QOF Plus Year 1 - Imperial College London
QOF Plus Year 1 - Imperial College London QOF Plus Year 1 - Imperial College London
It is prerequisite that in order to receive payment for + CVD PREVENT 1, practices have achievedthe existing QOF RECORDS 11 Indicator (The BP of patients aged 45 and over is recorded in thepreceding 5 years for at least 65% of patients.)For + CVD PREVENT 8, practices will be expected to follow the NICE Guidance on LipidModification (2008), which states that:“People should be offered information about their absolute risk of CVD and about theabsolute benefits and harms of an intervention over a 10-year period. This informationshould be in a form that:presents individualised risk and benefit scenarios-presents the absolute risk ofevents numerically, anduses appropriate diagrams and text.Before offering lipid modification therapy for primary prevention, all other modifiableCVD risk factors should be considered and their management optimised if possible.Baseline blood tests and clinical assessment should be performed, and comorbidities andsecondary causes of dyslipidaemia should be treated.Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lowerdose or alternative preparation such as pravastatin may be chosen.”Further guidance relating to CVD risk assessment, communication of risk and patient informationon CVD primary prevention can be found in the QOF+ Resource Pack. Prescribing patterns will beanalysed further by the PCT.It is proposed that these indicators will replace the existing NHS Hammersmith and Fulham LESfor CVD Primary Prevention. The outcome indicators below are included in the current LES forCVD Primary Prevention.The percentage of patients who had a multifactorial CVD risk assessment of ≥ 20% over10 years whose most recent BMI recorded in the previous 12 months is below 30 kg/m2The percentage of patients who had a multifactorial CVD risk assessment of ≥ 20% over10 years whose most recent BMI recorded in the previous 12 months is below 25 kg/m2The percentage of patients who had a multifactorial CVD risk assessment of ≥ 20% over10 years whose most recent blood pressure recorded in the previous 12 months is below150/90 mmHgIt is proposed that these outcome indicators are not included within QOF+ at this stage as thefirst priority for this area is to achieve comprehensive vascular screening of the population agedbetween 32-74. Subsequent years/phases of QOF+ could then include outcome-based indicators.20
Creation of practice CVD at-risk registerPractices will use a systematic strategy to identify individuals between the ages of 32-74 withoutdiabetes or CVD (who should be on their respective disease registers) with a record of a 20% orgreater 10-year risk of developing CVD (formally estimated through computerized Framingham1991 10-year risk equations, using CVD risk factors already documented in their primary caremedical records, and recorded using an appropriate Read code.) Central support for this processwill be provided by the PCT’s Health Informatics team. This process will generate a CVD At-RiskRegister for each practice.The term ‘Practice CVD At-Risk Register’ used in the indicators below will refer to this register.BackgroundThere is international consensus that for the management of hypertension, it is important toaddress cardiovascular risk for the purposes of primary prevention (Cooper et al., 2008). It is nowpossible to calculate cardiovascular risk for people not known to suffer from cardiovasculardisease, through the use of equations that take into account risk factors. These equations includethose derived through the Framingham data, as well as newer risk equations such as ASSIGN andQRISK. The recently issued NICE Guideline on Lipid Modification recommended the continued useof the Framingham equations at present to calculate risk (Cooper et al., 2008).Priority and relevance to national policyThere is national recognition of the need for a shift in the paradigm of cardiovascular prevention.Primary prevention of CVD is highlighted in the National Service Framework for Coronary HeartDisease (DoH, 2000) and for Older People (DoH, 2001) and in national guidelines of professionalbodies including the Joint British Societies and the British Hypertension Society. The targetsrecommended are reflected in indicators in the new GMS contract. The NSF specifies that“every practice should have a systematically developed and maintained practice-basedregister of people with clinical evidence of coronary heart disease (CHD), occlusivevascular disease and of people whose risk of [cardiovascular] events is [>20%] over 10years in place and actively used to provide structured care to those at high risk of CHD,”and that“every practice should have a protocol describing the systematic assessment, treatmentand follow-up of people at high risk of CHD, including those without evidence of existingarterial disease but whose risk of [cardiovascular] events is [>20%] over 10 years, agreedlocally and being used to provide structured care…”In addition, plans for implementing a national vascular screening programme have recently beenannounced by the Government, and the NICE Guideline on Lipid Modification has been published(Cooper et al., 2008) which includes information on primary prevention of CVD.21
- Page 1: Towards world class healthcare for
- Page 6 and 7: QOF+ report on breastfeeding ......
