorded in the previous 15 months
Library Reference Number/Identifier QOF EPILEPSY 8 Subject QOF Clinical domain : Epilepsy Category Ongoing management Detailed Descriptor The percentage of patients age 18 and over on drug treatment for epilepsy who have been seizure free for the last 12 months recorded in the previous 15 months Rationale Seizure control gives some indication of how effective the management of epilepsy is. However, it is recognised that seizure control is often under the influence of factors outside the general practitioners control. It is expected that exception-reporting in the epilepsy data set will be more common than in other chronic conditions (e.g. for patients with forms of brain injury which mean that their seizures cannot be controlled, patients who find the side effects of medication intolerable etc). The top level in this indicator has been deliberately kept at a lower level in order to encourage general practitioners to record the frequency of seizures as accurately as possible. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical

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Anonymous

Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF EPILEPSY 8 Additional Information

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Anonymous

There is currently no information for this item.

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Anonymous

The percentage of patients aged eight and over diagnosed as having asthma from 1 April 2006 with measures of variability or reversibility
Library Reference Number/Identifier QOF ASTHMA 8 Subject QOF Clinical domain : Asthma Category Initial management Detailed Descriptor The percentage of patients aged eight and over diagnosed as having asthma from 1 April 2006 with measures of variability or reversibility Rationale Accurate diagnosis is fundamental in order to avoid untreated symptoms as a result of underdiagnosis, and inappropriate treatment as a result of over-diagnosis. Both scenarios have implications both to the health of the patient, and the cost of providing healthcare. National and international guidelines emphasise the importance of demonstrating variable lung function in order to confirm the diagnosis of asthma. Variability of PEF and FeV1, either spontaneously over time or in response to therapy is a characteristic feature of asthma. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF ASTHMA 8 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio(or protein:creatinine ratio) test in the preceding 15 months
Library Reference Number/Identifier QOF CKD 6 Subject QOF Clinical Domain: Chronic Kidney Disease (CKD) Category Ongoing management Detailed Descriptor The percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio(or protein:creatinine ratio) test in the preceding 15 months Rationale Quantitative measurement of proteinuria will enable appropriate management of patients with CKD. There is good observational evidence linking proteinuria to adverse outcome. NICE recommends the use of ACE inhibitors when there is hypertension and an ACR of 30mg/mmol. When ACR 70mg/mmol NICE recommends ACE-1 are prescribed; even in the absence of hypertension. SIGN recommends the use of ACE-1 and/or ARBs as agents of choice in patients with proteinuria >0.5g/day (approximately equivalent to a PCR of >50mg/mmol). As with BP there are stricter standards for those with diabetes; ACR >2.5mg/mmol in men and >3.5mg/mmol in women with or without hypertension. Definition The percentage of patients on the CKD register whose notes have a record of a urine albumin:creatinine ratio (or protein:creatinine ratio) test in the preceding 15 months Units Numerical

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Anonymous

Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History New indicator for 2011-12 Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) There is currently no information for this item. Additional Information

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Anonymous

www.nice.org.uk/Guidance/CG73 www.sign.ac.uk/guidelines/fulltext/103/index.html

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Anonymous

The percentage of patients with asthma between the ages of 14 and 19 in whom there is a record of smoking status in the previous 15 months
Library Reference Number/Identifier QOF ASTHMA 3 Subject QOF Clinical domain : Asthma Category Ongoing management Detailed Descriptor The percentage of patients with asthma between the ages of 14 and 19 in whom there is a record of smoking status in the previous 15 months Rationale Many young people start to smoke at an early age. It is therefore justifiable to ask about smoking on an annual basis in this age group. The number of studies of smoking related to asthma are surprisingly few in number. Starting smoking as a teenager increases the risk of persisting asthma. There are very few studies that have considered the question of whether smoking affects asthma severity. One controlled cohort study suggested that exposure to passive smoke at home delayed recovery from an acute attack. There is also epidemiological evidence that smoking is associated with poor asthma control. It is recommended that smoking cessation be encouraged as it is good for general health and may decrease asthma severity. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage

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Anonymous

England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF ASTHMA 3 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with asthma who have had an asthma review in the previous 15 months
Library Reference Number/Identifier QOF ASTHMA 6 Subject QOF Clinical domain : Asthma Category Ongoing management Detailed Descriptor The percentage of patients with asthma who have had an asthma review in the previous 15 months Rationale Structured care has been shown to produce benefits for patients with asthma. The recording of morbidity, PEF levels, inhaler technique and current treatment and the promotion of selfmanagement skills are common themes of good structured care. SIGN/BTS proposes a structured system for recording inhaler technique, morbidity, PEF levels, current treatment and asthma action plans. National and international guidelines recommend the use of standard questions for the monitoring of asthma. Proactive structured review, as opposed to opportunistic or unscheduled review, is associated with reduced exacerbation rate and days lost from normal activity. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England

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Anonymous

Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF ASTHMA 6 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with hypothyroidism with thyroid function tests recorded in the previous 15 months
Library Reference Number/Identifier QOF THYROID 2 Subject QOF Clinical domain : Hypothroid Category Ongoing management Detailed Descriptor The percentage of patients with hypothyroidism with thyroid function tests recorded in the previous 15 months Rationale There is no clear evidence on the appropriate frequency of TSH/T4 measurement. However, the consensus group on thyroid disease recommended an annual check of TSH/T4 levels in all patients treated with thyroxine. In addition they recommend an annual check in patients previously treated with radio-iodine or partial thyroidectomy (Consensus statement for good practice and audit measures in the management of hypothyroidism and hyperthyroidism. BMJ 1996; 313: 539544). The practice should report the percentage of patients on its hypothyroid register who have had a TSH or T4 undertaken in the last 15 months. In verifying that this information has been correctly recorded, a number of approaches could be taken by a PCO: i. Inspection of the output from a computer search that has been used to provide information on this indicator. ii. Inspection of a sample of records of patients with hypothyroidism to look at the proportion with recorded TSH/T4. iii. Inspection of a sample of records of patients with hypothyroidism for whom a record of TSH/T4 is claimed, to see if there is evidence of this in the medical records. Definition

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Anonymous

This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level

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Anonymous

Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF THYROID 2 Additional Information There is currently no information for this item.

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Anonymous

The percentage of women prescribed an oral or patch contraceptive method who have also received information from the practice about long acting reversible methods of contraception in the preceding 15 months
Library Reference Number/Identifier QOF SH 2 Subject QOF Additional Services Category Contraception Detailed Descriptor The percentage of women prescribed an oral or patch contraceptive method who have also received information from the practice about long acting reversible methods of contraception in the preceding 15 months Rationale A womans contraceptive needs can change over her reproductive lifespan. Women requiring contraception should be given detailed information about and offered a choice of all methods, including LARC. This indicator seeks to encourage practices to review these needs on a regular basis and ensure that women are informed of advances in contraceptive choices. Definition The percentage of women prescribed an oral or patch contraceptive method who have also received information from the practice about long acting reversible methods of contraception in the preceding 15 months Units Numerical Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History New indicator in 2011-12 Update Frequency Annual publication (October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) There is currently no information for this item. Additional Information The FPA, a UK-wide sexual health charity, has an excellent range of contraception leaflets including Your Guide to Contraception, which, amongst other things, indicates LARC and nonLARC methods clearly through the use of shading. http://www.fpa.org.uk/Information/Readourinformationbooklets/guide

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Anonymous

The percentage of women prescribed emergency hormonal contraception at least once in the year by the practice who have received information from the practice about long acting reversible methods of contraception at the time of, or within 1 month of, the prescription
Library Reference Number/Identifier QOF SH 3 Subject QOF Additional Services Category Contraception Detailed Descriptor The percentage of women prescribed emergency hormonal contraception at least once in the year by the practice who have received information from the practice about long acting reversible methods of contraception at the time of, or within one month of, the prescription Rationale Women requiring emergency hormonal contraception should be given detailed information about and offered a choice of all methods, including LARC. It is often possible (and in many cases ideal practice) to commence an ongoing method of contraception at the same time as emergency hormonal contraception is given. Definition The percentage of women prescribed emergency hormonal contraception at least once in the year by the practice who have received information from the practice about long acting reversible methods of contraception at the time of, or within 1 month of, the prescription Units Numerical Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History New indicator in 2011-12 Update Frequency Annual publication (October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) There is currently no information for this item. Additional Information The FPA, a UK-wide sexual health charity, has an excellent range of contraception leaflets including Your Guide to Contraception, which, amongst other things, indicates LARC and nonLARC methods clearly through the use of shading. http://www.fpa.org.uk/Information/Readourinformationbooklets/guide

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Anonymous

The practice can produce a register of patients aged 18 and over receiving drug treatment for epilepsy
Library Reference Number/Identifier QOF EPILEPSY 5 Subject QOF Clinical domain : Epilepsy Category Records Detailed Descriptor The practice can produce a register of patients aged 18 and over receiving drug treatment for epilepsy Rationale The clinical indicators of epilepsy care cannot be checked unless the practice has a register of patients with epilepsy. The phrase receiving treatment has been included in order to exclude the large number of patients who had epilepsy in the past, and may have been off treatment and fitfree for many years. Some patients may still be coded as epilepsy or history of epilepsy and will be picked up on computer searches. Patients who have a past history of epilepsy who are not on drug therapy should be excluded from the register. Drugs on repeat prescription will be picked up on search. It is proposed that the disease register includes patients aged 18 and over as care for younger patients is generally undertaken outside of primary care. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England

