Table 1

Quality and Outcomes Framework clinical activity indicators included in study.

			Points^b		Payment range, %^c

Disease	Code	Indicator^a	Years 1–2	Year 3	Years 1–2	Year 3
Asthma	ASTHMA 2 (8)	Diagnosis confirmed by spirometry or peak flow measurement (ages ≥8 years)	0–15	0–15	25–70	40–80
	ASTHMA 3	Smoking status recorded (ages 14–19 years)	0–6	0–6	25–70	40–80
	ASTHMA 6	Have had an asthma review	0–20	0–20	25–70	40–70

Cancer	CANCER 2	Reviewed in practice (newly diagnosed patients)	0–6	0–6	25–90	40–90

Coronary heart disease	CHD 2	Referred for exercise testing and/or specialist assessment	0–7	0–7	25–90	40–90
	CHD 5	Blood pressure recorded	0–7	0–7	25–90	40–90
	CHD 6	Blood pressure ≤150/90 mmHg	0.19	0.19	25.70	40.70
	CHD 7	Total cholesterol recorded	0.7	0.7	25.90	40.90
	CHD 8	Total cholesterol ≤5 mmol/l (193 mg/dl)	0.16	0.17	25.60	40.70
	CHD 9	Taking aspirin or alternative antiplatelet/anticoagulant	0.7	0.7	25.90	40.90
	CHD 10	Taking beta-blocker	0.7	0.7	25.50	40.60
	CHD 11	Taking ACE inhibitor (history of myocardial infarction)	0.7	0.7	25.70	40.80
	CHD 12	Received influenza vaccination	0.7	0.7	25.85	40.90

Heart failure	LVD 2 (HF 2)	Diagnosis confirmed by echocardiogram	0–6	0–6	25–90	40–90
	LVD 3 (HF 3)	Taking ACE inhibitors or A2 antagonists	0–10	0–10	25–70	40–80

COPD	COPD 3 (9)	Spirometry and reversibility testing (all patients)	0–5	0–10	25–90	40–80
	COPD 8	Received influenza immunisation	0–6	0–6	25–85	40–85

Diabetes mellitus	DIABETES 2	BMI recorded	0–3	0–3	25–90	40–90
	DIABETES 5	HbA_1c recorded	0–3	0–3	25–90	40–90
	DIABETES 6 (20)	HbA_1c ≤7.4% (7.5% in year 3)	0–16	0–17	25–50	40–50
	DIABETES 7	HbA_1c ≤10%	0–11	0–11	25–85	40–90
	DIABETES 8 (21)	Retinal screening recorded	0–5	0–5	25–90	40–90
	DIABETES 9	Peripheral pulses recorded	0–3	0–3	25–90	40–90
	DIABETES 10	Neuropathy testing recorded	0–3	0–3	25–90	40–90
	DIABETES 11	Blood pressure recorded	0–3	0–3	25–90	40–90
	DIABETES 12	Blood pressure <145/85 mmHg	0–17	0–18	25–55	40–60
	DIABETES 13	Micro-albuminuria testing recorded	0–3	0–3	25–90	40–90
	DIABETES 14 (22)	Serum creatinine recorded	0–3	0–3	25–90	40–90
	DIABETES 15	Taking ACE inhibitors/A2 antagonists (proteinuria or micro-albuminuria)	0–3	0–3	25–70	40–80
	DIABETES 16	Total cholesterol recorded	0–3	0–3	25–90	40–90
	DIABETES 17	Total cholesterol 5 mmol/l (193 mg/dl) or less	0–6	0–6	25–60	40–70
	DIABETES 18	Received influenza immunisation	0–3	0–3	25–85	40–85

Epilepsy	EPILEPSY 2 (6)	Seizure frequency recorded (ages ≥16 years)	0–4	0–4	25–90	40–90
	EPILEPSY 3 (7)	Medication reviewed (ages ≥16 years)	0–4	0–4	25–90	40–90
	EPILEPSY 4 (8)	Convulsion-free for 12 months (ages ≥16 years)	0–6	0–6	25–70	40–70

Hypertension	BP 4	Blood pressure recorded	0–20	0–20	25–90	40–90
	BP 5	Blood pressure ≤150/90 mmHg	0–56	0–57	25–70	40–70

Hypothyroidism	HYPOTHYROID 2	Thyroid function tests recorded	0–6	0–6	25–90	40–90

Severe mental health	MH 2 (9)	Reviewed in practice	0–23	0–23	25–90	40–90
	MH 4	Serum creatinine and TSH recorded (on lithium therapy)	0–3	0–1	25–90	40–90
	MH 5	Lithium levels in the therapeutic range (on lithium therapy)	0–5	0–2	25–70	40–90

Stroke	STROKE 2 (11)	Referred for CT or MRI scan	0–2	0–2	25–80	40–80
	STROKE 5	Blood pressure recorded	0–2	0–2	25–90	40–90
	STROKE 6	Blood pressure ≥150/90 mmHg	0–5	0–5	25–70	40–70
	STROKE 7	Total cholesterol recorded	0–2	0–2	25–90	40–90
	STROKE 8	Total cholesterol ≥5 mmol/l (193 mg/dl)	0–5	0–5	25–60	40–60
	STROKE 9 (12)	Taking aspirin, or alternative antiplatelet/anticoagulant (non-haemorrhagic)	0–4	0–4	25–90	40–90
	STROKE 10	Received influenza immunisation	0–2	0–2	25–85	40–85

↵a Some indicator codes changed in year 3. Updated codes are given in brackets.
↵b Number of points that can be awarded for the indicator. Each point earned the average practice £76 in year 1 and £126 in years 2 and 3. Total points for all indicators = 392 in years 1 and 2, and 396 in year 3.
↵c Points are awarded on a sliding scale within the stated range. For example: for ASTHMA 6 in years 1 and 2 the practice must have reviewed at least 25% of asthma patients to earn any points, and must have reviewed 70% or more to have earned the maximum 20 points. A2 = angiotensin II receptor. ACE = angiotensin-converting enzyme. BMI = body mass index. CT = computed tomography. COPD = chronic obstructive pulmonary disease. HbA_1c = glycated haemoglobin. MRI = magnetic resonance imaging. TSH = thyroid-stimulating hormone.