CHD015 - CHD, age <80, with BP 140/90 mmHg or less

CHD015 - CHD, age <80, with BP 140/90 mmHg or less

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

The percentage of patients aged 79 years or under, with coronary heart disease, 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).


What do the business rules mean?

What makes a patient eligible?

Patients are eligible for the CHD015 denominator if they are on the CHD register and are 79 years old or younger.

How to achieve the indicator

To meet the criteria for CHD015, eligible patients must have met one of the following requirements:
  1. a latest blood pressure measured in clinic (ie: one that is not ambulatory or home-based) that was at most 140/90mmHg
  2. a latest blood pressure which was from an ambulatory test that was at most 135/85mmHg
  3. a latest blood pressure measured at home by the patient that was at most 135/85mmHg

What will remove patients from eligibility?

  1. Patients who have been coded as receiving maximal blood pressure therapy in the contract year 
  2. Patients for whom CHD quality care was unsuitable in the contract year
  3. Patients who chose not to have their blood pressure recorded or undertake home blood pressure or ambulatory blood pressure monitoring in the contract year
  4. Patients who chose not to receive CHD quality indicator care in the contract year
  5. Patients who have been invited twice (at least 7 days apart) for review with no subsequent blood pressure reading
  6. Patients whose most recent BP reading in the contract year was followed by two invites at least 7 days apart (ie: a raised result which needs re-checking)
  7. Patients who were diagnosed with CHD in the last 9 months of the contract year
  8. Patients who were newly registered with the practice in the last 9 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?

Separately coded systolic and diastolic values (especially for a clinic based reading) may not be counted towards the indicator. 
  1. Ensure all clinicians are aware of the coding requirements.
  2. Ensure all clinicians are aware of the blood pressure target thresholds and their impact on the indicator, especially towards the end of the contract year.


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 clinic blood pressure readings (CLINBP_COD)

SNOMED code

SNOMED code description

163020007

On examination - blood pressure reading

75367002Blood pressure
163034007Standing blood pressure
163035008Sitting blood pressure
163033001Lying blood pressure

Codes for home blood pressure readings (HOMEAMBBP_COD)

SNOMED code

SNOMED code description

1162737008

Self reported systolic blood pressure

1162735000Self reported diastolic blood pressure
413606001Average home systolic blood pressure
413605002Average home diastolic blood pressure
314446007Average day interval systolic blood pressure
314461008Average day interval diastolic blood pressure
314449000Average 24 hour systolic blood pressure
314462001Average 24 hour diastolic blood pressure
198081000000101Ambulatory systolic blood pressure
198091000000104Ambulatory diastolic blood pressure

Codes for maximal blood pressure (BP) therapy (HTMAX_COD)

SNOMED code

SNOMED code description

407567007

Patient on maximal tolerated antihypertensive therapy

Codes for coronary heart disease (CHD) quality indicator care unsuitable for patient (CHDPCAPU_COD)

SNOMED code

SNOMED code description

717111000000104

Excepted from coronary heart disease quality indicators - patient unsuitable

Codes indicating the patient has chosen not to have blood pressure procedure (BPDEC_COD)

SNOMED code

SNOMED code description

413123006

Blood pressure procedure declined

Codes indicating patient chosen not to undertake home blood pressure measurement (HBPM) (HOMEBPDEC_COD)

SNOMED code

SNOMED code description

1085031000000100

Home blood pressure monitoring declined

Codes indicating patient chosen not to undertake ambulatory blood pressure monitoring (ABPM) (ABPMDEC_COD)

SNOMED code

SNOMED code description

861231000000105

Ambulatory blood pressure recording declined

Codes indicating the patient has chosen not to receive coronary heart disease (CHD) quality indicator care (CHDPCADEC_COD)

SNOMED code

SNOMED code description

716091000000107

Excepted from coronary heart disease quality indicators - informed dissent

Invite for coronary heart disease (CHD) care review codes (CHDINVITE_COD)

SNOMED code

SNOMED code description

1083121000000102

Coronary heart disease monitoring invitation

1083131000000100Coronary heart disease monitoring invitation email
1110881000000106Quality and Outcomes Framework secondary prevention of coronary heart disease quality indicator-related care invitation
143451000000101Quality and Outcomes Framework secondary prevention of coronary heart disease quality indicator-related care invitation using preferred method of communication
248461000000107Coronary heart disease monitoring telephone invitation
401250009Coronary heart disease monitoring first letter
401251008Coronary heart disease monitoring second letter
401252001Coronary heart disease monitoring third letter
401253006
Coronary heart disease monitoring verbal invitation

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