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Anonymous

Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF EPILEPSY 5 Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients with asthma, excluding patients with asthma who have been prescribed no asthma-related drugs in the previous twelve months
Library Reference Number/Identifier QOF ASTHMA 1 Subject QOF Clinical domain : Asthma Category Records Detailed Descriptor The practice can produce a register of patients with asthma, excluding patients with asthma who have been prescribed no asthma-related drugs in the previous twelve months Rationale Proactive structured review as opposed to opportunistic or unscheduled review is associated with reduced exacerbation rates and days lost from normal activity. A register of patients who require follow up is a pre-requisite for structured asthma care. The diagnosis of asthma is a clinical one; there is no confirmatory diagnostic blood test, radiological investigation or histopathological investigation. In most people, the diagnosis can be corroborated by suggestive changes in lung function tests. One of the main difficulties in asthma is the variable and intermittent nature of asthma. Some of the symptoms of asthma are shared with diseases of other systems. Features of an airway disorder in adults such as cough, wheeze and breathlessness should be corroborated where possible by measurement of airflow limitation and reversibility. Obstructive airways disease produces a decrease in peak expiratory flow (PEF) and forced expiratory volume in one second (FeV1) but which persist after bronchodilators have been administered. One or both of these should be measured, but may be normal if the measurement is made between episodes of bronchospasm. If repeatedly normal in the presence of symptoms, then a diagnosis of asthma must be in doubt. A proportion of patients with COPD will also have asthma i.e. they have large reversibility 400mls or more on FeV1 but do not return to over 80 per cent predicted and have a significant smoking history. From 1 April 2006 these patients should be recorded on both the asthma and

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Anonymous

COPD registers. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level

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Anonymous

Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF ASTHMA 1 Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients with hypothyroidism

Library Reference Number/Identifier QOF THYROID 1 Subject QOF Clinical domain : Hypothroid Category Records Detailed Descriptor The practice can produce a register of patients with hypothyroidism Rationale A register is a prerequisite for monitoring patients with hypothyroidism. Many patients will have been diagnosed at some time in the past and the details of the diagnostic criteria may not be available. For this reason the patient population should consist of those patients taking thyroxine with a recorded diagnosis of hypothyroidism. The most effective method for identifying the patient population would be a computer search for repeat prescribing of thyroxine with a subsequent check of the records to confirm the clinical diagnosis. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF THYROID 1 Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of women who have been prescribed any method of contraception at least once in the last year, or other appropriate interval e.g. 5 years for an IUS
Library Reference Number/Identifier QOF SH 1 Subject QOF Additional Services Category Contraception Detailed Descriptor The practice can produce a register of women who have been prescribed any method of contraception at least once in the last year Rationale General practices provide 80% of prescribed contraception in the UK. This register is applicable to all methods of contraception that have been prescribed by the practice: Emergency hormonal contraception Combined oral contraception Progestogen only oral contraception Contraceptive patch Contraceptive diaphragm Intrauterine device (IUD) Intrauterine system (IUS) Contraceptive implant Any woman who has been prescribed any method at least once in the last year (or the appropriate prescribing interval for method of choice) should be included on the register. Definition The practice can produce a register of women who have been prescribed any method of contraception at least once in the last year Units Numerical

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Anonymous

Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History New indicator in 2011-12 Update Frequency Annual publication based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) There is currently no information for this item. Additional Information

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Anonymous

The FPA, a UK-wide sexual health charity, has an excellent range of contraception leaflets including Your Guide to Contraception, which, amongst other things, indicates LARC and nonLARC methods clearly through the use of shading. http://www.fpa.org.uk/Information/Readourinformationbooklets/guide

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Anonymous

Average waiting time for neurovascular clinics

Library Reference Number/Identifier CV19 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale There is currently no information for this item. Definition Check through the appointments for TIA/neurovascular clinic appointments made in the previous month to calculate the delay between referral and appointment for minor stroke/TIA This is to exclude sites who do not provide any service for TIA (e.g. rehabilitation only sites) Units Days Coverage England, Wales and Northern Ireland Source Sentinel Stroke Audit - Organisational Audit Calculations/Formula/Methodology Question 5.5iii) See full wording of questions for exceptions in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Only applicable to sites offering a TIA service with a neurovascular clinic. Creator / Producer

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Anonymous

Royal College of Physicians Status In use Quality It is in the public domain Date 2010 Version History There is currently no information for this item. Update Frequency Usually every 2 years. Exceptionally 2008 and 2009. The interim data collection for the NAO report Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf Publisher / Owner Royal College of Physicians Other related PI's (relation) There is currently no information for this item. Additional Information *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Anonymous

