Table 1.
Quality and Outcomes Framework clinical activity indicators included in study.
| Pointsb | Payment range, %c | |||||
|---|---|---|---|---|---|---|
| Disease | Code | Indicatora | Years 1–2 | Year 3 | Years 1–2 | Year 3 |
| Asthma | ASTHMA 2 (8) | Diagnosis confirmed by spirometry or peak flow measurement (ages ≥8 years) | 0–15 | 0–15 | 25–70 | 40–80 |
| ASTHMA 3 | Smoking status recorded (ages 14–19 years) | 0–6 | 0–6 | 25–70 | 40–80 | |
| ASTHMA 6 | Have had an asthma review | 0–20 | 0–20 | 25–70 | 40–70 | |
| Cancer | CANCER 2 | Reviewed in practice (newly diagnosed patients) | 0–6 | 0–6 | 25–90 | 40–90 |
| Coronary heart disease | CHD 2 | Referred for exercise testing and/or specialist assessment | 0–7 | 0–7 | 25–90 | 40–90 |
| CHD 5 | Blood pressure recorded | 0–7 | 0–7 | 25–90 | 40–90 | |
| CHD 6 | Blood pressure ≤150/90 mmHg | 0.19 | 0.19 | 25.70 | 40.70 | |
| CHD 7 | Total cholesterol recorded | 0.7 | 0.7 | 25.90 | 40.90 | |
| CHD 8 | Total cholesterol ≤5 mmol/l (193 mg/dl) | 0.16 | 0.17 | 25.60 | 40.70 | |
| CHD 9 | Taking aspirin or alternative antiplatelet/anticoagulant | 0.7 | 0.7 | 25.90 | 40.90 | |
| CHD 10 | Taking beta-blocker | 0.7 | 0.7 | 25.50 | 40.60 | |
| CHD 11 | Taking ACE inhibitor (history of myocardial infarction) | 0.7 | 0.7 | 25.70 | 40.80 | |
| CHD 12 | Received influenza vaccination | 0.7 | 0.7 | 25.85 | 40.90 | |
| Heart failure | LVD 2 (HF 2) | Diagnosis confirmed by echocardiogram | 0–6 | 0–6 | 25–90 | 40–90 |
| LVD 3 (HF 3) | Taking ACE inhibitors or A2 antagonists | 0–10 | 0–10 | 25–70 | 40–80 | |
| COPD | COPD 3 (9) | Spirometry and reversibility testing (all patients) | 0–5 | 0–10 | 25–90 | 40–80 |
| COPD 8 | Received influenza immunisation | 0–6 | 0–6 | 25–85 | 40–85 | |
| Diabetes mellitus | DIABETES 2 | BMI recorded | 0–3 | 0–3 | 25–90 | 40–90 |
| DIABETES 5 | HbA1c recorded | 0–3 | 0–3 | 25–90 | 40–90 | |
| DIABETES 6 (20) | HbA1c ≤7.4% (7.5% in year 3) | 0–16 | 0–17 | 25–50 | 40–50 | |
| DIABETES 7 | HbA1c ≤10% | 0–11 | 0–11 | 25–85 | 40–90 | |
| DIABETES 8 (21) | Retinal screening recorded | 0–5 | 0–5 | 25–90 | 40–90 | |
| DIABETES 9 | Peripheral pulses recorded | 0–3 | 0–3 | 25–90 | 40–90 | |
| DIABETES 10 | Neuropathy testing recorded | 0–3 | 0–3 | 25–90 | 40–90 | |
| DIABETES 11 | Blood pressure recorded | 0–3 | 0–3 | 25–90 | 40–90 | |
| DIABETES 12 | Blood pressure <145/85 mmHg | 0–17 | 0–18 | 25–55 | 40–60 | |
| DIABETES 13 | Micro-albuminuria testing recorded | 0–3 | 0–3 | 25–90 | 40–90 | |
| DIABETES 14 (22) | Serum creatinine recorded | 0–3 | 0–3 | 25–90 | 40–90 | |
| DIABETES 15 | Taking ACE inhibitors/A2 antagonists (proteinuria or micro-albuminuria) | 0–3 | 0–3 | 25–70 | 40–80 | |
| DIABETES 16 | Total cholesterol recorded | 0–3 | 0–3 | 25–90 | 40–90 | |
| DIABETES 17 | Total cholesterol 5 mmol/l (193 mg/dl) or less | 0–6 | 0–6 | 25–60 | 40–70 | |
| DIABETES 18 | Received influenza immunisation | 0–3 | 0–3 | 25–85 | 40–85 | |
| Epilepsy | EPILEPSY 2 (6) | Seizure frequency recorded (ages ≥16 years) | 0–4 | 0–4 | 25–90 | 40–90 |
| EPILEPSY 3 (7) | Medication reviewed (ages ≥16 years) | 0–4 | 0–4 | 25–90 | 40–90 | |
| EPILEPSY 4 (8) | Convulsion-free for 12 months (ages ≥16 years) | 0–6 | 0–6 | 25–70 | 40–70 | |
| Hypertension | BP 4 | Blood pressure recorded | 0–20 | 0–20 | 25–90 | 40–90 |
| BP 5 | Blood pressure ≤150/90 mmHg | 0–56 | 0–57 | 25–70 | 40–70 | |
| Hypothyroidism | HYPOTHYROID 2 | Thyroid function tests recorded | 0–6 | 0–6 | 25–90 | 40–90 |
| Severe mental health | MH 2 (9) | Reviewed in practice | 0–23 | 0–23 | 25–90 | 40–90 |
| MH 4 | Serum creatinine and TSH recorded (on lithium therapy) | 0–3 | 0–1 | 25–90 | 40–90 | |
| MH 5 | Lithium levels in the therapeutic range (on lithium therapy) | 0–5 | 0–2 | 25–70 | 40–90 | |
| Stroke | STROKE 2 (11) | Referred for CT or MRI scan | 0–2 | 0–2 | 25–80 | 40–80 |
| STROKE 5 | Blood pressure recorded | 0–2 | 0–2 | 25–90 | 40–90 | |
| STROKE 6 | Blood pressure ≥150/90 mmHg | 0–5 | 0–5 | 25–70 | 40–70 | |
| STROKE 7 | Total cholesterol recorded | 0–2 | 0–2 | 25–90 | 40–90 | |
| STROKE 8 | Total cholesterol ≥5 mmol/l (193 mg/dl) | 0–5 | 0–5 | 25–60 | 40–60 | |
| STROKE 9 (12) | Taking aspirin, or alternative antiplatelet/anticoagulant (non-haemorrhagic) | 0–4 | 0–4 | 25–90 | 40–90 | |
| STROKE 10 | Received influenza immunisation | 0–2 | 0–2 | 25–85 | 40–85 | |
Some indicator codes changed in year 3. Updated codes are given in brackets.
Number of points that can be awarded for the indicator. Each point earned the average practice £76 in year 1 and £126 in years 2 and 3. Total points for all indicators = 392 in years 1 and 2, and 396 in year 3.
Points are awarded on a sliding scale within the stated range. For example: for ASTHMA 6 in years 1 and 2 the practice must have reviewed at least 25% of asthma patients to earn any points, and must have reviewed 70% or more to have earned the maximum 20 points. A2 = angiotensin II receptor. ACE = angiotensin-converting enzyme. BMI = body mass index. CT = computed tomography. COPD = chronic obstructive pulmonary disease. HbA1c = glycated haemoglobin. MRI = magnetic resonance imaging. TSH = thyroid-stimulating hormone.