The National Institute for Health and Care Excellence (NICE) develops indicators to measure the quality of healthcare. This study aims to assess a proposed new NICE indicator for a long-term lung disease in which the lungs are damaged, making it harder for air to get in and out. This indicator will focus on care for people with this condition, called chronic obstructive pulmonary disease (COPD), who are at higher risk of being hospitalised.
The proposed indicator will measure the percentage of high-risk patients who have had a thorough review in the past year. This review should record how often the patient has had disease exacerbations (temporary flare-ups) and assess their breathlessness using a standard scale.
This study will use a database of UK medical records to look back at a group of COPD patients, selected using established methods. The study will describe which patients have factors putting them at higher risk of hospital admission, including previous admissions, other health conditions, and test results.
Researchers will then see how many high-risk patients have had the thorough review described in the past year. Results will be compared across deprivation levels in patients’ areas, to see if there are inequalities in how well patient reviews are being done.
Publishing this NICE indicator should improve services’ approach to ensure that those at highest risk of hospital admission are encouraged to attend an annual COPD review to get the support they need to prevent their symptoms getting worse.
The National Institute for Health and Care Excellence (NICE) develops indicators to measure quality of care outcomes. The aim of the current study is to assess the measurability of a proposed NICE general practice indicator: ‘The percentage of people with COPD at higher risk of hospital admission who have had a review in the preceding 12 months, including a record of the number of exacerbations and an assessment of breathlessness using the Medical Research Council dyspnoea scale’. This testing will help inform decisions about suitability for inclusion in the Quality and Outcomes Framework (an incentivised quality improvement scheme for general practices in England).
A retrospective observational cohort study will be conducted using CPRD Aurum primary care data linked to Hospital Episode Statistics Admitted Patient Care (HES APC). The COPD cohort will be defined according to the Quality and Outcomes Framework (QOF) business rules. From this population we will describe the number of people with modifiable risk factors, previous COPD-related hospital admissions, comorbidities, or assessment results that would put the patient at higher risk of hospital admission. We will then measure the proportion of high-risk individuals that had a COPD review in the previous 12 months, with a record of number of exacerbations and an assessment of breathlessness. Results will be stratified by patient-level Index of Multiple Deprivation (IMD) quintile to understand if the indicator reflects healthcare access inequalities.
Publication of this indicator will give service providers an understanding of whether their approach to annual COPD is inclusive of those at highest risk of hospital admission. This information will help them to develop their approach so that those at highest risk are encouraged to attend an annual review. This will ensure they get the support they need to prevent their COPD symptoms getting worse.
Prevalence of COPD; current smoking status; COPD exacerbations; COPD review; forced expiratory volume (FEV1); Medical Research Council (MRC) Dyspnoea Scale; previous COPD-related hospital admissions; cancer diagnosis; coronary heart disease, atrial fibrillation; heart failure, learning disability; serious mental illness; frailty.
Jonathan Wray - Chief Investigator - National Institute for Health and Clinical Excellence - NICE
Eleanor Yelland - Corresponding Applicant - National Institute for Health and Clinical Excellence - NICE
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation