COPD014 - MRC≥3 referred to pulmonary rehab
The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF).
This indicator is protected in the contract year 2024/25 and will be paid at 2023/24 performance levels
Indicator definition
Indicator ID | Description |
COPD014 | The percentage of patients with COPD and Medical Research Council (MRC) dyspnoea scale ≥3 at any time in the preceding 12 months, with a subsequent record of referral to a pulmonary rehabilitation programme (excluding those who have previously attended a pulmonary rehabilitation programme). |
What do the business rules mean?
What makes a patient eligible?
Patients are eligible for the COPD014 denominator if:
- they are on the COPD register
- an MRC score of 3 or more has been recorded during the contract year
- they have never previously attended pulmonary rehab
How to achieve the indicator
To meet the criteria for COPD014, eligible patients must have had a pulmonary rehabilitation referral code added.
What will remove patients from eligibility?
- Patients who have previously attended pulmonary rehabilitation
- Where a COPD service or pulmonary rehabilitation is unavailable
- Patients who are unsuitable for pulmonary rehabilitation
- Patients for whom COPD quality indicator care was unsuitable in the contract year
- Patients who chose not to receive COPD quality indicator care in the contract year
- Patients who have been invited twice for review (at least 7 days apart)
- Patients who were diagnosed in the last 3 months of the contract year
- 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.
Hints and tips for achieving this indicator
If a patient has attended pulmonary rehab in the current contract year, the timing of the pulmonary rehab and the earliest MRC 3/4/5 code is critical. To remove the patient from being eligible for COPD014, a pulmonary rehab attendance code needs to be added before the earliest MRC 3/4/5 code of the contract year. If the patient had been referred in the previous year, but an MRC score was recorded before the patient was able to attend pulmonary rehab, this is a situation where it may be necessary to add a referral or declined code at any time of the year to deal with the outstanding action. Alternatively where the indicator target can be achieved using other patients it should be possible to leave the patient unactioned for the remainder of the contract year.
A common theme that is seen with this indicator is that practices do not always record when pulmonary rehabilitation has been started or completed. This means that there often many more patients then necessary who are eligible for COPD and end up being coded for referral or have a PCA applied each year. It is worth working through eligible COPD patient records to see if any of them have attended pulmonary rehabilitation (in any form) previously and then adding the attended pulmonary rehabilitation code. Even if a pulmonary rehab attendance code does not change a patient's eligibility for the current contract year, it will ensure that the patient is not eligible for the next 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 indicating attendance at a pulmonary rehabilitation programme (PULRHBATT_COD)
SNOMED code | SNOMED code description |
1082401000000105 | Emergency hospital admission to programmed pulmonary rehabilitation service |
15081005 | Pulmonary rehabilitation |
229823004 | Pulmonary rehabilitation class |
391127007 | Assessment for pulmonary rehabilitation completed |
391128002 | Pulmonary rehabilitation program commenced |
391130000 | Pulmonary rehabilitation program completed |
860931000000107 | Did not complete pulmonary rehabilitation programme |
878051000000107 | Pulmonary rehabilitation review |
Codes for pulmonary rehabilitation programme unavailable (PULRHBSU_COD)
SNOMED code | SNOMED code description |
1111361000000101 | Quality and Outcomes Framework - pulmonary rehabilitation service not available |
939851000000104 | Pulmonary rehabilitation programme not available |
Codes indicating that a referral to a pulmonary rehabilitation programme is not suitable for the patient (PULRHBPU_COD)
SNOMED code | SNOMED code description |
1078921000000100 | Unsuitable for pulmonary rehabilitation |
| 305371000000101 | Pulmonary rehabilitation declined |
371611000000107 | Chronic obstructive pulmonary disease patient unsuitable for pulmonary rehabilitation |
Codes for chronic obstructive pulmonary disease (COPD) quality indicator care unsuitable for patient (COPDPCAPU_COD)
SNOMED code | SNOMED code description |
716311000000100 | Excepted from chronic obstructive pulmonary disease quality indicators - patient unsuitable |
Codes indicating the patient has chosen not to receive chronic obstructive pulmonary disease (COPD) quality indicator care (COPDPCADEC_COD)
SNOMED code | SNOMED code description |
716291000000101 | Excepted from chronic obstructive pulmonary disease quality indicators - informed dissent |
Invite for chronic obstructive pulmonary disease (COPD) care review codes (COPDINVITE_COD)
SNOMED code | SNOMED code description |
1066231000000103 | Chronic obstructive pulmonary disease monitoring email invitation |
| 1066281000000104 | Chronic obstructive pulmonary disease monitoring short message service text message invitation |
| 1066821000000101 | Chronic obstructive pulmonary disease monitoring short message service text message first invitation |
| 1066841000000108 | Chronic obstructive pulmonary disease monitoring short message service text message second invitation |
| 1066851000000106 | Chronic obstructive pulmonary disease monitoring short message service text message third invitation |
1109921000000106 | Quality and Outcomes Framework quality indicator-related care invitation |
| 1110861000000102 | Quality and Outcomes Framework chronic obstructive pulmonary disease quality indicator-related care invitation |
| 143371000000104 | Quality and Outcomes Framework chronic obstructive pulmonary disease quality indicator-related care invitation using preferred method of communication |
| 711431000000109 | Chronic obstructive pulmonary disease monitoring invitation |
716281000000103 | Chronic obstructive pulmonary disease monitoring verbal invitation |
716901000000101 | Chronic obstructive pulmonary disease monitoring telephone invitation |
716241000000106 | Chronic obstructive pulmonary disease monitoring first letter |
717021000000106 | Chronic obstructive pulmonary disease monitoring second letter |
717521000000104 | Chronic obstructive pulmonary disease monitoring third letter |
Codes indicating an offer of referral to a pulmonary rehabilitation programme (PULRHBOFF_COD)
SNOMED code | SNOMED code description |
24461000000105 | Referral to pulmonary rehabilitation |
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