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User Group Presentation June 2011

User Group Presentation June 2011. Alison Young. My Agenda. Vision Updates Data Collection DES QOF. Vision Updates. April Drug Dictionary is in progress at the moment DLM 320 on release DLM 321 on release User Guides available on the website Drug Changes require intervention.

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User Group Presentation June 2011

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  1. User Group PresentationJune 2011 Alison Young

  2. My Agenda • Vision Updates • Data Collection • DES • QOF

  3. Vision Updates • April Drug Dictionary is in progress at the moment • DLM 320 on release • DLM 321 on release • User Guides available on the website • Drug Changes require intervention

  4. HPA website automated collection NOT available in England and Wales yet but further testing is ongoing in 2011 Working in Scotland for flu vaccination and influenza like illness monitoring DES (England)Requirements published Ethnicity and Heart Failure retired Some changes to Alcohol, Learning Disabilities and Osteoporosis Guidelines on the website 13/6/11 Audits to follow soon Data Collection & DES

  5. QOF 2011-12 • NICE & Information Centre have taken over from April 2011 • NICE responsible for the guidance • NHS IC responsible for the Business Rules and collection of data • Documents for v19 have arrived • Retirements, Points and % changes • Business Rules • Version 19.00.00 Guidelines & Audits • Are on the website • V20 is published this week • Will need conformance • Will contain Q1 Read Codes • Will need QMAS switched on before rolling to site – expected September/October to be confirmed

  6. QOF 2011-12 • 96.5 points released by retiring indicators • 28 points available to conduct an internal review of prescribing • 21 points for internal review of care pathways use • 27.5 points for reviewing emergency admissions

  7. Retiring indicators • CHD5 & CHD7 • BP and cholesterol in the last 15m • DM5, DM11 & DM16 • HbA1c, BP and cholesterol in last 15m • STROKE5 • BP in last 15m • MH7 • Pts who DNA and are followed up within 14 days

  8. Retiring indicators cont…. • EPIL07 • Medication review in last 15m • Information4 • Patient given information to choose new practice on removal • RECORDS21 • Ethic origin for 100% of new registrations • PE7 and PE8 • Patient experience of appointment booking

  9. Replacement indicators • CHD11 -> CHD14 • Pts with MI from 01/04/2011 treated with ACE(or ARB if ACE intolerant), aspirin or alternate anti-platelet therapy, beta-blocker AND statin – 10pts • CHD2 -> CHD13 • Pts with new angina diagnosis from 01/04/2011 referred for specialist assessment – 7pts

  10. Replacement indicators • PP01 • Pts with new diagnosis of hypertension in the preceding 1st April to 31st March with risk assessment at the outset of diagnosis within 3 months -8pts • DM23 -> DM26 • Last IFCC-HbA1c is 59 mmol/mol or less (equivalent to 7.5% DCCT value) in last 15m -17pts • DM24 -> DM27 • Last IFCC-HbA1c is 64 mmol/mol or less (equivalent to 8% DCCT value) in last 15m -8pts • DM25 -> DM28 • Last IFCC-HbA1c is 75 mmol/mol or less (equivalent to 9% DCCT value) in last 15m – 10pts • Business Rules still allow both IFCC and DCCT Aligned values.

  11. Replacement Indicators • DM9 ->DM29 • The percentage of patients with diabetes with a record of a foot examination and risk classification: low risk, increased risk, high risk or ulcerated foot within the preceding 15 months – 4pts • New coding for foot risk 2G5E, 2G5F, 2G5G, 2G5H, 2G5I, 2G5J, 2G5K and 2G5L • Exceptions include single and bilateral amputees • DM12 -> DM30 & DM31 • BP 150/90 or less - 8pts • BP 140/80 or less – 10pts

  12. Replacement indicators • MH9 is now split into 6 indicators • MH11 MH Register patients with alcohol consumption recorded last 15m - 4pts • MH12 MH Register patients with BMI recorded last 15m – 4pts • NH13 MH Register patients with BP recorded last 15m -4pts • MH14 MH Register over 40 with cholesterol:hdl ratio (44PG.)recorded last 15m - 5pts • MH15 MH Register patients with blood glucose level recorded last 15m (excluding Diabetics) – 5pts • MH16 MH Register female patients 25-64 in Eng & NI, 20-60 in Scot and 20-64 in Wales with cytology last 5 years – 5pts

  13. Replacement indicators • MH04 -> MH17 • Pts on lithium with serum creatinine & TSH in the preceding 9m – 1pt • MH05 -> MH18 • Pts on lithium with lithium levels in therapeutic range preceding 4 months -2pts • MH06 -> MH10 • Pts with documented comprehensive care plan – 6pts • DEP02 -> DEP04 • New diagnosis of depression in last year assessment of severity at the time of diagnosis -17pts