Number of higher risk TIA cases who are scanned and treated within 24 hours
Library Reference Number/Identifier CV11 Subject Vital Signs Category National Requirement Tier 1 Detailed Descriptor Patients who spend at least 90% of their time on a stroke unit and higher risk TIA cases who are scanned and treated within 24 hours Rationale 110,000 people have a stroke each year, around a third of whom die. Stroke is the largest single cause of adult disability there are around 300,000 people in England living with moderate to severe disabilities as a result of a stroke. Good care on a dedicated stroke unit is the single most effective way to improve outcomes for people with stroke. Early initiation of treatment for Transient Ischaemic Attacks (TIAs) or minor stroke can reduce the number of people going on to have a major stroke by 80%. Higher risk TIA cases are defined as those with an ABCD2 score of 4 or above. These indicators are a good proxy for reducing disability and death due to stroke. Current Performance: Neither of these are currently measured, however, 56% of people with stroke spend the majority of their time in a stroke unit, 35% of people with TIAs are treated in 7 days. Expected Position by the end of 2010/11: 80% of people with stroke spend at least 90% of their time on a stroke unit and 60% of higher risk TIA cases are treated within 24 hours by 2010/11. National Stroke Strategy and other related information (including Action on Stroke Services Toolkit) can be found on www.dh.gov.uk/stroke Definition Patients who spend at least 90% of their time on a stroke unit : Detailed definition:

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Anonymous

As defined by the National Sentinel Stroke Audit a Stroke unit is a multidisciplinary team including specialist nursing staff based in a discrete ward which has been designated for stroke patients. This category includes the following sub-divisions: Acute stroke units that accept patients acutely but discharge early (usually within 7 days). This could include an ""intensive"" model of care with continuous monitoring and high nurse staffing levels. Rehabilitation stroke units which accept patients after a delay of usually 7 days or more and focus on rehabilitation Combined stroke unit (ie no separation between acute and rehabilitation beds) that accept patients acutely but also provide rehabilitation for at least several weeks if necessary. A stroke unit should have at least four of the key characteristics of a good stroke unit as defined by the National Sentinel Stroke Audit. The five key characteristics of a stroke unit are: Consultant physician with responsibility for stroke Formal links with patient and carer organisations Multidisciplinary meetings at least weekly to plan patient care Provision of information to patients about stroke Continuing education programmes for staff Patients with the ICD10 codes I60-I69 should be reported against this line. If a patient has two episodes on a stroke unit they should be counted twice. Number of people who were admitted to hospital following a stroke: Detailed definition: The same ICD10 codes apply as above. If a patient has two episodes of admissions to hospital following a stroke they should be counted twice. Transient Ischaemic Attack (TIA) cases with a higher risk of stroke who are treated within 24 hours: Detailed definition: Higher risk TIA cases are defined as those with an ABCD2 score of 4 or above. The ABCD2 score is calculated using the patient's age (A); blood pressure (B); clinical features (C); duration of TIA symptoms (D); and presence of diabetes (2). Scores are between 0 and 7 points. Age (60 years, 1 point); Blood pressure at presentation (140/90 mm Hg, 1 point); Clinical features (unilateral weakness, 2 points; speech disturbance without weakness, 1 point);

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Anonymous

 Duration of TIA symptoms (60 minutes, 2 points; 10-59 minutes, 1 point); and presence of diabetes (1 point). Low risk = 0-3 points; moderate risk = 4-5 points; high-risk = 6-7 points. If a patient has two episodes of TIA which are treated within 24 hours, in the period, they should be counted twice. Patients with the following ICD10 codes should be reported against this line. G450 Vertebro-basilar artery syndrome G451 Carotid artery syndrome (hemispheric) G452 Multiple and bilateral precerebral artery syndromes G453 Amaurosis fugax G458 Other transient cerebral ischaemic attacks and related synd G459 Transient cerebral ischaemic attack, unspecified Number of people who have a Transient Ischaemic Attack (TIA) who are at higher risk of stroke: Detailed definition: Higher risk TIA cases are defined as those with an ABCD2 score of 4 or above. If a patient has two episodes of TIA, in the period, they should be counted twice. The same ICD10 codes apply as above Direction: Current Performance: Neither of these are currently measured. The National Sentinel Stroke Audit, performed by the Royal College of Physicians every two years showed in 2006 that: 56% of individuals with stroke spend the majority of their time in a stroke unit; and 35% of TIAs are treated in 7 days. Expected Position by the end of 2010/11: 80% of patients spend at least 90% of their time on a stroke unit and 60% of higher risk TIA cases are scanned and treated within 24 hours by 2010/11 Units Denominator 1: number of people who have a stroke who admitted to hospital Numerator 1: number of people who spend at least 90% of their time on a stroke unit Denominator 2: number of people who have a TIA who are high risk Numerator 2: number of people who have a TIA who are scanned and treated within 24 hours Coverage

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Anonymous

England Source Sentinel Stroke Audit - Clinical Audit Calculations/Formula/Methodology UNIFY: All information posted on Vital Signs Forum http://nww.unify2.dh.nhs.uk/unify/interface/homepage.aspx Criteria for Plan Sign-off: The expected position is 80% of patients spend at least 90% of their time on a stroke unit and 60% of higher risk TIA cases are treated within 24 hours by 2010/11 In order to deliver their contribution to the national position we would expect to see at Q4 2008/09 - 65%, at Q4 2009/10 -70%, at Q4 2010/11 -80% at Q4 2008/09 - 25%, at Q4 2009/10 -45%, at Q4 2010/11 -60% Creator / Producer There is currently no information for this item. Status The data for this indicator is no longer available, so the results have been taken down from the website. Quality Baseline: The baseline for planning purposes will be the latest collection of Vital Signs Monitoring Return Date This data has not previously been collected. The National Sentinel Stroke Audit, performed by the Royal College of Physicians every two years showed in 2006 that: 56% of individuals with stroke spend the majority of their time in a stroke unit Version History Updated for 09/10 Refresh (V1.21) Update Frequency Quarterly

