Business Rules for Quality and Outcomes Framework (QOF) 2016/17 Dementia

Transcription

1 Business Rules for Quality and Outcomes Framework (QOF) 2016/17 Dementia Author: Primary Care Domain Specification Development Service (SDS), NHS Digital Date: 29/07/2016 Version: 35.0

2 Contents 1. Amendment History Background Document Purpose Business Rules Supporting Information Clinical Codes Guidance Dataset specification Qualifying Dates Patient selection criteria GMS registration status Populations Clinical Code Clusters Clinical Data Extraction Criteria Outputs Indicator(s) DEM DEM DEM Payment Count(s) Management Information Count(s) Patient-level Extract(s) Appendix - Supporting data for NHS Digital SDS NHS Digital is the trading name of the Health and Social Care Information Centre. Page 2 of 29

3 This document is produced by NHS Digital on behalf of NHS England. It is published in PDF format. If anyone intends to re-use the information contained within it or publish in another format then they should acknowledge the source document, NHS Digital and NHS England. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 3 of 29

4 1. Amendment History Version Date Amendment history The version number starts at 7.1 in order to coincide with existing datasets and business rules November 2005 From Phil Brown November 2005 Amended following review by Peter Horsfield December 2005 Draft revised for internal review February 2006 Amended following internal & 4 Countries review March 2006 Signed off following 4 Country review May 2006 Responding to queries raised Amend wording for Note May 2006 Approved by NHSE October 2006 April Read Code Release April SNOMED CT Release October Read Code Release Corrections and amendments following feedback November 2006 Responding to queries raised by 4 Country Review November 2006 Approved by NHSE April 2007 April 2007 Read Code Release June 2007 Signed off following 4 Country review August 2007 April 2007 SNOMED CT Release September 2007 October 2007 Read Code Release October 2007 SNOMED CT Release November 2007 Signed off following 4 Country review June 2008 April 2008 Read Code Release April 2008 SNOMED CT Release NHS Digital is the trading name of the Health and Social Care Information Centre. Page 4 of 29

5 July 2008 Following 4-Country Review: Bring Numerator Rule 1 into line with Denominator Rule 1 for indicator DEM July 2008 Signed off following 4 Country review October 2008 October 2008 Read Code Release October 2008 SNOMED CT Release December 2008 Signed off following 4 Country review March 2009 QOF Review May 2009 Signed off following 4 Country review June 2009 April 2009 Read Code Release August 2009 Sign off following 4 Country release October 2009 October 2009 Clinical Code Release October 2009 October 2009 Clinical Code Release review December 2009 Sign off following 4 Country review May 2010 April 2010 Read Code Release following NHS IC review October 2010 October 2010 Read Code Release following NHS IC review December 2010 Signed off following 4 Country review May 2011 April 2011 Read Code Release following NHS IC review November 2011 October 2011 Read Code Release following NHS IC review December 2011 Signed off following 4 Country review May 2012 April 2012 Read Code Release following HSCIC review October 2012 October 2012 Read Code Release following HSCIC review March 2013 Signed off following consultation June 2013 April 2013 Read Code Release following HSCIC review October 2013 October 2013 Read Code Release following HSCIC review NHS Digital is the trading name of the Health and Social Care Information Centre. Page 5 of 29

6 Dates_ January 2014 Review of proposed date changes for QOF 2014/15 Jan14_Review 23 January 2014 Internal review of changes for 2014/ March 2014 Signed off following review and negotiations. Changes made to incorporate new date terminology June 2014 April 2014 Read Code Release following HSCIC review October 2014 October 2014 Read Code Release following HSCIC review Review_10_14 31 October 2014 Document for Review Panel containing NICE QOF Advisory Committee recommendations from June December 2014 Signed off following review and negotiations May 2015 April 2015 Read Code Release following HSCIC review October 2015 October 2015 Read Code Release following HSCIC review March 2016 Signed off following review and negotiations July 2016 April 2016 Read Code Release following NHS Digital review NHS Digital is the trading name of the Health and Social Care Information Centre. Page 6 of 29

