New NICE indicators to curb asthma misdiagnosis and overtreatment risks
Author: Caroline White
The National Institute for Health and Care Excellence (NICE) has published a suite of indicators, including for asthma, chronic obstructive pulmonary disease (COPD), and heart failure, which aim to improve diagnosis and curb the risk of overtreatment.
These could form part of the Quality and Outcomes Framework (QOF) for 2020/21.
A review of the current QOF indicators for these conditions was agreed following NHS England’s 2018 review of the QOF.
Four of the new indicators are intended to help improve diagnosis and ongoing care of people with asthma. A misdiagnosis of asthma can have life-long implications and result in unnecessary treatment, says NICE.
The new asthma indicators encourage general practice staff to undertake an annual review that includes an assessment of asthma control using a validated asthma control questionnaire (including assessment of short-acting beta agonist use), a recording of the number of worsening bouts of asthma and a written personalised action plan.
Assessing the use of short-acting beta agonists and recording exacerbations can help identify patients who are at increased risk of poor outcomes, says NICE.
People with asthma can use the information and advice from these reviews to manage their condition better themselves, maximising their future health.
Similarly, the new COPD indicators recognise the importance of using objective testing to confirm a diagnosis. The new indicators link diagnosis and objective testing to entry onto the QOF COPD register. This should help cut both misdiagnosis and the risk of overtreatment in people with COPD.
A new potential QOF indicator for people with heart failure shortens the timeframe in which an echocardiogram or specialist assessment should take place. Ensuring people with heart failure receive the right diagnosis and timely treatment will improve quality of life and help reduce the risk of premature death, says NICE.
The suite also includes a range of indicators to help people cut down their drinking and an indicator that can be used to measure multimorbidity.
NICE’s menu of QOF indicators has been developed to inform negotiations for the 2020/21 QOF in England as part of the General Medical Services (GMS) contract. Proposed changes to QOF will be subject to negotiations between NHS England and the British Medical Association’s General Practitioners Committee.
NICE has also developed indicators for use outside of the national QOF to improve outcomes for people with familial hypercholesterolaemia and support implementation of the NICE quality standard on HIV testing (QS157). These indicators can be used to support quality improvement and measurement at a local level, it says.
Professor Gillian Leng, deputy chief executive and director of health and social care at NICE commented: “There is currently no gold standard test for asthma which makes diagnosing a particularly difficult task for clinicians.
“It’s important that GPs take the appropriate steps to avoid misdiagnosing the condition which can lead to overtreatment. These new indicators should increase the likelihood of improved outcomes and support the personalisation of care for people with asthma.”