QOF Update
Dr Dave Jeffery
Primary Care Data Quality Manager
and QOF Management Lead
NHS Herefordshire
EMIS NUG Conference
Warwick 6th Sep 2012
•QOF 2012-13
•QOF 2013-14
•CQRS
Leeds 7th March 2012
Where is Hereford?
Clinical points 2011
from http://www.ic.nhs.uk/qof
QOF 2012-13
• reminders for last year = 2011-12
•
•
•
•
•
then this year = 2012-13
indicators retired: CHD13, AF4, QP1-5
indicators changed
new indicators inc Osteoporosis & PAD
changes to thresholds
and also…
• pounds per point increased
–£130.51 → £133.76 (2.5%)
–no square root adjustment to PF
–no 5% cut-off
–“maintain accurate register”
• exemption exclusion
persisting
exception
expiring
www.nhsemployers.org/PayAndContracts/GeneralMedi
calServicesContract/QOF/Pages/ChangestoQOF2013.aspx
Read codes & Business Rules v23
www.pcc.nhs.uk/business-rules-v23.0
Read codes & Business Rules v23
www.pcc.nhs.uk/qof-read-codes-v23.0
Changes to thresholds
• Those that were 40-90% - all lower
thresholds raised to 50-90%
• Those that had upper threshold between
70-85% - all lower thresholds raised to 45%
• and changes to CHD6, CHD10, PP1, PP2,
HF4, STROKE6, STROKE8, DM17, DM31,
COPD10, BP5, MH10 and DEM2
Diabetes
•
•
DM 19 → DM 32: register of patients aged 17 years
and 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
1. code diabetes using the parent term
C10 Diabetes mellitus
2. update records when their type of diabetes confirmed
Diabetes – new codes
• Diabetes mellitus Type 1 (C10E%) or Type 2 (C10F%)
(excluding C10F8 Reaven's Syndrome = Metabolic
Syndrome X)
• C10
Diabetes mellitus
• C109J
Insulin treated Type 2 diabetes mellitus
• C109K
Hyperosmolar non-ketotic state in type 2 DM
• C10C
Diabetes mellitus autosomal dominant
• C10D
Diabetes mellitus autosomal dominant type 2
• C10G% Secondary pancreatic diabetes mellitus
• C10H% Diabetes mellitus induced by non-steroid drugs
• C10M% Lipoatrophic diabetes mellitus
• C10N% Secondary diabetes mellitus
HbA1c
• DM 26, 27 & 28: now IFCC only
e.g. DM 26: The percentage of patients with
diabetes in whom the last IFCC-HbA1c is
59 mmol/mol or less in the previous 15
months
Epilepsy
• EP 9: % of women with epilepsy under the
age of 55 who are taking antiepileptic drugs
who have a record of information and
counselling about contraception, conception
and pregnancy in the previous 15 months
1.
2.
3.
4.
Risk of congenital malformations 1.5%  6%
Register starts at 18 years so 18-55
Need to advise on all 3
Exception codes eg pregnancy
Mental Health 10-16 last year
→ MH 10-13, 16, 19 & 20 this year
• MH 10: % of patients on the register who
have a comprehensive care plan
documented in the records agreed between
individuals, their family and/or careers as
appropriate
• new mental health remission exception
codes, min 5 yrs
• Recode for relapse
Asthma
• ASTHMA 3 → ASTHMA 10: The percentage
of patients with asthma between the ages of 14
and 19 years in whom there is a record of
smoking status in the previous 15 months.
New exception:
137k Refusal to give smoking status
• ASTHMA 6 → ASTHMA 9: The percentage 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 RCP
questions
Asthma 9 questions –
In the last month:
1. have you had difficulty sleeping because of
your asthma symptoms (including cough)?
2. have you had your usual asthma symptoms
during the day (cough, wheeze, chest
tightness or breathlessness)?
3. has your asthma interfered with your usual
activities e.g. housework, work/school etc?
Asthma 9 questions –
In the last month:
1. have you had difficulty sleeping because of
your asthma symptoms (including cough)?
2. have you had your usual asthma symptoms
during the day (cough, wheeze, chest
tightness or breathlessness)?
3. has your asthma interfered with your usual
activities e.g. housework, work/school etc?
Asthma 9 – Read codes
Asthma annual review 66YJ 66YK 66YQ
66YR 8B3j 9OJA
90J2 Refuses asthma monitoring
(as before)
And the same day – answers to all 3
questions
So if repeat review?
Asthma 9 – Read codes
1) In the last month, have you had difficulty
sleeping because of your asthma symptoms
(including cough)? eg
• Asthma disturbing sleep
663N
• Asthma not disturbing sleep
663O etc
2) Asthma symptoms by day eg
• Asthma daytime symptoms
663q etc
3) Interference with activities eg
• Asthma not limiting activities
663Q etc
Asthma 8
• ASTHMA 8: % patients aged eight and over
diagnosed as having asthma from 1 April 2006
with measures of variability or reversibility
• If diagnosed < 8 yrs then come on to register?
• Either carry out spirometry or PEFR within 3
months
• Or use 8I2j Spirometry contraindicated
(expiring)
Dementia:
• DEM 3 → DEM 4: The percentage of patients
with a new diagnosis of dementia recorded
between 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 6 months
before or after entering on to the register
• i.e. not cumulative
• Remember all tests within (before or after) 6/12
of diagnosis, one code from each group
Depression
• DEP4 → DEP 6: In those patients with a new
diagnosis of depression, recorded between the
preceding 1 April to 31 March, the percentage of
patients who have had an assessment of severity
at the time of diagnosis* using an assessment
tool validated for use in primary care
• Change to prevalence calculation – now
cumulative from April 2006
* within 28 days of the entry of the diagnosis which
means up to 28 days after not before
Depression
• DEP 5 → DEP 7: In those patients with a new
diagnosis of depression and assessment of
severity recorded between the preceding 1 April
to 31 March, the percentage of patients who
have had a further assessment of severity 2-12
weeks (inclusive) after the initial recording of the
assessment of severity. Both assessments
should be completed using an assessment tool
validated for use in primary care
• Was 4-12 weeks
Atrial Fibrillation
• AF 4: % with AF diagnosed after 1 April 2008
with ECG or specialist confirmed diagnosis
• AF 3: The percentage of patients with atrial
fibrillation who are currently treated with anticoagulant drug therapy or an anti-platelet
therapy
• AF 5: The percentage of patients with atrial
fibrillation in whom stroke 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)
Atrial Fibrillation
• AF 6: In those patients with atrial fibrillation in
whom there is a record of a CHADS2 score of 1,
the percentage of patients who are currently
treated with anti-coagulation drug therapy or an
anti-platelet therapy
• AF 7: In those patients with atrial fibrillation
whose latest record of a CHADS2 score is
greater than 1, the percentage of patients who
are currently treated with anti-coagulation drug
therapy
Atrial Fibrillation
• AF 6: In those patients with atrial fibrillation in
whom there is a record of a CHADS2 score of 1,
the percentage of patients who are currently
treated with anti-coagulation drug therapy or an
anti-platelet therapy
• AF 7: In those patients with atrial fibrillation
whose latest record of a CHADS2 score is
greater than 1, the percentage of patients who
are currently treated with anti-coagulation drug
therapy
What?