7 2. Background 2.1. Document Purpose The dataset and business rules documents produced by the NHS Digital Primary Care Domain Specification Development Service are created primarily for the uses of GPES and GP system suppliers. These documents contain specifications to communicate technical details of extracts from Primary Care systems which may be used to provide Practice-level information regarding services and/or allocate rewards, such as payments or QOF points. This document is not intended to be used in place of clinical guidelines, but may be referred to by any individual or organisation to aid understanding of which patients and/or activity are included in each population or output. Non-technical, textual descriptions of business rules can be found in the table columns highlighted in pale blue throughout the document. The business rules registers for QOF and Enhanced Services are constructed solely for the purpose of supporting the practice, GP Suppliers, and NHS England in fulfilling the claims and audit requirements for the indicators. Therefore, while a register may carry the name of a particular disorder for business rules purposes, it may well not be sufficiently precise to encompass all of those patients who might be clinically assessed as requiring follow-up or clinical intervention. It is advised that where a practice wishes to construct a register for the purposes of call, recall and clinical management that it is patient based rather than solely disorder based Business Rules Supporting Information Further information regarding the setup of the business rules, terminology used and the calculation methods can be found in version 1.1 of the supporting information document which can be accessed here: Clinical Codes Any part of the dataset specification which uses clinical codes will have the relevant code cluster ID and version specified. The expanded code lists for each cluster can be accessed from the following location: NHS Digital is the trading name of the Health and Social Care Information Centre. Page 7 of 29

8 Clinical code clusters are applied to the April 2016 release of Read codes version 2 and clinical terms version 3 (CTV3) for this ruleset Guidance Guidance for all Quality Services can be found on the NHS Employers website through the following links: NHS Digital is the trading name of the Health and Social Care Information Centre. Page 8 of 29

9 3. Dataset specification 3.1 Qualifying Dates The dataset and rules in this document refer to various dates, which may include any number of the dates from the table below. Further information regarding how to use these dates within calculations can be found in the supporting information document (see section 2.2). Term Definition Timeframe for this Service Quality Service Start Date (QSSD) Quality Service End Date (QSED) The first day of the period during which a GP Practice provides the Quality Service 01/04/2016 The last day of the period during which a GP Practice provides the Quality Service 31/03/2017 Quality Service Period Quality Service Data Extract Frequency Quality Service Payment Period Payment Period Start Date (PPSD) Payment Period End Date (PPED) Achievement Date (ACHV_DAT) The period during which a GP Practice provides the Quality Service specified in this document. The frequency of data extracts associated with the Quality Service The frequency of payments associated with the Quality Service. In any given Quality Service Period there may be one, multiple or no payment periods. The first day of each period for which payments are made for the Quality Service. (i.e. for monthly payment periods, the PPSD will be the 1 st of the month in question). Where there are no payment periods (e.g. where payments are made as part of core contract) the PPSD denotes the first day of the extract period in question. The last day of each period for which payments are made for the Quality Service. (i.e. for monthly payment periods, the PPED will be the last day of the month in question). Where there are no payment periods (e.g. where payments are made as part of core contract) the PPED denotes the last day of the extract period in question. The date up to which pertinent patient information is considered when determining the output for each extraction. This is usually the same as the RPED; however, where interim extracts are made the achievement date will vary for each extraction. The time period between the QSSD and the QSED Monthly Annual Date not used in this ruleset. 31/03/2017 The last day of each month NHS Digital is the trading name of the Health and Social Care Information Centre. Page 9 of 29

10 Term Definition Timeframe for this Service Reporting Period Reporting Period Start Date (RPSD) Reporting Period End Date (RPED) The full period which data is being extracted for. The date from which pertinent patient information is considered for the reporting period in question For non-cumulative* data extracts this relates to the extract frequency (e.g. for a monthly data extract the RPSD will be the 1 st of the month in question). For cumulative* data extracts the time period will usually equal the QSSD or PPSD (e.g. for a within quarter cumulative count the RPSD is the first day of the quarter, for an annual cumulative count the RPSD is the QSSD) The last date of the period the extract relates to (usually the last day of a month e.g. 30 th April, 31 st May, etc.). The time period between the RPSD and the ACHV_DAT Date not used in this ruleset. Date not used in this ruleset. * For the purposes of the business rules Cumulative data collections are extracts which have varying incremental end dates but where groups of extracts or all extracts have a single start date e.g. each extract across the year starts at the QSSD and is taken up the achievement date. Due to the fact that patients may change practice during the year this is not a true cumulative data collection as patients may drop out of counts or enter counts at a later stage; however, this is the terminology used in this document to describe these kinds of counts. Non-cumulative refers to data collections which are discrete extracts between two dates. These non-cumulative data collections do not overlap. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 10 of 29

11 3.2 Patient selection criteria All Populations and Outputs in this Ruleset are to be returned at Practice-level GMS registration status Qualifying criteria Action if true Action if false Non-technical Description (If REG_DAT Null If DEREG_DAT = Null) (If REG_DAT Null If DEREG_DAT > ACHV_DAT) End of rules Select Reject Select patients who meet either of the criteria below registered for GMS prior to or on the achievement date and did not subsequently deregister from GMS (Currently registered for GMS) registered for GMS prior to or on the achievement date and subsequently deregistered from GMS after the achievement date (Previously registered for GMS) (i.e. patients who were registered for GMS on the achievement date) Reject the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 11 of 29

12 3.2.2 Populations Case registers Each patient can only be included once per register. Register Name Description Applied to patients defined in: DEM_REG Dementia register: Patients with a dementia diagnosis up to the end of the reporting period GMS registration status SDS use only: Version 100 Rule number Rule Action if true Action if false Rule description or comments 1 If DEM_DAT <= ACHV_DAT Select Reject End of rules Select patients from the specified population who have a dementia diagnosis recorded up to the achievement date. Reject the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 12 of 29

13 Cohorts N/A - there are no cohorts for this service. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 13 of 29

14 3.2.3 Clinical Code Clusters The dataset may include dates and values associated with the presence of clinical codes in a patient s record. All clinical code clusters referred to in the clinical data extraction criteria are detailed below. The expanded cluster lists for each cluster can be found on the HSCIC website (see section 2.3). Cluster Name Description Read V2 CTV3 Cluster Version DEM_COD Codes for Dementia Eu02.%, E00..%, Eu01.%, E02y1, E012.%, Eu00.%, E041., Eu041, F110.-F112., F116., F118., F21y2, A410., A411.% X002w% (excluding X003E, X003F, X001T), Eu02.%, XE1Xt, E00z., E02y1 102 DEMEXC_COD Dementia exception reporting codes 9hD0., 9hD1. XaLFo, XaLFp 100 FBC_COD Full blood count test recording 423.., 426.., 42A.., 42H.. Xa96v, 426.., 42A.., XaIdY 100 CALC_COD Calcium test recording 44h4., 44I8., 44h7., 44IE., 44ID., 44IC., 44h9., 44hD., 4Q721, 44h90, 44IC0 XaDvd, XE2q3, XaIRk, XaIdR, XaIU0, 44IC., XaIRn, XaX4E, XaZyY, Xabpr, Xabpk 100 GLUC_COD Glucose test recording 44TM., 44f..%, 44g..%, 44T1.-44T3., 44TA., 44TE.- 44TK. (excluding 44TJ0, 44TJ1, 44TJ2, 44TJ3, 44TJ4, 44TJ5, 44TJ6, 44TJ7, 44TJ9, 44TJA), 44U..% (excluding 44Uz.), 44V..- 44V3., 44V6., R102., R10D., R1057, 7P172 X772z% (excluding Xa974%, XE2mr, XE2ms, XE2mt, XaXcx, XaXdZ, XaXda, XaXdX, XaXdW, XaXdY, XaXee, XaXcf, XaaFu, XaaFo, XaaFq, XaaFn, XaaFs, XaaFp, Xabmv, Xabmw), 44f..%, XM0ly%, 44T10, 44T11, 44T12, 44U8., 44U9., XE25Z, 44V1., 44V2., 44V3., XaMLQ, R102., XaFxf, XS7Nb 102 RENAL_COD Renal test recording 44J9., 44JA., 44J3., 44JF., 44JC., 44JD. XM0lt, XaDvl, XE2q5, XaETQ, XaERX, XaERc 100 NHS Digital is the trading name of the Health and Social Care Information Centre. Page 14 of 29

15 Cluster Name Description Read V2 CTV3 Cluster Version LIVER_COD Liver test recording 44GA., 44GB., 44E.., 44EC., 44E9., 44G7., 44G9. XaLJx, XaIRi, 44E.., XaERu, XaETf, XaES4, XaES3 100 DEMTFT_COD Thyroid function tests for dementia screening 442A., 442W., 442X. XaELV, XaELW, XE2wy 100 VITB12_COD B12 level tests 42T.., 44Le. XE2pf, XaJ FOL_COD Folate level tests 42U5., 42U4., 42UE. 42U5., 42U4., X76tC 100 IFCCHBAMD_COD IFCC HbA1c monitoring and diagnostic range codes 42W5., 42W50, 42W51 Xaezd, Xaeze, XaPbt 100 SERFRUC_COD Serum fructosamine codes 44Z1. XE2eE 100 GLUCEXC_COD Glucose test exception codes 8IEG. XaYH6 100 BLOODEXC_COD Codes for blood test declined 41M.. XaZOq 100 DEMCP_COD Dementia care plan codes 8CMZ., 8CSA., 8CMe0, 8CMZ0 XaaBZ, XabEk, XacLx, XacIx 101 DEMCPEXC_COD Dementia care plan exception codes 8IAe0, 8CMZ2 XabEi, XacIz 101 DEMCPRVW_COD Dementia care plan review codes 8CMG2, 8CMZ1 XabEl, XacIy 101 DEMCPRVWEXC_COD End of clusters Dementia care plan review exception codes 8IAe2, 8CMZ3 XacM2, XacJ0 101 NHS Digital is the trading name of the Health and Social Care Information Centre. Page 15 of 29

16 3.2.4 Clinical Data Extraction Criteria Field number Field name Code cluster (if applicable) Qualifying criteria 1 PAT_ID n/a Unconditional 2 REG_DAT n/a Latest <= ACHV_DAT 3 DEREG_DAT n/a Earliest > REG_DAT 4 DEM_DAT DEM_COD Earliest <= ACHV_DAT 5 DEMEXC_DAT DEMEXC_COD Latest <= ACHV_DAT 6 FBC_DAT FBC_COD 7 CALC_DAT CALC_COD 8 GLUC_DAT GLUC_COD 9 RENAL_DAT RENAL_COD Earliest >= (DEM_DAT 1 year) <= (DEM_DAT days) <= ACHV_DAT Earliest >= (DEM_DAT 1 year) <= (DEM_DAT days) <= ACHV_DAT Earliest (>= DEM_DAT 1 year) <= (DEM_DAT days) <= ACHV_DAT Earliest >= (DEM_DAT 1 year) <= (DEM_DAT days) <= ACHV_DAT Non-technical Description The patients unique ID number for the practice in question The most recent date that the patient registered for GMS, where this registration occurred on or before the achievement date The first occurrence of the patient deregistering from GMS following the latest GMS registration Date of the first dementia diagnosis recorded up to the achievement date. Date of the most recent dementia exception reporting code recorded up to the achievement date. Date of the first full blood count test recording within the period from 1 year before the patient s dementia diagnosis and up to EITHER 186 days after the patient s dementia diagnosis the achievement date (whichever date is earliest). Date of the first calcium test recording within the period from 1 year before the patient s dementia diagnosis and up to EITHER 186 days after the patient s dementia diagnosis the achievement date (whichever date is earliest). Date of the first glucose test recording within the period from 1 year before the patient s dementia diagnosis and up to EITHER 186 days after the patient s dementia diagnosis the achievement date (whichever date is earliest). Date of the first renal test recording within the period from 1 year before the patient s dementia diagnosis and up to EITHER 186 days after the patient s dementia diagnosis the achievement date (whichever date is earliest). NHS Digital is the trading name of the Health and Social Care Information Centre. Page 16 of 29