  14. Replacement indicators • DEP03 -> DEP05 • Second assessment of severity with 4-12 weeks after initial recording – 8pts • COPD01 -> COPD14 • Register of patients with COPD – 3pts • COPD12 -> COPD15 • Percentage of pts diagnosed after 1st April confirmed by post-bronchodilator spirometry

  15. New Indicators • EP09 - The percentage of women under 55on anti-epileptic drugs who have a record of contraception, conception and pregnancy counselling in the last 15m - 3pts 40-90% • LD02 – The percentage of patients on the Learning Disabilities register with Down’s Syndrome over 18 who have a blood TSH in the last 15m (exc. those on thyroid disease register) - 3pts 40-70% • And QP Indicators – not reported through Vision • QP1-5 – Internal review of prescribing and assessment of cost effectiveness. • QP 6-8 – Internal review of out-patient referrals for commissioning and service design improvements • QP 9-11 – Internal review of emergency admissions for commissioning and service design improvements

  16. Reduced Points and Thresholds • DEP01 Case finding for Depression in Diabetics and CHD patients goes down from 8 to 6 points. • BP4 Percentage of pts with hypertension with record of BP last 9 months down from 18 to16points

  17. Increased Thresholds • CHD06 -Patients with CHD last BP less than 150/90 threshold increased to 71% • STROKE06 – Patients with Stroke or TIA last BP less than 150/90 increased to 71% • DM30 – Patients with Diabetes last BP less than 150/90 increased to 71%

  18. V20 changes……. • Asthma • now H33% no exclusions • Added • 33950 Diurnal variation of peak expiratory flow rate • 745D4 Post bronchodilator spirometry • Cancer new code in April release • B627E Diffuse large B-cell lymphoma • Flu vaccinations in all domains • Removed H1N1 vaccines

  19. V20 changes….. • CHD, HF & Diabetes – new AII/ARB codes • OLMESARTAN+HYDROCHLOROTHIAZIDE 40mg/12.5mg tablets • OLMETEC PLUS 40mg/12.5mg tablets • COPD • new review codes • 66YB0 Chronic obstructive pulmonary disease 3 monthly review • 66YB1 Chronic obstructive pulmonary disease 6 monthly review • New FEV1 code • 339O1 Forced expired volume in one second/vital capacity ratio

  20. V20 changes….. • Stroke & TIA register • Removed • G669. Cerebral palsy, not congenital or infantile, acute • Added • G665. Pure motor lacunar syndrome • G666. Pure sensory lacunar syndrome • Gyu63 [X]Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs • Gyu64 [X]Other cerebral infarction • Gyu65 [X]Occlusion and stenosis of other precerebral arteries • Gyu66 [X]Occlusion and stenosis of other cerebral arteries • Gyu6G [X]Cereb infarct due unsp occlus/stenos precerebr arteries • Cytology – hysterectomy codes • Added • 26L3. Uterine cervix absent • Removed • ZV6G8 [V]Acquired absence of uterus

  21. V20 changes…. • Dementia • TFT codes included • 442A. TSH - thyroid stim. Hormone • Liver test codes included • 44F3. Total alkaline phosphatase • 44FH. Alkaline phosphatase liver isoenzyme level • 44CU. Plasma alkaline phosphatase level • 44G4. Gamma - G.T. level • 44GA. Plasma alanine aminotransferase level

  22. V20 Changes…. • Epilepsy • Sterilisation code • 7E1C3 Endoscopic bilateral placement of intrafallopian implants • Hysterectomy codes • Added • 26L3. Uterine cervix absent • Removed • ZV6G8 [V]Acquired absence of uterus

  23. V20 Changes….. • Mental health • Alcohol codes • 136a. Increasing risk drinking • 136c. Higher risk drinking • 136d. Lower risk drinking • Hysterectomy codes • Added 26L3. Uterine cervix absent • Removed ZV6G8 [V]Acquired absence of uterus • Total Cholesterol:HDL ratio • Removed 44PG. HDL:Total cholesterol ratio • Added • 44PF. Total cholesterol:HDL ratio • 44l2. Cholesterol/HDL ratio • 44lF. Serum cholesterol/HDL ratio • 44lG. Plasma cholesterol/HDL ratio

  24. V20 Changes… • Sexual Health • New Diagnostic code for IUD • 61511 – Insertion of T shaped 375 mm squared copper coated IUCD • New Diagnostic code for IUS • 61R.. – Intrauterine system contraception • New Diagnostic code for Contraceptive Implant • 9kr.. – Subdermal etonogestrel implant insertion ESA • LARCS Advice original code or BOTH verbal & written • 8CAw. Advice about long acting reversible contraception • 679K2 Education for intrauterine system • Verbal 8CAw1 – Verbal advice about long acting reversible contraception • Written 8CAw2 – Written advice about long acting reversible contraception

  25. V20 Changes…… • Smoking • Added • 9NS02 Referral for smoking cessation service offered • Removed • 13p8. Lost to smoking cessation follow-up • 13p7. Smoking status at 12 weeks

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