QOF - 2015
The QOF for the upcoming year 2015/16 in England will see several changes that have been updated in line with new NICE guidance. These affect the clinical issues only of the QOF.
The main changes you will notice are:
- CKD : you only need to keep a register of CKD patients now. This is interesting as you will find if you view Saeed Ahmed’s lecture on CKD here on gplectures. What happens to patients with deteriorating Stage 2 CKD who have evidence of renal disease? These will no longer be visible to us.
- Atrial Fibrillation : CHADS2 has been replaced by CHA2DS2Vasc. The original CHADS2 score was based on a retrospective Medicare registry; CHA2DSVasc is a prospective score based on patients from several countries aged 18 years and older (Ref 1). This is interesting as it will lead to more patients being identified with a high risk, yet a comparison of the C statistic shows that both of these risk scores are similar. The C statistic is a number between 0.5 (no better than chance) and 1.0 (perfect prediction) indicating predictive ability. In this study CHADS2 had a C statistic of 0.637 compared to CHA2DS2Vasc of 0.647. A "good" C statistic is usually at least 0.7 or better, indicating than neither system is particularly accurate in predicting stroke risk. (ref 2)
- CHD : The recording of data as to whether patients are on a statin, ACEI or beta blocker have gone. Interesting.
- Dementia : New changes include the need to to perform a care plan review annually as well as relaxing the time limits on the diagnostic blood tests, now extending from 12 months prior to diagnosis and extending to 6 months afterwards
A full summary of the QOF 2015/16 changes has been produced by Primary Care Commissioning and the link is here
Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137(2):263-72. PMID http://www.ncbi.nlm.nih.gov/pubmed/19762550
Lip GY, Frison L, Halperin JL, Lane DA. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke. 2010;41(12):2731-8. PMID http://www.ncbi.nlm.nih.gov/pubmed/20966417