17 Field number Field name Code cluster (if applicable) 10 LIVER_DAT LIVER_COD 11 DEMTFT_DAT DEMTFT_COD 12 VITB12_DAT VITB12_COD 13 FOL_DAT FOL_COD 14 IFCCHBA_DAT IFCCHBAMD_COD Qualifying criteria Earliest >= (DEM_DAT 1 year) <= (DEM_DAT days) <= ACHV_DAT Earliest >= DEM_DAT 1 year) <= (DEM_DAT days) <= ACHV_DAT Earliest >= DEM_DAT 1 year) <= (DEM_DAT days) <= ACHV_DAT Earliest >= (DEM_DAT 1 year) <= (DEM_DAT days) <= ACHV_DAT Earliest >= DEM_DAT 1 year) <= (DEM_DAT days) <= ACHV_DAT 15 SERFRUC_DAT SERFRUC_COD Latest <= ACHV_DAT 16 GLUCEXC_DAT GLUCEXC_COD Latest <= ACHV_DAT 17 BLOODEXC_DAT BLOODEXC_COD Latest <= ACHV_DAT 18 DEMCP_DAT DEMCP_COD Latest <= ACHV_DAT Non-technical Description Date of the first liver test recording within the period from 1 year before the patient s dementia diagnosis and up to EITHER 186 days after the patient s dementia diagnosis the achievement date (whichever date is earliest). Date of the first thyroid function test for dementia screening that was recorded within the period from 1 year before the patient s dementia diagnosis and up to EITHER 186 days after the patient s dementia diagnosis the achievement date (whichever date is earliest). Date of the first B12 level test recording within the period from 1 year before the patient s dementia diagnosis and up to EITHER 186 days after the patient s dementia diagnosis the achievement date (whichever date is earliest). Date of the first folate level test recording within the period from 1 year before the patient s dementia diagnosis and up to EITHER 186 days after the patient s dementia diagnosis the achievement date (whichever date is earliest). Date of the first IFCC HbA1c recording within the period from 1 year before the patient s dementia diagnosis and up to EITHER 186 days after the patient s dementia diagnosis the achievement date (whichever date is earliest). Date of the most recent serum fructosamine code recorded up to the achievement date. Date of the most recent glucose test exception code recorded up to the achievement date. Date of the most recent blood test declined code recorded up to the achievement date. Date of the most recent dementia care plan recorded up to the achievement date. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 17 of 29

18 Field number Field name Code cluster (if applicable) Qualifying criteria 19 DEMCPEXC_DAT DEMCPEXC_COD Latest <= ACHV_DAT 20 DEMCPRVW_DAT DEMCPRVW_COD Latest <= ACHV_DAT 21 DEMCPRVWEXC_DAT DEMCPRVWEXC_COD Latest <= ACHV_DAT End of fields Non-technical Description Date of the most recent dementia care plan exception code recorded up to the achievement date. Date of the most recent dementia care plan review recorded up to the achievement date. Date of the most recent dementia care plan review exception code recorded up to the achievement date. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 18 of 29

19 4. Outputs 4.1. Indicator(s) Additional supporting information is displayed below each set of indicator tables if required. Indicator ID Description Applied to population: DEM001 The contractor establishes and maintains a register of patients diagnosed with dementia DEM_REG SDS use only: Version 100 The terms of this indicator will be satisfied if the practice is able to produce a data extraction according to the rules for the population specified above. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 19 of 29

20 Indicator ID Description Applied to population: DEM004 The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months DEM_REG SDS use only: Version 100 The numerator is applied to the patients selected into the denominator for this indicator. Denominator Rule number 1 2 (If DEMCP_DAT > (PPED 12 months) If DEMCP_DAT >= DEM_DAT) (If DEMCPRVW_DAT > (PPED 12 months) If DEMCPRVW_DAT >= DEM_DAT) Rule Action if true Action if false Rule description or comments If DEMCPEXC_DAT > (PPED 12 months) If DEMCPRVWEXC_DAT > (PPED 12 months) Select Reject Next rule Next rule 3 If REG_DAT > (PPED 3 months) Reject Next rule 4 If DEMEXC_DAT > (PPED 12 months) Reject Next rule 5 If DEM_DAT > (PPED 3 months) Reject Select End of denominator rules Select patients from the specified population who had either of the following recorded in the 12 months leading up to the payment period end date: Had a dementia care plan on or after the date of the dementia diagnosis Had a dementia care plan review on or after the date of the dementia diagnosis Pass all remaining patients to the next rule. Reject patients passed to this rule who had either of the following recorded in the 12 months leading up to the payment period end date: Dementia care plan exception reporting code Dementia care plan review exception reporting code. Pass all remaining patients to the next rule. Reject patients passed to this rule who registered with the Practice in the 3 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who had a dementia exception reporting code in the 12 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule whose dementia diagnosis was in the 3 months leading up to the payment period end date. Select the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 20 of 29

21 Numerator Rule number 1 (If DEMCP_DAT > (PPED 12 months) If DEMCP_DAT >= DEM_DAT) (If DEMCPRVW_DAT > (PPED 12 months) If DEMCPRVW_DAT >= DEM_DAT) End of numerator rules Rule Action if true Action if false Rule description or comments Select Reject Select patients from the denominator who had either of the following recorded in the 12 months leading up to the payment period end date: Had a dementia care plan on or after the date of the dementia diagnosis Had a dementia care plan review on or after the date of the dementia diagnosis. Reject the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 21 of 29