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Anonymous

Accessibility Available at: https://www.hub.info4local.gov.uk/DIHWEB/Logon/default.aspx?Timeout=True Disaggregated by: Commissioner (PCT) General information available from http://www.rcplondon.ac.uk/pubs/books/strokeaudit/ Publisher / Owner Department of Health (DH) Other related PI's (relation) VSA14 Additional Information The National Sentinel Stroke Audit, performed by the Royal College of Physicians every two years showed in 2006 that: 56% of individuals with stroke spend the majority of their time in a stroke unit National Stroke Strategy and other related information (including Action on Stroke Services Toolkit) can be found on www.dh.gov.uk/stroke *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4' This data has not previously been collected. However, existing data on organisation of services for, and clinical treatment of, TIA and stroke can be found in the National Stroke Sentinel Audit (http://www.rcplondon.ac.uk/pubs/books/strokeaudit/)

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Anonymous

Proportion of sites with early supported discharge team attached to the stroke multidisciplinary team
Library Reference Number/Identifier CV08 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale The Cochrane review of Early Supported Discharge after stroke shows that it is an effective alternative to continued in-patient stroke unit management Definition Early supported discharge team refers to a multidisciplinary team which provides rehabilitation and support in a community setting with the aim of reducing the duration of hospital care for stroke patients. Units There is currently no information for this item. Coverage England, Wales and Northern Ireland Source Sentinel Stroke Audit - Organisational Audit Calculations/Formula/Methodology Question 4.1 See full wording of questions for exceptions in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc

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Anonymous

Creator / Producer Royal College of Physicians Status In use Quality It is in the public domain Date 2010 Version History There is currently no information for this item. Update Frequency Usually every 2 years. Exceptionally 2008 and 2009. The interim data collection for the NAO report Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf Publisher / Owner Royal College of Physicians Other related PI's (relation) There is currently no information for this item. Additional Information

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Anonymous

*Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Anonymous

Proportion of stroke patients given a mood assessment

Library Reference Number/Identifier CV03 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale See help booklet for clinical audit at http://www.mqi.ic.nhs.uk/documents/2008%20Clinical%20audit%20help-booklet%20FINAL.doc re question 5.3 clinical audit Definition This includes 2 separate questions question 5.3 and 5.4. Only 5.3 is in the public domain. Exceptions are: if patient unconscious throughout or patient died within 7 days Units There is currently no information for this item. Coverage England, Wales and Northern Ireland Source Sentinel Stroke Audit - Clinical Audit Calculations/Formula/Methodology Questions 5.3 and 5.4 See full wording of questions for exceptions in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Applies to all patients discharged alive. Calculation of % compliance yes/(yes+no)

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Anonymous

Creator / Producer Royal College of Physicians Status Only 1 feeder question is included in the public report (mood) Quality Only 1 feeder question is included in the public report (mood) Date 2010 Version History There is currently no information for this item. Update Frequency Every two years depending on funding. Most recent round includes data on patients admitted between April and June 2008. Next data collection tbc estimated as April 2010 Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf Publisher / Owner Royal College of Physicians Other related PI's (relation) There is currently no information for this item. Additional Information

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Anonymous

*Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Anonymous

Proportion of stroke patients who see occupational therapist within 4 working days
Library Reference Number/Identifier CV04 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale See help booklet for clinical audit attached re questions 3.6 physio, 4.1 speech therapy (not in public domain), 4.2 Occupational therapy, (within 4 working days is the standard released to the public) http://www.mqi.ic.nhs.uk/documents/2008%20Clinical%20audit%20helpbooklet%20FINAL.doc Definition There is currently no information for this item. Units There is currently no information for this item. Coverage England, Wales and Northern Ireland Source Sentinel Stroke Audit - Clinical Audit Calculations/Formula/Methodology issue - numerous questions, not all publicly available See help booklet for clinical audit attached re questions 3.6 physio, 4.1 speech therapy (not in public domain), 4.2 Occupational therapy, (within 4 working days is the standard released to the

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Anonymous

public) http://www.mqi.ic.nhs.uk/documents/2008%20Clinical%20audit%20helpbooklet%20FINAL.doc See full wording of questions for exceptions in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Calculation of compliance yes/(yes+no) Creator / Producer Royal College of Physicians Status Only 2 feeder questions are included in the public report Quality Only 2 feeder questions are included in the public report Date 2010 Version History There is currently no information for this item. Update Frequency Every two years depending on funding. Most recent round includes data on patients admitted between April and June 2008. Next data collection tbc estimated as April 2010 Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf Publisher / Owner

