The National Institute for Health and Care Excellence (NICE) develops measures of the quality of care patients are receiving, called indicators, based on published recommendations. These indicators are also put forward for possible inclusion in the Quality Outcomes Framework (QOF), which is a scheme to incentivise good clinical practice in specific areas.
An indicator has been proposed to look at stopping smoking rates in people with severe mental illness. More people within this group are smokers, which puts them at higher risk of a range of health problems. Focused initiatives to support them to not smoke is of major benefit to the patient.
The work proposed here will check how well the proposed indicator can be measured within primary care data. We will calculate an indicator measure for the 31st March 2023. We will select a group of patients with a history of severe mental illness at any time before that date, who were recorded as current smokers 1 to 3 years before the 31st of March 2023. From this group, we will look at the number that were recorded as ex-smokers in the last year before the 31st of March 2023. This provides an indicator of the number of people in this group who have stopped smoking.
Checking how well this information can be measured is very important to being able to accurately report on this group and subsequently support general practices in their work in with this patient population to stop smoking.
The National Institute for Health and Care Excellence (NICE) develops indicators to measure quality of care outcomes. This piece of work looks to validate the measurement of a proposed NICE indicator in primary care data. This indicator will focus on how well the data can be used to measure the recording of smoking status, and particularly a change from a current to ex-smoker status, in a cohort of patients with severe mental illness. This indicator is being designed as a potential QOF indicator and must therefore be measurable in primary care data.
The study population of interest are patients with a history of severe mental illness who were previously recorded to have a ‘current smoker’ status. General Practitioners are encouraged to support these patients both to stop smoking and to maintain their ex-smoker status if they have.
Severe mental illness and a prior record of being a current smoker are the primary exposures that qualify a patient for inclusion in the study, and a recent record of being an ‘ex smoker’ is the outcome of interest. A retrospective cohort study design is to be used, with the indicator being calculated as at 31st March 2023. CPRD Aurum primary care data will be the main data source used, with patient-level Index of Multiple Deprivation data additionally linked to stratify the indicator by deprivation quintile. This will support description of potential health inequalities within this indicator measure.
There is a higher prevalence of smoking in patients with severe mental illness and publication of this indicator will provide practices with a clearer picture of how well these patients are being supported to lead healthier lives through good clinical practice. Targeted indicators such as this will benefit patients by focusing and incentivising good clinical practice in areas of clinical need.
SMI (schizophrenia, bipolar affective disorder, psychosis); smoking status
Eleanor Yelland - Chief Investigator - National Institute for Health and Clinical Excellence - NICE
Jonathan Wray - Corresponding Applicant - National Institute for Health and Clinical Excellence - NICE
Eileen Taylor - Collaborator - National Institute for Health and Clinical Excellence - NICE
Patient Level Index of Multiple Deprivation