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.

The information contained within this article is from version 50 of the Business Rules for Quality and Outcomes Framework (QOF).                 

Indicator definition

What do the business rules mean?

What makes a patient eligible?

Patients are eligible for the STIA014 denominator if they are on the Stroke register and are 79 years old or younger.

How to achieve the indicator

To meet the criteria for STIA014, 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 Stroke 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 stroke quality indicator care in the contract year
5. Patients who 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. Patient who were diagnosed with a stroke 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 maximal blood pressure (BP) therapy (HTMAX_COD)

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

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

Invite for stroke care review codes (STIAINVITE_COD)