Bipolar, schizophrenia and other psychoses: 6 physical health checks
Indicator
Percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who, in the preceding 12 months, received all 6 elements of physical health checks for people with severe mental illness.
Indicator type
General practice indicator suitable for use in the Quality and Outcomes Framework. It should only be used in conjunction with existing individual indicators on the 6 care processes in order to understand where to focus quality improvement.
This document does not represent formal NICE guidance. For a full list of NICE indicators, see our menu of indicators.
To find out how to use indicators and how we develop them, see our NICE indicator process guide.
Rationale
The aim of the annual checks is to identify and address modifiable risk factors linked to premature death. People with severe mental illness (SMI) are at a greater risk of poor physical health and die on average 15 to 20 years earlier than the general population. Major causes of death in people with SMI include cardiovascular disease, respiratory disease, diabetes and hypertension. It is expected that this indicator, incorporating all 6 elements of the physical health check, will increase the number of people with SMI who receive these checks annually.
Source guidance
Tobacco: preventing uptake, promoting quitting and treating dependence. NICE guideline NG209 (2021, updated 2022), recommendation 1.11.1
Bipolar disorder: assessment and management. NICE guideline CG185 (2014, updated 2020), recommendations 1.2.12, 1.10.2
Psychosis and schizophrenia in adults: prevention and management. NICE guideline CG178 (2014), recommendations 1.1.3.6, 1.3.6.1, 1.5.3.2 and 1.5.3.3
Alcohol-use disorders: prevention. NICE guideline PH24 (2010), recommendations 6, 7 and 9
Specification
Numerator: the number in the denominator who, in the preceding 12 months, received all 6 elements of physical health checks for people with severe mental illness.
Denominator: the total number of registered patients with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses.
Calculation: Numerator divided by the denominator, multiplied by 100.
Definitions: The 6 elements of physical health checks are:
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a record of blood pressure
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a record of BMI
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a record of alcohol consumption
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a record of a lipid profile
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a record of blood glucose or HbA1c
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a record of smoking status.
At the patient level, personalised care adjustments (PCAs) against each health check should be considered to account for situations where the patient is in remission, declines physical health checks, does not respond to invite or if the physical health check is not appropriate.
The denominator will include:
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patients who have received all 6 physical health checks
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patients who have not received all 6 checks, and for at least 1 of these checks there is no personalised care adjustment recorded.
Patients who have received less than 6 health checks but whose total number of health checks plus PCAs equals exactly 6 will be rejected from the denominator as a PCA.
ISBN: 978-1-4731-5933-4