The Quality and Outcomes Framework (QOF) is a programme which rewards GP practices in England for good practice across different areas. Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work as well as they should. One of the indicators GP practices are assessed against in the QOF is whether they maintain a list of patients with CKD. Alongside QOF indicators, NICE develop general practice indicators which are suitable for use in the QOF and can be used in different settings to support high quality care.
NICE are looking into publishing two new indicators for the care of people with CKD, adding to the existing suite of indicators for kidney disease. These will measure treatment with certain drugs and blood pressure monitoring. We want to know what level these measures should be used at – per GP practice, per group of practices serving a local community (primary care networks) or per group of practices serving a larger area (integrated care system). To determine if these indicators could be measured per practice, we need to know how many people in each practice would be included in each measure. We can do this using CPRD data.
When published, healthcare providers can use these NICE indicators to monitor and improve the delivery of care processes which NICE have found strong evidence for being linked to better outcomes, like blood pressure monitoring for patients with severe CKD. This will improve the quality of care received by patients with CKD.
The aim of this study is to understand the number of individuals on the chronic kidney disease (CKD) register per GP practice who would be included in the denominator of the following two proposed NICE indicators for CKD:
1. The percentage of patients on the CKD register and with an albumin to creatinine ratio (ACR) of 70 mg/mmol or more, without diabetes, who are currently treated with an ARB or an ACE inhibitor.
2. The percentage of patients on the CKD register and with an albumin to creatinine ratio (ACR) of 70 mg/mmol or more, without moderate or severe frailty, in whom the last blood pressure reading (measured in the preceding 12 months) is less than 125/75 mmHg if using ambulatory or home monitoring, or less than 130/80 mmHg if monitored in clinic.
Using CPRD Aurum, the study population is those who should be on the CKD register according to the Quality and Outcomes Framework: patients aged 18 and over with CKD stages G3a to G5.
We will extract, per practice, the number of patients who would be in the denominators of the two proposed indicators, respectively:
1. The number of patients on the CKD register and with an ACR of 70 mg/mmol or more, without diabetes.
2. The number of patients on the CKD register and with an ACR of 70 mg/mmol or more, without moderate or severe frailty.
This is a descriptive study with no statistical testing. Only counts and proportions will be extracted per practice, and a mean or median count and proportion calculated across practices.
The addition of these new NICE indicators should improve the care of people with CKD, as treatment with ARBs or ACE inhibitors and optimal blood pressure control can prevent or delay CKD progression and reduce the risk of cardiovascular disease.
Number of patients on the CKD register per practice with: ACR recorded; ACR of 70mg/mmol or more; ACR of 70mg/mmol or more and without diabetes; ACR of 70mg/mmol or more and without moderate or severe frailty
Tsz Wing Vanessa Kam - Chief Investigator - National Institute for Health and Clinical Excellence - NICE
Tsz Wing Vanessa Kam - Corresponding Applicant - National Institute for Health and Clinical Excellence - NICE
Robert Willans - Collaborator - National Institute for Health and Clinical Excellence - NICE