COPD014 - MRC≥3 referred to pulmonary rehab (Retired v50 2025/26)

COPD014 - MRC≥3 referred to pulmonary rehab (Retired v50 2025/26)

Warning
This indicator was retired in the contract year 2025/26 but remains in the business rules                                                                                                                                                          
Warning
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.
Info
The information contained within this article is from version 50 of the Business Rules for Quality and Outcomes Framework (QOF).                               

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:
  1. they are on the COPD register
  2. an MRC score of 3 or more has been recorded during the contract year
  3. 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?

  1. Patients who have previously attended pulmonary rehabilitation
  2. Where a COPD service or pulmonary rehabilitation is unavailable
  3. Patients who are unsuitable for pulmonary rehabilitation
  4. Patients for whom COPD quality indicator care was unsuitable in the contract year
  5. Patients who chose not to receive COPD quality indicator care in the contract year
  6. Patients who have been invited twice for review (at least 7 days apart)
  7. Patients who were diagnosed in the last 3 months of the contract year
  8. Patients who were newly registered with the practice in the last 3 months of the contract year

Notes
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

Warning
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

305371000000101Pulmonary 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

1066281000000104Chronic obstructive pulmonary disease monitoring short message service text message invitation
1066821000000101Chronic obstructive pulmonary disease monitoring short message service text message first invitation
1066841000000108Chronic obstructive pulmonary disease monitoring short message service text message second invitation
1066851000000106Chronic obstructive pulmonary disease monitoring short message service text message third invitation
1109921000000106
Quality and Outcomes Framework quality indicator-related care invitation
1110861000000102Quality and Outcomes Framework chronic obstructive pulmonary disease quality indicator-related care invitation
143371000000104Quality and Outcomes Framework chronic obstructive pulmonary disease quality indicator-related care invitation using preferred method of communication
711431000000109Chronic 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