Annex

Extract from theCompendium of Clinical and Health Indicators User Guide National Centre for Health Outcomes Development Thyroid and renal function testing in patients on lithium therapy
Purpose:

To help reduce the level of risk to health for NHS patients on lithium therapy and ensure high standards of primary health care and treatment delivered to them. There is a much higher than normal incidence of hypercalcaemia and hypothyroidism, and of abnormal renal function tests, in patients with severe mental health problems treated with lithium. It is therefore necessary to check thyroid function and renal function on an annual basis. Definition of indicator and its variants:

Proportion of patients on lithium therapy with a record of serum creatinine and thyroid stimulating hormone (TSH) levels in the preceding 15 months. Statistic
Organisation
File_worksheet Name
(see glossary)
Trend data

Numerator:

Numerator data - Patients on lithium therapy with a record of serum creatinine and TSH levels in the 15 months before the reference date. Source of numerator data - Quality and Outcomes Framework (QOF).

Comments on numerator data - The data for this primary care indicator are derived from the Quality Management
Analysis System (QMAS) and supplied by the Prescribing Support Unit at The NHS Information Centre for health and
social care. The QOF is part of the General Medical Services (GMS) contract, with a focus on prevalence and
management of common chronic diseases at general practice level. It is aimed at measuring the achievement of
general practices against a set of evidence based negotiated standards and encouraging good practice.
The data to support the clinical quality indicators (i.e. clinical achievement data) are extracted from individual GP
practice clinical systems and sent automatically to QMAS once a month. Practices can make additional submissions
of clinical data at any time.
The ‘reference date’ is the specified date of patient records held by the general practice modelled for the end of the QOF year (midnight 31st March). It is the same for the data from all practices and may differ from the date of data submission.
Denominator:

Denominator data - All patients on lithium therapy excluding those who have been exception reported. Patients may be exception reported for the following reasons: lithium prescribing recorded more than six months before the reference date registered in the three months before the reference date; mental health exception reported in the 15 months before the reference date; lithium prescribing recorded in the three months before the reference date. For more details regarding the description of the selection criteria and dataset rules of the relevant indicator set see the following documentation available at: Source of denominator data - See “Numerator data”.

Comments on denominator data - The denominator is a count of patients for whom the clinical indicator should be
met. However, the selection rules do not provide the same opportunity for all patients included in the denominator to
take advantage of the full period (maximum number of months after the diagnosis) allowed by good practice for the
Extract from theCompendium of Clinical and Health Indicators User Guide National Centre for Health Outcomes Development test, measurement or treatment to be undertaken (e.g. if good practice for angina patients allows for a particular test to be conducted up to 12 months after diagnosis then patients diagnosed between four and 11 months before the reference date do not have the full period of 12 months for the test). Additionally, patients can be removed from the denominator through the application of exception reporting.
Statistical methods:

The data are presented as raw (unadjusted) figures as recorded by the practices. Ideally, comparisons between PCOs should take into account differences between their populations in terms of age, gender and case-mix. However, this is not possible at present as the supplied data are not broken down by these characteristics. Interpretation of indicators:

Quality of indicator - Users of data derived from QMAS should recognise that QMAS was established as a mechanism to support the calculation of practice QOF payments and not as a person based epidemiological tool. It is not a comprehensive source of data on quality of care in general practice, but it is potentially a rich and valuable source of such information, providing that the limitations of the data are acknowledged. There have been some significant revisions to the QOF, compared to previous years. Therefore direct comparisons cannot be made except for the indicators that have not been subject to definitional changes.
Further reading:
1. The NHS Information Centre for health and social care. National Quality and Outcomes Framework Achievement Data 2009/10, October 2010. Availabl 2. NHS Employers and BMA. Quality and Outcomes Framework guidance for GMS contract 2009/10, March 2010. 3. The NHS Information Centre for health and social care. National Quality and Outcomes Framework Achievement Data 2008/09, September 2009. Available a 4. NHS Employers and General Practitioners Committee BMA. Quality and Outcomes Framework guidance for GMS contract 2008/09, April 2008. Available at: 5. The NHS Information Centre for health and social care. National Quality and Outcomes Framework Statistics for 6. The Information Centre for health and social care, Prescribing Support Unit. National Quality and Outcomes Framework Statistics for England 2006/07. Available at: 7. The Information Centre for health and social care, Prescribing Support Unit. National Quality and Outcomes Framework or England 2005/06. Available at: 8. The Health and Social Care Information Centre, National Quality and Outcomes Framework Statistics for England 9. Ashworth M, Armstrong D. The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004-5, BMC Family Practice, London: Ashworth and Armstrong, 2006 7:68. Available at: 10. Department of Health, Investing in General Practice. The New General Medical Services Contract. Available at: 11. Eastern Region Public Health Observatory, The limitations of Quality and Outcomes Framework (QOF) data. 12. Tanday S. News: Mental health QOF targets are intentionally difficult, 2007. Available at: Extract from theCompendium of Clinical and Health Indicators User Guide National Centre for Health Outcomes Development
Updated: June 2011

Source: https://groups.ic.nhs.uk/archivedcompendia/public/Documents/June%202011/2011_06_Specifications/Spec_31K_648.pdf