Qof 2012 13
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QOF 2012-13. Primary Care Commissioning (PCC) Gail Sampson – QOF Manager & Jamie Lewin – Clinical Audit & Data Quality Specialist. What am I going to be talking about?. Working through all areas of the QOF showing the changes between 2011-12 and 2012-13

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QOF 2012-13

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Qof 2012 13

QOF 2012-13

Primary Care Commissioning (PCC)

Gail Sampson – QOF Manager

&

Jamie Lewin – Clinical Audit & Data Quality Specialist


Qof 2012 13

What am I going to be talking about?

  • Working through all areas of the QOF showing the changes

  • between 2011-12 and 2012-13

  • Indicators retired (CHD13, AF4, QP1-5)

  • Indicators changed

  • New indicators (inc. Osteoporosis & PAD)

  • Changes to thresholds

  • Quality & Productivity indicators

  • General Practice Extraction Service

  • Year end 2011-12


Qof 2012 13

Changes to thresholds

  • Where currently 40-90% all lower thresholds raised to 50-90%

  • Where currently with upper thresholds between 70-85% all lower thresholds raised to 45%

  • Some upper threshold changes for CHD6, CHD10, PP!, PP2, HF4,STROKE6, STROKE8, DM17, DM31 & COPD10

  • Lower & upper threshold changes for BP5, MH10 & DEM2


Qof 2012 13

Clinical Domain –

CHD13 retired March 2012


Qof 2012 13

Diabetes

  • (DM19 ) DM32: Register of patients aged 17 years & over with Diabetes Mellitus, which specifies the type of diabetes where a Diagnosis has been confirmed

  • Diagnosed by: - Fasting plasma glucose > 7.0mmol/l or - 2 hour plasma glucose > 11.1mol/l or - IFCC* HbA1c > 48mmol/l (=6.5%)

  • If too early to diagnose the specific type of diabetes, or

  • If the specific diagnosis is uncertain

  • Code diabetes using the parent term “Diabetes Melitus”

  • Update records when their type of diabetes is confirmed

  • *International Federation of Clinical Chemistry


Qof 2012 13

Diabetes Continued READ codes


Qof 2012 13

New code for COPD15

  • 33720 Unable to perform Spirometry – from October 2011

  • As well as for Asthma

  • 8I3b.Spirometry test declined (upper case i)

  • 8I6L.Spirometry not indicated (upper case i)

  • 8I2j.Spirometry contraindicated (upper case i)


Qof 2012 13

Epilepsy

  • EP9 The % of women with Epilepsy under the age of 55, who are taking anti epileptic drugs who have a record of information & counselling about: Contraception, Conception & Pregnancy in the previous 15 months

  • Risk of congenital malformations

  • Register starts at 18, so 18-55 years

  • Need to advise on all three

  • Exception codes e.g. Pregnancy

  • Although patient maybe pregnant you will still need to provide advice onContraception & Pregnancy


Qof 2012 13

Epilepsy continued

Now includes telephone reviews


Qof 2012 13

Mental Health

  • MH10 The % of patients on the register who have a comprehensive care plan documented in the records agreed between individuals, their family or carers as appropriate. (replaces MH6)

  • New mental health remission exception codes min 5 years – new guidance

  • Recode for relapse

  • MH11 The % of schizophrenia, bipolar affective disorder & other psychoses who have a record of alcohol consumption in the proceeding 15 months


Qof 2012 13

Mental Health continued

  • MH12 BMI

  • MH13 BP

  • MH19 Total cholesterol: hdl ratio. Now excludes those with hypertension, CHD, stroke or TIA, diabetes, PAD or familial hypercholesterolemia (replaces MH14)

  • MH20 Blood glucose level or HbA1c. Now excludes those already diagnosed with diabetes


Qof 2012 13

Asthma

  • Asthma3 Asthma10 The % of patients with asthma between the ages of 14 & 19 years in whom there is a record of smoking status in the previous 15 months

  • New exception – Refusal to give smoking status 137k.

  • Asthma6 Asthma9 The % of patients with asthma who have had an asthma review in the last 15 months that includes an assessment of asthma control, using the 3 RCGP questions


Qof 2012 13

Asthma continued

Asthma questions – In the last month?