• CHADS2 = clinical prediction rule for estimating
the risk of stroke in patients with AF
• GRASP-AF = Guidance on Risk Assessment
and Stroke Prevention in Atrial Fibrillation
• PRIMIS+ = Primary Care Information Services
www.primis.nhs.uk
• CHART = Care and Health Analysis in Real
Time
• MIQUEST = Morbidity Information Query and
Export Syntax
Atrial Fibrillation 5, 6 & 7
CHADS2 Item
Points
Chronic Heart Failure
1
Hypertension (History of)
1
Age >75
1
Diabetes
1
Stroke (previously or TIA)
2
AF 5, 6 & 7 - choice of
intervention
CHADS2
score
Adjusted annual
stroke rate (%)
Number needed to treat
(NNT)
0
1.9
53
1
2.8
36
2
4.0
25
3
5.9
17
4
8.5
12
5
12.5
8
6
18.2
5
BENEFITS OF WARFARIN OUTWEIGH RISKS WHEN CHADS2 2
Atrial Fibrillation
• AF 6: In those patients with Atrial Fibrillation in
whom there is a record of a CHADS2 score of 1,
the percentage of patients who are currently
treated with anti-coagulation drug therapy or an
anti-platelet therapy
• AF 7: In those patients with Atrial Fibrillation in
whom there is a record of a CHADS2 score of
greater than 1, the percentage of patients who
are currently treated with anti-coagulation drug
therapy
Atrial Fibrillation – codes
• 38DE CHADS2 score + value
• does include dabigatrin - guidance confusing
• otherwise same as eg CHD 9 re anticoagulants
and antiplatelets:
– Aspirin prophylaxis contraindicated 8I24
– Warfarin contraindicated
8I25
– Clopidogrel contraindicated
8I2K
– Dipyridamole contraindicated
8I2b
Smoking: Denominator for 5 & 6 now
includes Peripheral Arterial Disease
• SMOK 3 → SMOK 5: patients with specific
diseases have smoking status last 15/12
• SMOK 4 → SMOK 6: patients with specific
diseases who are smokers advised to stop
• RECORDS 23 → SMOK 7: all pts > 15 years
have smoking status recorded last 27/12
• (new) SMOK 8: the percentage of patients aged
15 years and over who are recorded as current
smokers who have a record of an offer of support
and treatment within the preceding 27/12
diseases
all pts
Smoking 6 and 8: advice or script
from v23 – no need to record both
• SMOKE 6: The percentage of patients with any or any
combination of the following conditions: CHD, PAD,
stroke or TIA, hypertension, diabetes, COPD, CKD,
asthma, schizophrenia, bipolar affective disorder or other
psychosis who smoke whose notes contain a record that
smoking cessation advice or referral to a specialist
service, where available, has been offered within the
previous 15 months.
• SMOK 8: the percentage of patients aged 15 years and
over who are recorded as current smokers who have a
record of an offer of support and treatment within the
preceding 27/12
• 8IEM NRT declined
Peripheral arterial disease (1)
• PAD 1: The practice can produce a register of
people with peripheral arterial disease
• codes same as CVD – PP1:
G73 G73z% (except G73z1) Gyu74
• Patient unsuitable 9hS0
• Informed dissent
9hS1
Peripheral arterial disease (2)
• PAD 2: The percentage of patients with
peripheral arterial disease with a record in the
preceding 15 months that aspirin or an
alternative anti-platelet is being taken
• codes same as CHD 9:
– Aspirin prophylaxis contraindicated 8I24
– Clopidogrel contraindicated
8I2K
• Excluded if warfarin prescribed or Anticoagulant
prescribed by third party
8B2K
Peripheral arterial disease (3)
• PAD 3: The percentage of patients with
peripheral arterial disease in whom the last
blood pressure reading (measured in the
preceding 15 months) is 150/90 or less
• For PAD 3 and PAD 4 only, newly registered &
newly diagnosed is last 9 months of QOF year
not 3 months (PAD 2 is 3 months)
– O/E – BP reading
246%
– BP procedure refused
8I3Y
– Max tol antihypertensive Rx 8BL0
Peripheral arterial disease (4)
