GP Dr Gavin Jamie looks at how practices can attain maximum points within the stroke and TIA area of QOF’s clinical domain
Summary indicators and value
- Indicators: 4
- Points: 11
- Prevalence: 1.9% (this is an estimate based on latest available QOF data and current trends)
- £/patient on the register (estimated): £13.20
Background
The stroke area has been in the QOF since its inception and prevalence is pretty stable.
Indicator STIA001: Maintain patient register (2 points)
There is a wide range of pathology that comes under the heading of stroke and transient ischaemic attack (TIA) and there are over 60 diagnostic codes that will put a patient on the register. The rules reflect this complexity.
As these patients are often on the same cardiovascular medicines as those on other registers they can be difficult to search for if not coded. The diagnosis is usually made in secondary care – searching for CT scans of the head may throw up some missed patients, particularly if you have access to hospital results.
The official guidance says that it is up to practices when a ‘dizzy turn’ or amaurosis fugax should be coded as a TIA. Practically that decision might be made after a CT scan has been performed.
Indicator STIA014: Blood pressure 140/90 or less in under 80-year-olds (3 points)
Indicator STIA015: Blood pressure 150/90 or less in over 80-year-olds (2 points)
These two indicators were introduced in 2019/20 to replace the previous single blood pressure target indicator with two age-stratified indicators, introducing a tighter target blood pressure for the under-80s.
There are five points for patients whose final blood pressure is under the appropriate threshold for their age. These are the same levels as the hypertension area and they have equivalent exception codes for patient consent, suitability and maximal tolerated antihypertensive therapy.
Blood pressure measurement will normally take place in an annual review. Remember that a hypertension code may also be appropriate to put the patient on the hypertension register.
Indicator STIA007: Antiplatelets or anticoagulant prescription (4 points)
Four points are available for the prescription of antiplatelets or anticoagulant to a patient who has had a non-haemorrhagic stroke. This is a much smaller range of diagnoses and where there is ambiguity patients will not qualify for this indicator. The majority of qualifying codes use the word ‘infarction’.
Prescriptions of aspirin, clopidogrel, dipyridamole and oral anticoagulants will count towards this indicator, as well as a record of the use of, or advice about, over-the-counter aspirin.
There is exception reporting (now known as ‘personalised care adjustment’) for the whole stroke area. To exception report for this indicator alone there will need to be individual codes entered for aspirin, clopidogrel, dipyridamole and oral anticoagulation – that is four separate codes.
Indicators in full
- The contractor establishes and maintains a register of patients with stroke or TIA (STIA001).
- The percentage of patients aged 79 years or under with a history of stroke or TIA in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading). (STIA014). Payment threshold: 40-73%
- The percentage of patients aged 80 years and older with a history of stroke or TIA in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less or equivalent home blood pressure reading). (STIA015). Payment threshold: 46-86%
- The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an antiplatelet agent, or an anti-coagulant is being taken (STIA007). Payment threshold: 57-97%
Dr Gavin Jamie is a GP in Swindon and runs the QOF Database website
Further reading/resources
NHS England – Quality and Outcomes Framework guidance for 2023/24. Published 30 March 2023.