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Anonymous

Royal College of Physicians Other related PI's (relation) There is currently no information for this item. Additional Information *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Anonymous

Proportion of stroke patients who see Physiotherapist within 72 hours of admission

Library Reference Number/Identifier CV05 Subject Royal College of Physicians (RCP) Category National Sentinel Stroke Audit Detailed Descriptor See full question wording in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Rationale See help booklet for clinical audit attached re questions 3.6 physio, 4.1 speech therapy (not in public domain), 4.2 Occupational therapy, (within 4 working days is the standard released to the public) http://www.mqi.ic.nhs.uk/documents/2008%20Clinical%20audit%20helpbooklet%20FINAL.doc Definition There is currently no information for this item. Units There is currently no information for this item. Coverage England, Wales and Northern Ireland Source Sentinel Stroke Audit - Clinical Audit Calculations/Formula/Methodology issue - numerous questions, not all publicly available See help booklet for clinical audit attached re questions 3.6 physio, 4.1 speech therapy (not in public domain), 4.2 Occupational therapy, (within 4 working days is the standard released to the

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Anonymous

public) http://www.mqi.ic.nhs.uk/documents/2008%20Clinical%20audit%20helpbooklet%20FINAL.doc See full wording of questions for exceptions in http://www.mqi.ic.nhs.uk/documents/Stroke%20Clinical%20Proforma%202008%20REVISED.doc Calculation of compliance yes/(yes+no) Creator / Producer Royal College of Physicians Status Only 2 feeder questions are included in the public report Quality Only 2 feeder questions are included in the public report Date 2010 Version History There is currently no information for this item. Update Frequency Every two years depending on funding. Most recent round includes data on patients admitted between April and June 2008. Next data collection tbc estimated as April 2010 Accessibility General website available at: http://www.rcplondon.ac.uk/CLINICAL-STANDARDS/CEEU/CURRENT-WORK/Pages/Strokeprogramme.aspx Latest documents available at: http://www.rcplondon.ac.uk/clinical-standards/ceeu/Currentwork/Documents/Public%20organisational%20report2008.pdf and http://www.mqi.ic.nhs.uk/documents/FINAL%20Public%20full%20report%202008%20final%20incl %20appendices.pdf Publisher / Owner

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Anonymous

Royal College of Physicians Other related PI's (relation) There is currently no information for this item. Additional Information *Organisation Code: 'RPA, 5L3-4' = 'RPA, 5L3 & 5L4'

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Anonymous

The percentage of new patients with a stroke or TIA who have been referred for further investigation
Library Reference Number/Identifier QOF STROKE 13 Subject QOF Clinical domain : Stroke and Transient Ischaemic Attack (TIA) Category Records Detailed Descriptor The percentage of new patients with a stroke or TIA who have been referred for further investigation Rationale The NAO Report highlights that UK national guidelines recommend that all patients with suspected TIA should be assessed and investigated within seven days, but notes that only a third of people with TIA are seen in a clinic. The UK Guideline and the NAO concern reflect the evidence that there is a high early risk of stroke following TIA, and that there is insufficient recognition of the serious nature of this diagnosis. This indicator refers to patients diagnosed with a stroke or a TIA from 1 April 2008. Practices should note that a referral should be considered for each new stroke or TIA unless specific agreement has been reached with a local specialist not to refer the patient. A new TIA in someone who has had previous TIAs should be treated as an urgent case. For the purposes of the QOF, an appropriate referral being undertaken between three months before and one month after a diagnosis of presumptive stroke or TIA being made would be considered as having met the requirements of this indicator. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator.

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Anonymous

Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011/12 Version History There is currently no information for this item. Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation)

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Anonymous

QOF STROKE 13 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with a history of TIA or stroke in whom the last blood pressure reading (measured in the previous 15 months) is 150/90 or less
Library Reference Number/Identifier QOF STROKE 6 Subject QOF Clinical domain : Stroke and Transient Ischaemic Attack (TIA) Category Ongoing management Detailed Descriptor The percentage of patients with a history of TIA or stroke in whom the last blood pressure reading (measured in the previous 15 months) is 150/90 or less Rationale All patients should have their blood pressure checked and hypertension persisting for over two weeks should be treated. The British Hypertension Society Guidelines state that optimal blood pressure treatment targets are systolic pressure less than or equal to 140 mm Hg and diastolic blood pressure (DBP) less than or equal to 85 mm Hg. The proposed audit standard is less than or equal to 150/90. In one major overview, a long-term difference of 5-6 mm Hg in usual DBP is associated with approximately 35-40 per cent less stroke over five years. The PROGRESS trial demonstrated that blood pressure lowering reduces stroke risk in people with prior stroke or TIA. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage

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Anonymous

England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF STROKE 6 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record that an anti-platelet agent (aspirin, clopidogrel, dipyridamole or a combination), or an anti-coagulant is being taken (unless a contraindication or side effects are recorded)
Library Reference Number/Identifier QOF STROKE 12 Subject QOF Clinical domain : Stroke and Transient Ischaemic Attack (TIA) Category Ongoing management Detailed Descriptor The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record that an anti-platelet agent (aspirin, clopidogrel, dipyridamole or a combination), or an anti-coagulant is being taken (unless a contraindication or side-effects are recorded) Rationale Long-term antiplatelet therapy reduces the risk of serious vascular events following a stroke by about a quarter. Antiplatelet therapy, normally aspirin, should be prescribed for the secondary prevention of recurrent stroke and other vascular events in patients who have sustained an ischaemic cerebrovascular event. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source

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Anonymous

Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF STROKE 12 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with TIA or stroke who have a record of blood pressure in the notes in the preceding 15 months
Library Reference Number/Identifier QOF STROKE 5 Subject QOF Clinical domain : Stroke and Transient Ischaemic Attack (TIA) Category Ongoing management Detailed Descriptor The percentage of patients with TIA or stroke who have a record of blood pressure in the notes in the preceding 15 months Rationale All patients should have their blood pressure checked and hypertension persisting for over two weeks should be treated. The British Hypertension Society Guidelines state that optimal blood pressure treatment targets are systolic pressure less than or equal to 140 mm Hg and diastolic blood pressure (DBP) less than or equal to 85 mm Hg. The proposed audit standard is less than or equal to 150/90. In one major overview, a long-term difference of 5-6 mm Hg in usual DBP is associated with approximately 35-40 per cent less stroke over five years. The PROGRESS trial demonstrated that blood pressure lowering reduces stroke risk in people with prior stroke or TIA. Definition ***DROPPED This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical

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Anonymous

Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status ***DROPPED Quality QOF indicators are based on best available clinical evidence Date 2010-11 Version History N/A Update Frequency Annual publication (October in 2010) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF STROKE 5 Additional Information

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Anonymous

There is currently no information for this item.

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Anonymous

The percentage of patients with TIA or stroke who have a record of total cholesterol in the last 15 months
Library Reference Number/Identifier QOF STROKE 7 Subject QOF Clinical domain : Stroke and Transient Ischaemic Attack (TIA) Category Ongoing management Detailed Descriptor The percentage of patients with TIA or stroke who have a record of total cholesterol in the last 15 months Rationale The Heart Protection Study demonstrated that all cause mortality, vascular and stroke risk was significantly reduced by treating people at high risk of vascular disease with a statin. Subsequent sub-group analyses demonstrated that in patients with prior stroke or TIA, statin therapy reduced risk of subsequent vascular events. An economic analysis of this trial concluded that it was highly cost-effective to treat such patients. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF STROKE 7 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with TIA or stroke who have had influenza immunisation in the preceding 1 September to 31 March
Library Reference Number/Identifier QOF STROKE 10 Subject QOF Clinical domain : Stroke and Transient Ischaemic Attack (TIA) Category Ongoing management Detailed Descriptor The percentage of patients with TIA or stroke who have had influenza immunisation in the preceding September to 31 March Rationale While there have been no randomised controlled trials (RCTs) looking at the impact of flu vaccination specifically in people with a history of stroke or TIA, there is evidence from observation studies that flu vaccination reduces risk of stroke. This is included in JCVI recommendations. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality There is currently no information for this item. Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF STROKE 10 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with TIA or stroke whose last measured total cholesterol (measured in the previous 15 months) is 5mmol/l or less
Library Reference Number/Identifier QOF STROKE 8 Subject QOF Clinical domain : Stroke and Transient Ischaemic Attack (TIA) Category Ongoing management Detailed Descriptor The percentage of patients with TIA or stroke whose last measured total cholesterol (measured in the previous 15 months) is 5mmol/l or less Rationale The Heart Protection Study demonstrated that all cause mortality, vascular and stroke risk was significantly reduced by treating people at high risk of vascular disease with a statin. Subsequent sub-group analyses demonstrated that in patients with prior stroke or TIA, statin therapy reduced risk of subsequent vascular events. An economic analysis of this trial concluded that it was highly cost-effective to treat such patients. Definition This indicator has a numerator and a denominator which give a measure of underlying achievement in respect of relevant patients. Practices are awarded points depending on level of underlying achievement. Practices do not need to reach 100% underlying achievement to achieve 100% of points available for this indicator. Units Numerical Coverage England Source Quality Outcomes Framework

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Anonymous

Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF STROKE 8 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with any (or any combination of) the following conditions: coronary heart disease, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses, who smoke and whose notes contain a record that smoking cessation advice or referral to a specialist service, where available, has been offered within the previous 15 months
Library Reference Number/Identifier QOF Smoking 4 Subject QOF Clinical domain : Smoking Category On-going management Detailed Descriptor The percentage of patients with any (or any combination of) the following conditions: coronary heart disease, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses, who smoke and whose notes contain a record that smoking cessation advice or referral to a specialist service, where available, has been offered within the previous 15 months Rationale Many strategies have been used to help people to stop smoking. A meta-analysis of controlled trials in patients post myocardial infarction showed that a combination of individual and group smoking cessation advice, and assistance reinforced on multiple occasions initially during cardiac rehabilitation and reinforced by primary care teams gave the highest success rates. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage

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Anonymous

England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History New indicator in 2011-12 Update Frequency Annual publication (October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF Smoking 4 Additional Information There is currently no information for this item.

