Q&A

With DM014 ‘education for newly DM patients, in the preceding 1 April – 31st March’, the indicator is looking back 21 months from 31st March 2016. This is in line with the ‘data set rules’ guidance.

This will carry over all patients who were not achieved last year. Also it appears that all those who refused last year are asking for a new entry of refusal for this year! This has been passed over to the NHS Employers for re-consideration.

This means that you will have to re-enter the patient’s wishes again if their diagnosis was on or after the 1st July 2017 and they refused the offer. I would suggest you back date to April of this year the refusal code with free text – patient declined within the QOF criteria see entry on xxxxx’ but ensure when entering the Read code it is within nine months of the diagnosis

There is no exclusion code for resolved for this indicator. We suggest you enter the ‘ACE/ARB ‘not indicated’ Codes. Please remember to use all the ‘not indicated’ codes as if you exclude the patent from and ACE the system will then look for an ARB

 

Not just for diabetes but for 95% of the QOF, if you receive correspondence from secondary care, community care or even private care you should enter all the relevant information into the patients record using where at all possible a QOF read code if it is part of the QOF criteria.

This information includes BP, bloods, feet check, diagnostic test and blood tests etc. You are not expected to duplicate work that has already been done.

The thing to remember about the QOF is it does not matter where the intervention took place – primary care, community or secondary care as long as the patient receives all interventions that are appropriate for their care and well-being and the practice ensures the results are acted upon, if required.

The areas you cannot use secondary/community care information is

Cancer Review

Dementia review

RA review

Depression

Asthma

 

Yes the patients require a test to identify those DM patient who have a diagnosis of either nephropathy (clinical proteinuria) or micro albuminuria but the indicator itself is only looking for those patients with confirmation of nephropathy (clinical proteinuria) or micro albuminuria who are currently treated with an ACE or ARB, not those who have had the test done and are negative. I have checked two practices and for example one practice had 222 patients on their register of which only 59 appear in DM006 as they are the only ones with a confirmed diagnosis and of the 59 patients the practice has achieved the indicator for 52 patients as they are currently being treated with an ACE-I or ARB.

The exception code for patients who have declined to give a urine specimen

CTV3                   Version 2

Xaa3v                     9RX..               Declines to give urine specimen

You would need to record the patient as depression resolved and this will remove the patient from the QOF. The read code for this is:

 

Version 2                                                                                                  CVT3

212S.     Depression resolved                                   XaLG0   Depression resolved

 

 

: We asked a professor of Renal Medicine and the answer received was as follows:

 

I think the reasons for repeat testing of MA in DM even after establishing its presence are:

– In 30% of T1DM at least (T2DM less clear) MA will regress and disappear

– In some patients MA progresses to macroalbuminuria

Both of these events have implications for a patient’s renal function in the long term – one good, one bad – so probably some merit in knowing what’s happening in order to keep patient informed and health care staff on their toes in dealing with other modifiable risks as appropriate.

The new Read Codes are listed below with the conversion table:

International Federation of Clinical Chemistry (IFCC) Standardization of HbA1c conversion table

 

IFCC HbA1c NGSP HbA1c (%)
31 5
42 6
53 7
64 8
75 9
86 10
97 11
108 12

 

Version 2

42W5.   Haemoglobin A1c level – International Federation of Clinical Chemistry and Laboratory Medicine standardised

 

CTV3

XaPbt    Haemoglobin A1c level – International Federation of Clinical Chemistry and Laboratory Medicine standardised

It is recommended you still discuss the three topics with patients as CQRS are extracting this data. Although the results will not be used to assess practice achievement

CTV3                      Version 2

XaRFa                    8IB4.                     Pregnancy advice for patients with epilepsy not indicated

XaRFb                   8IB3.                     Pre-conception advice for patients with epilepsy not indicated

XaRFc                    8IB2.                     Contraceptive advice for patients with epilepsy not indicated

To achieve this indicator you would need to have patients diagnosed with proteinuria or micro-albuminuria that you would treat with an ACE inhibitors (or A2 antagonists). If you are aware of patients with a diagnosis of either proteinuria or micro-albuminuria, you need to check the Read Codes used.

 

 

Both codes are part of QOF so there is not an issue there and both results have been sent by the lab for about a year now. The 42W5 being the International Federation of Clinical Chemistry and Laboratory Medicine standardised and the more familiar code 42W4.HbA1c level (DCCT aligned)

 

We should be working towards familiarising ourselves with the new levels although there has not been any change to the rule sets regarding the 42W4, this is still acceptable at the moment

 

Comparing DCCT-HbA1c and IFCC-HbA1c Results

 

The chart below allows the practices to convert the levels and I would be surprised if practices did not have a copy, we did hand them out to the audit clerks last year

 

 

 

 

DCCT-HbA1c (%)             IFCC-HbA1c (mmol/mol)

6                                                              42

6.5                                                          48

7                                                              53

7.5                                                          59

8                                                              64

9                                                              75

 

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