  • Q1) have you had difficulty sleeping because of your asthma symptoms (including cough?) - 663N. Asthma disturbing sleep - 663O. Asthma not disturbing sleep (etc)

  • Q2) have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness or breathlessness) - 663q.Asthma daytime symptoms (etc)

  • Q3) has your asthma interfered with your usual activities e.g. housework, work or school etc? - 663Q. Asthma not limiting activities (etc)


Qof 2012 13

Asthma continued

READ codes

  • Asthma annual review: 66YJ - 66YK - 66YQ - 66YR - 8B3j & 9OJA

  • 9OJ2. Refuses asthma monitoring

  • And the same day* - answers to all 3 questions:

  • * The intent of the indicator & the logic within the rules is that the review & the RCGP questions are all recorded on the same day. Where a review that included the recording of the RCGP 3 questionshas occurred, is followed by a subsequent consultation that is also recorded as a review, but where the 3 RCGP questions are not asked, the preceding recording is overwritten


Qof 2012 13

Dementia

  • (DEM3 ) DEM4 The % of patients with a new diagnosis of dementia recorded between the preceding 1st April to 31st March with a record of FBC, calcium, glucose, renal & liver function test, serum vitamin B12 & folate levels recorded 6 months before or after entering on to the register

  • i.e. not cumulative

  • Remember all tests within (before or after) 6 months of diagnosis, one code from each group


Qof 2012 13

Depression

  • (DEP4 ) DEP6 The % of patients with a new diagnosis of depression recorded between the preceding 1st April to 31st March, the % of patients who have had an assessment of severity at the time of diagnosis* using an assessment tool validated for use in primary care

  • * Within 28 days of the entry of the diagnosis which means up to 28 days not before


Qof 2012 13

Depression continued

  • (DEP5 ) DEP7 In those patients with a new diagnosis of depression & assessment of severity recorded between the preceding 1st April to 31st March, the % of patients who have had a further assessment of severity 2-12 weeks* (inclusive) after the initial recording of severity.

  • Both assessments should be completed using an assesment tool validated for use in primary care

  • * Used to be 4-12 weeks


Qof 2012 13

Atrial Fibrillation

  • AF4 & AF3 - No longer

  • AF5 The % of patients with AF in whom stoke risk has been assessed using the CHADS2 risk stratification scoring system in the preceding 15 months (excluding those whose previous CHADS2 score is greater than 1)

  • AF6 In those patients with AF in whom there is a record of a CHADS2 score of 1, the % of patients who are currently treated with anticoagulation drug therapy or an anti-platelet therapy

  • AF7 In those patients with AF whose latest record of a CHADS2 score is greater than 1, the % of patients who are currently treated with anticoagulation therapy


Qof 2012 13

Atrial Fibrillation continued


Qof 2012 13

Atrial Fibrillation continued - READ codes

  • 38DE0 Congestive heart failure, hypertension, age 2, diabetes mellitus, stroke 2, vascular disease, age, sex category score

  • No new anticoagulation codes

  • Otherwise same as e.g. CHD9 re: anticoagulants & anti-platelets

  • 8I24.Aspirin prophylaxis contra-indicated

  • 8I25.Warfarin contraindicated

  • 8I2K.Clopidogrel contraindicated

  • 8I2b.Dipyridamole contraindicated


Qof 2012 13

Smoking: Denominator for 5 & 6 now includes Peripheral Arterial Disease

  • (SMOK3) SMOK5 Patients with specific diseases have smoking status last 15 months

  • (SMOK4) SMOK6 Patients with specific diseases who are smokers advised to stop

  • (RECORDS 23) SMOK7 All patients aged 15 years plus have smoking status recorded last 27 months

  • New – SMOK8 The % of patients aged 15 years & over who are recorded as current smokers, who have a record of an offer of support & treatment within the preceding 27 months


Qof 2012 13

Peripheral Arterial Disease (PAD)

  • PAD1 The practice can produce a register of people with PeripheralArterial Disease

  • Codes same as CVD – PP1: G73 – G73z (except G73z1) – Gyu74

  • 9hS0.Excepted from peripheral arterial disease quality indicators: patient unsuitable

  • 9hS1.Excepted from peripheral arterial disease quality indicators: informed dissent


Qof 2012 13

Peripheral Arterial Disease (PAD) continued

  • PAD2 The % of patients with PeripheralArterial Disease with a record in the preceding 15 months that aspirin or an alternative anti-platelet is being taken

  • Codes same as CHD9: -8I24.Aspirin prophylaxis contra-indicated -8I2b.Dipyridamole contraindicated -8I2K.Clopidogrel contraindicated

  • Excluded if warfarin prescribed or anticoagulation prescribed by third party-8B2K.Anticoagulant prescribed by third party


Qof 2012 13

Peripheral Arterial Disease (PAD) continued

  • PAD3 The % of patients with PeripheralArterial Disease in whom the last BP reading (measured in the preceding 15 months) is 150/90 or less

  • For PAD3 & PAD4 only, newly registered & newly diagnosed is last 9 months of the QOF year, not 3 months (PAD2 is 3 months) -246.O/E - blood pressure reading - 8I3Y.Blood pressure procedure refused -8BL0.Patient on maximal tolerated antihypertensive therapy

