AST007 - Asthma annual review

AST007 - Asthma annual review

The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF).                                                                     

Indicator definition

Indicator ID

Description

AST007

The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using a validated asthma control questionnaire, a recording of the number of exacerbations, an assessment of inhaler technique and a written personalised asthma plan.


What do the business rules mean?

What makes a patient eligible?

Patients are eligible for the AST007 denominator if they are on the Asthma register.

How to achieve the indicator

Patients must have completed all the requirements of the review to pass the indicator:
  1. a completed asthma review 
  2. a written care plan (on the same day as an asthma review) 
  3. an assessment of asthma control using ACT score (between 1 month before the asthma review up until the date of an asthma review) 
  4. a recording of the number of exacerbations (between 1 month before the asthma review up until the date of an asthma review)

What will remove patients from eligibility?

  1. Patients for whom asthma quality care was unsuitable in the contract year
  2. Patients who choose not to receive monitoring in the contract year
  3. Patients who chose not to receive any asthma quality indicator care in the contract year
  4. Patients who have not responded to two invitations for an asthma review at least 7 days apart in the contract year
  5. Patients who were diagnosed with asthma in the last 3 months of the contract year
  6. Patients who were newly registered with the practice in the last 3 months of the contract year

If a patient achieves the indicator at any point during the year, any exclusions that have also been added are ignored.

What are the common pitfalls/what do I need to watch out for?

Clinicians not completing all of the required data points for the review within the correct time frame is a common reason for not performing on this indicator.  
While the 4 components do not have to all be coded on the same day, this is the easiest way to ensure a complete review is done. Note that the Care Plan must be added on the same day as a review, but it is possible to document number of exacerbations and ACT score on different days (as long as they are followed by a review within the next month/30 days).
  1. In theory, multiple asthma reviews can be conducted during the contract year. As long as the care plan, ACT score, and number of exacerbations are within the required timeframes of any asthma review code, the patient will achieve the indicator.
  2. Not coding asthma invites correctly will often be a reason for not hitting this target.
Despite being referenced in the indicator description, Inhaler technique is not actually a required coded component for QOF.

SNOMED codes used in this indicator

The codes referenced in this article are taken from the NHS Technology Reference Update Distribution (TRUD).  Not all of these may be present or selectable in all clinical systems.

Codes for asthma review (REV_COD)

SNOMED code

SNOMED code description

270442000

Asthma monitoring check done

390872009

Change in asthma management plan

390877003

Step up change in asthma management plan

390878008

Step down change in asthma management plan

394700004

Asthma annual review

394701000

Asthma follow-up

394720003

Asthma medication review

401182001

Asthma monitoring by nurse

401183006

Asthma monitoring by doctor

754061000000100

Asthma review using Royal College of Physicians three questions

Codes for written personalised asthma action plan (WRITPASTP_COD)

SNOMED code
SNOMED code description
527171000000103
Patient has a written asthma personal action plan
810901000000102
Asthma self-management plan review
811921000000103
Asthma self-management plan agreed

Codes for assessment of asthma control (ASTCONTASS_COD)

SNOMED code

SNOMED code description

443117005

Asthma control test score

763077003

Asthma Control Questionnaire score

905301000000103

Childhood Asthma Control Test score

Codes for the number of asthma exacerbations in the last year (ASTEXACB_COD)

SNOMED code

SNOMED code description

366874008

Number of asthma exacerbations in past year

Codes for asthma quality indicator care unsuitable for patient (ASTPCAPU_COD)

SNOMED code

SNOMED code description

717291000000103

Excepted from asthma quality indicators - patient unsuitable

Codes indicating the patient has chosen not to receive asthma monitoring (ASTMONDEC_COD)

SNOMED code

SNOMED code description

763221007

Asthma monitoring declined

Patients who have chosen not to receive any asthma quality indicator care (ASTPCADEC_COD)

SNOMED code
SNOMED code description
716491000000100
Excepted from asthma quality indicators - informed dissent

Patients who have been invited twice for an asthma review at least 7 days apart (ASTINVITE_COD)

SNOMED codeSNOMED code description
1110841000000103Quality and Outcomes Framework asthma quality indicator-related care invitation
185731000Asthma monitoring call first letter
185732007Asthma monitoring call second letter 
185734008Asthma monitoring call third letter
185735009Asthma monitoring call verbal invite
185736005Asthma monitoring call telephone invite
92161000000104Quality and Outcomes Framework asthma quality indicator-related care invitation using preferred method of communication
928451000000107Asthma monitoring invitation short message service text message
928511000000107Asthma monitoring invitation email
959401000000101Asthma monitoring short message service text message first invitation
959421000000105Asthma monitoring short message service text message second invitation
959441000000103Asthma monitoring short message service text message third invitation


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