22 Indicator ID Description Applied to population: DEM005 The percentage of patients with a new diagnosis of dementia recorded in the preceding 1 April to 31 March with a record of FBC, calcium, glucose, renal and liver function, thyroid function tests, serum vitamin B12 and folate levels recorded between 12 months before or 6 months after entering on to the register DEM_REG SDS use only: Version 102 The numerator is applied to the patients selected into the denominator for this indicator. Denominator Rule number Rule Action if true Action if false Rule description or comments 1 If DEM_DAT <= (PPED 18 months) Reject Next rule If DEM_DAT > (PPED 6 months) Reject patients from the specified population who were diagnosed with dementia at least 18 months before the payment period end date. Pass all remaining patients to the next rule. 2 (If FBC_DAT = Null If CALC_DAT = Null (If GLUC_DAT = Null If IFCCHBA_DAT = Null) If RENAL_DAT = Null If LIVER_DAT = Null If DEMTFT_DAT = Null If VITB12_DAT = Null If FOL_DAT = Null) Reject Next rule Reject patients passed to this rule who were newly diagnosed with dementia in the 6 months leading up to the payment period end date and who meet any of the criteria below: Had no full blood count test recording Had no calcium test recording Had no glucose test and no IFCC HbA1c test recording Had no renal test recording Had no liver test recording Had no thyroid function test for dementia screening recording Had no B12 level test recording Had no folate level test recording. Pass all remaining patients to the next rule. 3 If FBC_DAT <= (PPED 12 months) Reject Next rule Reject patients passed to this rule who had all of the following prior to the start of the current quality service NHS Digital is the trading name of the Health and Social Care Information Centre. Page 22 of 29

23 If CALC_DAT <= (PPED 12 months) (If GLUC_DAT <= (PPED 12 months) If IFCCHBA_DAT <= (PPED 12 months)) If RENAL_DAT <= (PPED 12 months) If LIVER_DAT <= (PPED 12 months) period i.e. current QOF year: a full blood count test recording a calcium test recording a glucose test or a IFCC HbA1c test recording a renal test recording a liver test recording a thyroid function test for dementia screening recording a B12 level test recording a folate level test recording a dementia diagnosis. (Note: these tests must have been performed in the previous QOF year due to the reject logic in rule 1) Pass all remaining patients to the next rule. If DEMTFT_DAT <= (PPED 12 months) If VITB12_DAT <= (PPED 12 months) If FOL_DAT <= (PPED 12 months) If DEM_DAT <= (PPED 12 months) 4 If FBC_DAT Null If CALC_DAT Null Select Next rule Select patients passed to this rule who meet all of the criteria below: Had a full blood count test recording Had a calcium test recording Had a glucose test or a IFCC HbA1c test recording Had a renal test recording Had a liver test recording NHS Digital is the trading name of the Health and Social Care Information Centre. Page 23 of 29

24 (If GLUC_DAT Null If IFCCHBA_DAT Null) Had a thyroid function test for dementia screening recording Had a B12 level test recording Had a folate level test recording. Pass all remaining patients to the next rule. If RENAL_DAT Null If LIVER_DAT Null If DEMTFT_DAT Null If VITB12_DAT Null If FOL_DAT Null 5 If FBC_DAT Null If CALC_DAT Null (If GLUCEXC_DAT > (PPED 12 months) If SERFRUC_DAT > (PPED 12 months)) If RENAL_DAT Null Reject Next rule Reject patients passed to this rule who meet all of the criteria below: Had a full blood count test recording Had a calcium test recording Had a glucose test exception reporting code in the 12 months leading up to the payment period end date or had a serum fructosamine recording in the 12 months leading up to the payment period end date Had a renal test recording Had a liver test recording Had a thyroid function test for dementia screening recording Had a B12 level test recording Had a folate level test recording NHS Digital is the trading name of the Health and Social Care Information Centre. Page 24 of 29

25 Pass all remaining patients to the next rule. If LIVER_DAT Null If DEMTFT_DAT Null If VITB12_DAT Null If FOL_DAT Null 6 If BLOODEXC_DAT > (PPED 12 months) Reject Next rule 7 If REG_DAT > (PPED 3 months) Reject Next rule 8 If DEMEXC_DAT > (PPED 12 months) Reject Next rule 9 If DEM_DAT > (PPED 3 months) Reject Select End of denominator rules Reject patients passed to this rule who had a blood test declined code in the 12 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who registered with the Practice in the 3 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who had a dementia exception reporting code in the 12 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule whose dementia diagnosis was in the 3 months leading up to the payment period end date. Select the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 25 of 29