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Anonymous

The percentage of patients with any (or any combination of) the following conditions: coronary heart disease, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses, whose notes record smoking status in the previous 15 months
Library Reference Number/Identifier QOF Smoking 3 Subject QOF Clinical domain : Smoking Category On-going management Detailed Descriptor The percentage of patients with any (or any combination) of the following conditions: coronary heart disease, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses, whose notes record smoking status in the previous 15 months Rationale 1. CHD. Smoking is known to be associated with an increased risk of coronary heart disease. 2. Stroke/TIA. There are few randomised clinical trials of the effects of risk factor modification in the secondary prevention of ischaemic or haemorrhagic stroke. However inferences can be drawn from the findings of primary prevention trials that cessation of cigarette smoking should be advocated. 3. Hypertension. The British Hypertension Society recommends that all patients with hypertension should have a thorough history and physical examination and a smoking history is taken. 4. Diabetes. The risk of vascular complications in patients with diabetes is substantially increased. Smoking is an established risk factor for cardiovascular and other diseases. 5. COPD. Smoking cessation is the single most effective and cost-effective intervention to reduce the risk of developing COPD and stop its progression. 6. Asthma. There are a surprisingly small number of studies on smoking related to asthma. Starting smoking as a teenager increases the risk of persisting asthma. One controlled cohort study suggested that exposure to passive smoke at home delayed recovery from an acute attack. New grade A evidence suggests that smoking reduces the benefits of inhaled steroids and this adds further justification for recording this outcome. 7. Chronic Kidney Disease. There is good evidence from observational studies that people with CKD are at increased cardiovascular risk and hence the rationale for including CKD here.

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Anonymous

8. Schizophrenia, bipolar affective disorder or other psychoses. People with serious mental illness are far more likely to smoke than the general population (61% of people with schizophrenia and 46% of people with bipolar disorder smoke compared to 33% of the general population). Premature death and smoking related diseases, such as respiratory disorders and heart disease, are however, more common among people with serious mental illness who smoke than in the general population of smokers. 9. Non-smokers. It is recognised that lifelong non-smokers are very unlikely to start smoking and indeed find it quite irritating to be asked repeatedly regarding their smoking status. Smoking status for this group of patients should be recorded every 15 months up to and including 25 years of age. 10. Ex-smokers. There are two ways in which a patient can be recorded as an ex-smoker. Firstly ex-smokers can be recorded as such in the previous 15 months. It is recognised that once a patient has been an ex-smoker for more than three years they are unlikely to restart. In recognition of this practices may choose to record ex-smoking status on an annual basis for three consecutive QOF years.Thereafter smoking status need only be recorded if there is a change. In this instance QOF years should be interpreted as a 12 month period. Definition The percentages reported on are based on achievement rather than patients. A practice can deliver the required care to fewer than 100 per cent of its patients to achieve the full (100 per cent) points available. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx Creator / Producer NHS Employers/Department of Health (DH) Status In use

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Anonymous

Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History There is currently no information for this item. Update Frequency Annual publication (October 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF Smoking 3 Additional Information There is currently no information for this item.

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Anonymous

The practice can produce a register of patients aged 16 and over with a Body Mass Index (BMI) greater than or equal to 30 in the previous 15 months
Library Reference Number/Identifier QOF OB 1 Subject QOF Clinical domain : Obesity Category Records Detailed Descriptor The practice can produce a register of patients aged 16 and over with a Body Mass Index (BMI) greater than or equal to 30 in the previous 15 months Rationale This register is prospective. It is envisaged that it will include, all people whose body mass index (BMI) has been recorded in the practice as part of routine care. It is expected that this data will inform public health measures. Definition Against this indicator there is a count of patients on the relevant clinical register. Where there is a register the number of associated QOF points is also recorded. Units Numerical Coverage England Source Quality Outcomes Framework Calculations/Formula/Methodology http://www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/QOF/Pages/Qua lityOutcomesFramework.aspx

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Anonymous

Creator / Producer NHS Employers/Department of Health (DH) Status In use Quality QOF indicators are based on best available clinical evidence Date 2011-12 Version History N/A Update Frequency Annual publication (October in 2012) based on previous financial year end Accessibility NHS Information Centre for Health and Social Care website: http://www.qof.ic.nhs.uk/ spreadsheets, bulletin, on-line database. Available at practice, PCT, SHA and national level Publisher / Owner NHS Information Centre for Health and Social Care Other related PI's (relation) QOF OB 1 Additional Information There is currently no information for this item.

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Anonymous