Immunisation: flu vaccine for people with long-term conditions

Indicator

The percentage of patients with coronary heart disease, stroke or transient ischemic attack, diabetes and/or chronic obstructive pulmonary disease who have had influenza immunisation in the preceding 1 August and 31 March.

Introduction

This report covers a new indicator that is part of the NICE menu of potential Quality and Outcomes Framework (QOF) indicators for 2016/17, following the recommendations of the NICE indicator advisory committee in June 2015. The indicator has been piloted as part of the NICE QOF indicator development process.

This report considers the likely resource impact of incentivising the interventions associated with the proposed indicator in terms of the number of additional interventions provided and the cost of each intervention. Costs to NHS commissioners are outlined where relevant.

People with the health conditions referred to in the indicator (coronary heart disease (CHD), stroke/transient ischaemic attack (TIA), diabetes and chronic obstructive pulmonary disease (COPD) are at greater risk of poor health outcomes if they contract influenza. Annual influenza vaccination for people with these conditions should reduce their risk of influenza-related ill-health and their need for healthcare arising from influenza.

Number of people affected

Based on pilot data, the number of people with with these high risk conditions that may benefit from influenza immunisation within the indicator is estimated at 4 million.

Current care

The current QOF already incentivises influenza vaccinations for people on the individual GP practice disease registers for CHD, stroke/TIA, diabetes and COPD:

• CHD007. The percentage of patients with coronary heart disease who have had influenza immunisation in the preceding 1 August to 31 March
• STIA009. The percentage of patients with stroke or TIA who have had influenza immunisation in the preceding 1 August to 31 March
• DM018. The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March
• COPD007. The percentage of patients with COPD who have had influenza immunisation in the preceding 1 August to 31 March.

People who have more than one of these conditions will be included in more than one of the current indicator denominators.

Proposed care

The potential new indicator would still incentivise influenza vaccination for people with any of these four conditions, but would only ‘reward’ the GP practice once if the new indicator replaced the 4 existing indicators in the QOF.

Resource impact

QOF indicator achievement for the indictors being combined is as follows for 2013/14 (Health and Social Care Information Centre, 2014):

• CHD004: The percentage of patients with coronary heart disease who have had influenza immunisation in the preceding 1 September to 31 March is 94.3% (CHD007 from 2014/15, when the 1 September start date was changed to 1 August).
• STIA006: The percentage of patients with stroke or TIA who have had influenza immunisation in the preceding 1 September to 31 March is 93.2% (STIA009 from 2014/15, when the 1 September start date was changed to 1 August).
• DM010: The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 September to 31 March is 93.4% (DM018 from 2014/15, when the 1 September start date was changed to 1 August).
• COPD006: The percentage of patients with COPD who have had influenza immunisation in the preceding 1 September to 31 March is 96.2% (CHD007 from 2014/15, when the 1 September start date was changed to 1 August).

As the only change is to ‘reward’ the GP practice once if the new indicator replaced the 4 existing indicators in the QOF, no significant costs are anticipated.

References

Health and Social Care Information Centre, 2014, Data table for Quality and Outcomes Framework (QOF) 2013-14. 

University of Birmingham and University of York Health Economics Consortium Health (NICE External Contractor), Development feedback report on piloted indicators, 2015.