• PAD 4: The percentage 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 CHD 8 eg
– Max tolerated lipid-lowering Rx
– Adverse reaction to statin
– etc
8BL1
U60CA
Osteoporosis (1)
Includes men
• DES discontinued but…
DES was 65-74 yrs
• OST 1: The practice can produce a register of
patients:
– 1) aged 50-74 years with a record of a
fragility fracture after 1 April 2012 and a
diagnosis of osteoporosis confirmed on DXA
scan, and
– 2) aged 75 and over with a record of a
fragility fracture after 1 April 2012
Osteoporosis (2)
• OST 2: The percentage of patients aged
between 50 and 74 years, with a fragility
fracture, in whom osteoporosis is confirmed on
DXA scan, who are currently treated with an
appropriate bone-sparing agent
• < 75 years need scan to confirm
Osteoporosis (3)
• OST 3: The percentage of patients aged 75 and
over with a fragility fracture, who are currently
treated with a bone-sparing agent
• > 75 years no need to scan
Osteoporosis (4)
– OST 2 Read codes
1. Fragility #
N331N or N331M
2. Earliest positive DXA scan with either:
• Specific mention of osteoporosis
eg 58E4 Forearm DXA scan result osteoporotic
• Or non-specific code + value of T-score < -2.5
eg 58E2 Forearm DXA scan T score
+ value < -2.5
3. Osteoporosis
N330
4. Plus appropriate script
Osteoporosis (5)
– OST 3 Read codes
1. Fragility # N331N or N331M
2. Plus appropriate script only
– no need for osteoporosis code or scan in
patients over 75 years
ORGANISATIONAL DOMAIN
• Records 23 → Smoking 7
• Education1 → Education11:
There is a record of all practice-employed
clinical staff and clinical partners having
attended training / updating in basic life
support skills in the preceding 18 months
Quality and productivity (1)
•
•
•
•
•
Prescribing
Referrals
Emergency admissions
Internal review, external review
Using care pathways
Quality and productivity (2)
• Q: QP pathways, do these have to be new ones?
See FAQ 4 in the QP supplementary guidance:
• A: The short answer is no.
Practices will be required to undertake an internal and
external review. In doing this practices will need to
consider the data afresh to determine whether
improvements that need to be made can be delivered
through following the existing pathways more closely,
whether the existing pathways developed in 2011/12
require amending or whether alternative pathways should
be developed.
Quality and productivity (3)
• QP1-5 retired
but…
Quality and productivity (4)
Indicators QP 6–8
(21 points)
REFERRALS
Indicators QP 9–11
ADMISSIONS
(27.5 points)
EMERGENCY
Indicators QP 12-14 A&E ATTENDANCES
(28 points)
QP 12 A&E ATTENDANCES
The practice meets internally to review the data
on accident and emergency attendances
provided by the PCO no later than 31 July 2012.
The review will include consideration of whether
access to clinicians in the practice is appropriate
in light of the patterns on accident and
emergency attendance.
QP 12 A&E ATTENDANCES
•
•
•
•
explore reasons for patients’ attendances
any emerging patterns
consider available care pathways
consider capability and access within primary care
1. older patients with co-morbidities at high risk of admission
(>65)
2. children with minor illness/injury (<15 years) and
3. frequent re-attenders 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
QP 13 A&E ATTENDANCES
The practice participates in an external peer review with a
group of practices to compare its data on accident and
emergency 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 30 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)
QP 14 A&E ATTENDANCES
The practice implements the improvement plan
that aims to reduce avoidable accident and
emergency attendances and produces a report
of the action taken to the PCO no later than 31
March 2013.
(14 points)
QOF 13-14
V
QOF 2013-14 ?
