CKD as a new clinical domain in the Quality Outcomes Framework

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CKD as a new clinical domain in the Quality
Outcomes Framework Dr. Ian Wilkinson
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• 9651 Patients
• 5 GPs
• 1 Nurse Practitioner (Partner)
• 3 Practice Nurses (1 Partner)
• Healthcare Assistant
• Range of attached staff
• 1043 QOF points (05 06)
• CKD Register 1468 patients

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• Practice Lead
• Chronic Disease Register active case finding
• Data Set national -gt local -gt practice
• Computer Template - flexibility
• Nurse led/protocol driven
• Chronic Disease Management Co-ordinator
• Call/Recall 6 monthly partial, 12 monthly full
• Audit

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• Blood pressure target lt 130/85
• Aspirin
• Smoking smoking cessation programme
• BMI (? Abdominal Girth) target lt25 Europid lt23
  Asian
• Lipids target total lt 4.5 mmol/L LDL lt 1.3
  mmol/L
• U E
• eGFR MDRD - stage on 2 consecutive measures
• Calcium Phosphate
• FBC
• Urinalysis proteinuria/haematuria
• Immunisation flu, pneumococcal

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Lab. Normal Range
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CKD Stage 3
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Age and CKD

• Female CKD 2 - Mean Age 64.7 yrs
• Male CKD 2 Mean Age 61.8 yrs
• Female CKD 3 Mean Age 74.6 yrs
• Male CKD 3 Mean Age 71.5 yrs
• MEAN TIME FROM CKD 2 TO CKD 3 IS
• 10 YEARS

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Deaths and Patients on CKD Register
Female (1/4/05 -31/3/06) 21 Male (1/4/05
31/3/06) 34 130 excess male deaths in 10 yrs
from CKD 2 to CKD 3 Excess Premature Male Deaths
account for Female predominance in CKD 3 Register
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General Practitioners Committee - Annual Report
2006 As expected, GPs have risen admirably to
the challenges of the new contract, particularly
in the Quality and Outcomes Framework (QOF),
where they have achieved very high average
scores Hamish Meldrum
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Pulse April 20th 2006
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Average Practice QOF Achievement 2005 2006
England 1010.5 points West Yorks. 994.5
points Bradford City 909.8 points Bradford
North 993.4 Bradford S W 1016.4
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Average Practice QOF Achievement 2005
2006 Bradford PCTs
CHD - 92.7 to 99.7 Stroke 86.0 to 100 BP
92.2 to 98.0 DM 88.4 to 99.3
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Quality Outcomes FrameworkChronic Kidney Disease
1(CKD1)

• CKD 1 The practice can produce a register of
  patients aged 18 years and over with CKD ( US
  National Kidney Foundation Stage 3 to 5 CKD )
• 6 Points

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Quality Outcomes FrameworkChronic Kidney Disease
1(CKD1)

• 25 of all patients in practice have had Se.
  Creatinine in previous 12 months
• 97 of CKD patients will be on CHD, Stroke,
  Hypertension or DM registers
• Prevalence ( Perazella Reilly)
• CKD 3 - 4.3 (253)
• CKD 4 0.2 (11)
• CKD 5 0.1 (5)
• (CKD1) - 6 points

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Quality Outcomes FrameworkChronic Kidney Disease
2 (CKD2)

• CKD 2 The percentage of patients on the CKD
  register whose notes have a record of blood
  pressure in the previous 15 months
• 6 Points
• 40 90 threshold

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Quality Outcomes FrameworkChronic Kidney Disease
2 (CKD2)

• BP 4 (BP recorded in last 9 months) 94-99.9
• CHD 5 (BP recorded in last 15 months) 95.7
  -100
• DM 11(BP recorded in last 15 months) 96.6
  -100
• Stroke 5 (BP recorded in last 15 months) 75 -
  100
• CKD2 would be 96.5 (90 threshold)
• (CKD2) 6 points

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Quality Outcomes FrameworkChronic Kidney Disease
3 (CKD3)

• CKD 3 The percentage of patients on the CKD
  register in whom the last blood pressure reading
  measured in the previous 15 months, is 140/85 or
  less
• 11 Points
• 40 70 threshold

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Quality Outcomes FrameworkChronic Kidney Disease
3 (CKD3)

• BP 5 (lt 150/90 last 9 months) 85 - 87.1
• CHD 6 (lt150/90 last 15 months) 98.9. - 99.4
• DM 12 (lt145/85 last BP) 94.1 - 100
• Stroke 6 (lt150/90 last BP in last 15 months)
  84 - 100
• CKD3 would be 82.6 (70 threshold)
• (CKD3) - 11 points

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Quality Outcomes FrameworkChronic Kidney Disease
4 (CKD4)

• CKD 4 The percentage of patients on the CKD
  register with hypertension who are treated with
  an angiotensin converting enzyme inhibitor (ACE
  1) or angiotensin receptor blocker (ARB) (unless
  a contraindication or side effects are recorded)
• 4 Points
• 40 80 threshold

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Quality Outcomes FrameworkChronic Kidney Disease
4 (CKD4)

• 50 75 CKD Patients will have Hypertension (A.
  Levey)
• 70 on BP register on ACE or ARB
• CKD 4 would be 70 (40 80 threshold)
• (CKD4) - 3 points

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Quality Outcomes FrameworkChronic Kidney Disease
26 points out of 27 available
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Quality Outcomes FrameworkChronic Kidney Disease
The Future

• CKD 1 CKD 2 on register
• At risk patients on register
• BP target 130/80
• Full vascular risk assessment
• Anaemia management
• Bone minerals
• PCR
• newly registered patients aged over 18 on GP
  system as transplant donors

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Thank you
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Any Questions ?