- Page 8 and 9: QOF+ report on patient safety .....
- Page 10 and 11: CreditsProject boardJosip CarMiles
- Page 12: AcknowledgementsWe are indebted to
- Page 15 and 16: Executive summaryIntroductionPrevio
- Page 18: Support with QOF+If you have a prob
- Page 22 and 23: The quality and outcomes framework
- Page 24 and 25: Effect of measurement on health ine
- Page 26 and 27: How might a local QOF operate in pr
- Page 28 and 29: Doran T, Fullwood C, Kontopantelis
- Page 30 and 31: Continued…QOFQOF+IndicatorUpperTh
- Page 32 and 33: Alcohol Chapter 4 (p27)IndicatorQOF
- Page 34 and 35: RecordsIndicator+ PRESCRIPTION 1. T
- Page 36 and 37: Patient experience Chapter 12 (p77)
- Page 39: C3QOF+ report on cardiovasculardise
- Page 43 and 44: achieved through primary prevention
- Page 45 and 46: Workload and training implicationsI
- Page 47 and 48: QOF+ report on alcoholProposed indi
- Page 49 and 50: Local contextThe Hammersmith and Fu
- Page 51 and 52: Workload and training implicationsR
- Page 53 and 54: QOF+ report on smokingProposed indi
- Page 55 and 56: Local context24% of adults (35,000)
- Page 57: ReferencesBritish Medical Associati
- Page 60 and 61: The NICE Clinical Guideline on Ante
- Page 62 and 63: Health impactThere are significant
- Page 65 and 66: QOF+ report on breastfeedingPropose
- Page 67 and 68: Local contextIn 2006/7, the percent
- Page 69 and 70: Degree of perceived professional co
- Page 71 and 72: QOF+ report on ethnicityProposed In
- Page 73 and 74: Associated Morbidity and MortalityT
- Page 75: Workload and training implicationsP
- Page 78 and 79: Priority and relevance to national
- Page 80 and 81: Specific reasons for this framework
- Page 82 and 83: Workload and training implicationsT
- Page 85 and 86: QOF+ report on newpatient screening
- Page 87 and 88: Review of evidence to support the p
- Page 89 and 90: QOF+ report onpatient informationPr
Creation of practice CVD at-risk registerPractices will use a systematic strategy to identify individuals between the ages of 32-74 withoutdiabetes or CVD (who should be on their respective disease registers) with a record of a 20% orgreater 10-year risk of developing CVD (formally estimated through computerized Framingham1991 10-year risk equations, using CVD risk factors already documented in their primary caremedical records, and recorded using an appropriate Read code.) Central support for this processwill be provided by the PCT’s Health Informatics team. This process will generate a CVD At-RiskRegister for each practice.The term ‘Practice CVD At-Risk Register’ used in the indicators below will refer to this register.BackgroundThere is international consensus that for the management of hypertension, it is important toaddress cardiovascular risk for the purposes of primary prevention (Cooper et al., 2008). It is nowpossible to calculate cardiovascular risk for people not known to suffer from cardiovasculardisease, through the use of equations that take into account risk factors. These equations includethose derived through the Framingham data, as well as newer risk equations such as ASSIGN andQRISK. The recently issued NICE Guideline on Lipid Modification recommended the continued useof the Framingham equations at present to calculate risk (Cooper et al., 2008).Priority and relevance to national policyThere is national recognition of the need for a shift in the paradigm of cardiovascular prevention.Primary prevention of CVD is highlighted in the National Service Framework for Coronary HeartDisease (DoH, 2000) and for Older People (DoH, 2001) and in national guidelines of professionalbodies including the Joint British Societies and the British Hypertension Society. The targetsrecommended are reflected in indicators in the new GMS contract. The NSF specifies that“every practice should have a systematically developed and maintained practice-basedregister of people with clinical evidence of coronary heart disease (CHD), occlusivevascular disease and of people whose risk of [cardiovascular] events is [>20%] over 10years in place and actively used to provide structured care to those at high risk of CHD,”and that“every practice should have a protocol describing the systematic assessment, treatmentand follow-up of people at high risk of CHD, including those without evidence of existingarterial disease but whose risk of [cardiovascular] events is [>20%] over 10 years, agreedlocally and being used to provide structured care…”In addition, plans for implementing a national vascular screening programme have recently beenannounced by the Government, and the NICE Guideline on Lipid Modification has been published(Cooper et al., 2008) which includes information on primary prevention of CVD.21
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