26 Numerator Rule number If FBC_DAT Null Rule Action if true Action if false Rule description or comments If CALC_DAT Null 1 (If GLUC_DAT Null If IFCCHBA_DAT Null) If RENAL_DAT Null If LIVER_DAT Null If DEMTFT_DAT Null Select Reject Select patients from the denominator who meet all of the criteria below: Had a full blood count test recording Had a calcium test recording Had a glucose test or a IFCC HbA1c test recording Had a renal test recording Had a liver test recording Had a thyroid function test for dementia screening recording Had a B12 level test recording Had a folate level test recording. Reject the remaining patients. If VITB12_DAT Null If FOL_DAT Null End of numerator rules NHS Digital is the trading name of the Health and Social Care Information Centre. Page 26 of 29

27 Indicator-specific Supporting Information Overview This indicator has been developed to measure the effectiveness of the provision of a clinical care component for patients with dementia. The aspect that is being measured is that relating to the provision of a complete set of screening tests. Disease register The disease register is made up of patients who are eligible to receive the required care component. In this case, patients who have a diagnosis of dementia (i.e. there is evidence in the patient s electronic health record of a dementia diagnosis code). Numerator and Denominator The success criteria for this indicator (numerator) are achieved for those patients in the denominator who have all of the tests recorded (not necessarily on the same day) up to 1 year before or up to 186 days after entering on to the register. The patients that make up the denominator for this indicator are those patients where it is appropriate for the care component to be carried out. This is the relevant disease register adjusted for exclusions and exceptions. Exclusions For this indicator there are three exclusions. The indicator is specifically looking at newly diagnosed patients within the QOF period. However, as the tests can be carried out in the 6 months after the diagnosis any patient with a dementia diagnosis in the preceding 18 months needs to be checked. If a patient has a dementia diagnosis which falls outside this time span they will be excluded. Consideration has to be made for those patients diagnosed with dementia within 6 months of the end of the QoF period i.e. the 6 month window for the tests would then span 2 years. If at least one of the tests has not been carried then it would be unreasonable for the patient to be considered unsuccessful until the full 6 months are checked, which can only be done in the next QOF period. Such patients are excluded for this year. Consideration has to be made for those patients who have been diagnosed with dementia in the previous QOF financial year have successful recordings for all the tests in the previous QOF Financial Year because practices will have been rewarded for the indicator in that earlier year. This rule is in place to prevent duplicate payments. Exceptions Patients that don t achieve the success criteria of the indicator are checked for valid exceptions. For this indicator the exceptions are: NHS Digital is the trading name of the Health and Social Care Information Centre. Page 27 of 29

28 any patient that has either: i) a relevant glucose test exception code, and/or ii) a serum fructosamine code, recorded in the preceding 12 months. any patient that has a relevant blood test exception code recorded in the preceding 12 months. any patient who has been registered within the last 3 months of the qualifying year (new patient). New patients may be regarded as exceptions if they fulfil the criteria of the indicator but have not yet had all of the tests - maybe because there hasn t been an opportunity in the qualifying year to arrange them. any patient that has a relevant dementia exception code recorded within the preceding 12 months. any patient that has been diagnosed with dementia within the last 3 months of the year (new diagnosis of dementia). Newly diagnosed patients may be regarded as exceptions if they fulfil the criteria of the indicator but have not yet had the tests -maybe because there hasn t been an opportunity in the qualifying year to arrange them. Note: For the new dementia patient exception, this is only applicable for the first ever diagnosis of dementia for the patient. For a subsequent diagnosis, this exception rule is not considered. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 28 of 29

29 4.2. Payment Count(s) N/A - there are no payment counts for this service Management Information Count(s) N/A - there are no management information counts for this service Patient-level Extract(s) N/A - Not applicable for this service. 5. Appendix - Supporting data for NHS Digital SDS Category Database value TRUD version V21_0_0 Document version 35.0 Ruleset Database ID Dementia Database Service ID QOF QSR Reference if applicable n/a NHS Digital is the trading name of the Health and Social Care Information Centre. Page 29 of 29