  • PAD4 The % of patients with Peripheral Arterial Disease in whom the last measured total cholesterol (measured in preceding 15 months) is 5.0 mmol/l or less

  • Codes same as CHD8: -8BL1.Patient on maximal tolerated lipid lowering therapy - U60CA[X]Statin causing adverse effect in therapeutic use


Qof 2012 13

Osteoporosis

  • DES now discontinued and was for 65-74 years

  • OST1 The practice can produce a register of patients

  • 1) aged 50-74 years with a record of a fragility fracture after 1st April 2012 & a diagnosis of osteoporosis confirmed on DXA scan

  • And

  • 2) aged 75 and over with a record of a fragility fracture after 1st April 2012


Qof 2012 13

Osteoporosis continued

  • The register is in 2 parts which form the denominators for OST2 & OST3. Both are cumulative

  • OST2 The % of patients aged between 50 & 74 years, with a fragility fracture in whom osteoporosis is confirmed on DXA scan, who are currently treated with an appropriate bone sparing agent

  • OST3 The % of patients aged 75 and over with a fragility fracture, who are currently treated with a bone sparing agent

  • For patients aged under 75 years, need DXA scan to confirm

  • For patients aged over 75 years, no need to scan


Qof 2012 13

Osteoporosis continued – READ codes

  • N331NFragility fracture

  • N331MFragility fracture due to unspecified osteoporosis - DXA scan with either

  • Specific mention of osteoporosis -58E4.Forearm DXA scan result osteoporotic

  • Or

  • Non specific code + value of T score < -2.5 - 58E2.Forearm DXA scan T score + value <-2.5

  • N330.Osteoporosis


Qof 2012 13

Minor changes to wording of:

  • CHD9 “Last” changed to “Preceding”

  • CHD10 “unless a contraindication or side effect are recorded” removed – same for CHD9, CHD14 & STROKE 12 (but still count)

  • DM26, 27 & 28 – Now IFCC* only

  • DM26 now = The % of patients with diabetes in whom the last IFCC-HbA1c is 59 mmol/mol or less in the previous 15 months

  • * International Federation of Clinical Chemistry


Qof 2012 13

Organisational domain

  • RECORDS 23Smoking 7

  • Education 1 Education 11

  • There is a record of all practice employed clinical staff & clinical partners having attended training / updating in basic life support skills in the preceding 18 months


Qof 2012 13

Quality & Productivity

  • Indicators QP 6 – 8 Referrals = 21 points

  • Indicators QP 9 – 11 Emergency Admissions = 27.5 points

  • Indicators QP 12 – 14 A&E Attendances = 28 points

  • QP12 A&E Attendances The practice meets internally to review the data on accident & emergency attendances provided by the PCO no later than 31st July 2012. The review will include consideration of whether access to clinicians in the practice is appropriate in light of the patterns on A&E attendance

  • Data from 1st Jan 2012 to 31st March 2012 i.e. Now – then monthly = 6 points


Qof 2012 13

Quality & Productivity continued

  • QP 12 A&E attendances

  • - Explore reasons for patients attendances - Any emerging patterns - Consider available care pathways- Consider capability & access within primary care - Older patients with co-morbidities - Children with minor illness / injury (<15 years) and- Frequent re-attender’s that could be dealt with in primary care- Consider same day access to clinicians - Compare this & the level of A&E attendances- Can improvements be made to avoid inappropriate attendances


Qof 2012 13

Quality & Productivity continued

  • QP 13 A&E attendances

  • The practice participates in an external peer review with a group of practices to compare its data on A&E attendances, either with practices in the group of practices or practices in the PCO area and agrees an improvement plan firstly with the group and then with the PCO, no later than 30th September 2012.

  • The review should include, if appropriate, proposals for improvement to access arrangements in the practice in order to reduce avoidable A&E attendances and may also include proposals for commissioning or service design improvements to the PCO = 8 points -The practice implements the improvement plan that aims to reduceavoidable A&E attendances & produces a report of the action taken tothe PCT no later than 31st March 2013


Qof 2012 13

General Practice Extraction Service – GPES

  • GPES is a centrally managed primary care data extraction service which will replace QMAS

  • GPES is currently in development and its first major deliverable will be data for the Quality and Outcomes Framework (QOF) from April 2013.

  • EMISare the first GP practice system supplier to sign a contract with the NHS IC to produce GPES extracts.

  • EMIS may have already contacted some practices about this

  • http://www.ic.nhs.uk/gpes


Qof 2012 13

Year end 2011-12

  • PCT to input information from ePACT by the end of May 2012

  • QP 6-11 reviewed by clinical panel

  • PCT to inform practices who have not achieved any QP indicators

  • Sign off by practices

  • Payment by the end of June 2012

  • Exact timetable to be released ASAP


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