• COPD: % with COPD and MRC Dyspnoea
Scale ≥3 at any time in the preceding 15
months, with a record of oxygen saturation
value within the preceding 15 months
• COPD: % with COPD and MRC Dyspnoea
Scale ≥3 at any time in the preceding 15
months, with a subsequent record of an
offer of referral to a pulmonary
rehabilitation programme
Heart Failure and MI
• % of patients with heart failure diagnosed within
the preceding 15 months with a record of an
offer of referral for an exercise based
rehabilitation programme
• % of patients with an MI within the preceding 15
months with a record of a referral to a cardiac
rehabilitation programme
Diabetes
• % of male patients with diabetes with a
record of being asked about erectile
dysfunction in the preceding 15 months
• % of male patients with diabetes who have
a record of erectile dysfunction with a
record of advice and assessment of
contributory factors and treatment options
in the preceding 15 months
Cancer
• % of patients with cancer diagnosed within
the preceding 15 months who have a
review recorded as occurring within 3
months of the practice receiving
confirmation of the diagnosis
Hypertension
• % aged under 80 years old with
hypertension in whom the last recorded
blood pressure (measured in the
preceding 9 months) is 140/90 or less
• % aged 80 years and older with
hypertension in whom the last recorded
blood pressure (measured in the
preceding 9 months) is 150/90 or less
Depression
•
•
% with a new diagnosis of depression in
the preceding 1 April to 31 March who
have had a bio-psychosocial assessment
by the point of diagnosis
% with a new diagnosis of depression in
the preceding 1 April to 31 March who
have been reviewed within 10-35 days of
the date of diagnosis
Depression
• The biopsychosocial analysis will be divided into
16 ‘themes' including a patient's symptoms, any
alcohol and substance use, suicidal ideation and
any family history of mental illness.
• GPs will also have to look at the quality of
interpersonal relationships, an assessment of
social support, living conditions, any
employment/financial worries and have a
discussion over treatment options
Rheumatoid Arthritis
•
•
•
•
•
The practice can produce a register of all patients
aged 16 years and over with rheumatoid arthritis.
% with rheumatoid arthritis in whom CRP or ESR has
been recorded at least once in the preceding 12
months.
% with rheumatoid arthritis aged 30-84 years who
have had a cardiovascular risk assessment using a
CVD risk assessment tool adjusted for RA in the
preceding 15 months. (QRISK2 DJ)
% with rheumatoid arthritis aged 50-90 years who
have had an assessment of fracture risk using a risk
assessment tool adjusted for RA in the preceding 15
months. (FRAX score DJ)
% with rheumatoid arthritis who have had a face to
face annual review in the preceding 15 months.
Retired indicators
• Cancer 3: % with cancer, diagnosed within the
preceding 18 months, who have a patient review
recorded as occurring within 6 months of the
practice receiving confirmation of the diagnosis
• CHD10: % with CHD who are currently treated
with a beta-blocker
• CKD2. % on the CKD register whose notes have
a record of BP in the preceding 15 months
Retired indicators
• DEP1. % on the diabetes register and/or the CHD
register for whom case finding for depression has been
undertaken on 1 occasion during the preceding 15
months using two standard screening questions
• DEP6: In those patients with a new diagnosis of
depression, recorded between the preceding 1 April to
31 March, the percentage of patients who have had an
assessment of severity at the time of diagnosis using an
assessment tool validated for use in primary care
• DEP7: In those patients with a new diagnosis of
depression and assessment of severity recorded
between the preceding 1 April to 31 March, the
percentage of patients who have had a further
assessment of severity 2 - 12 weeks (inclusive) after the
initial recording of the assessment of severity. Both
assessments should be completed using an assessment
tool validated for use in primary care
Retired indicators
• DM10: % with diabetes with a record of
neuropathy testing in the preceding 15
months
• DM2: % with diabetes whose notes record
BMI in the preceding 15 months
• DM22: % with diabetes who have a record
of estimated glomerular filtration rate
(eGFR) or serum creatinine testing in the
preceding 15 months
Retired indicators
• EPILEPSY6: % aged 18 years and over on drug
treatment for epilepsy who have a record of seizure
frequency in the preceding 15 months
• BP4: % with HT in whom there is a record of the BP in
the preceding nine months
• BP5: % with HT in whom the last BP (measured in the
last 9 months) is 150/90 or less
• Records 11: The BP of patients aged 45 years and over
is recorded in the last 5 y for at least 65% of patients
• Records 17: The BP of patients aged 45 years and over
is recorded in the last 5 y for at least 80% of patients
QMAS
replacement =
CQRS
Calculating
Quality Reporting
Service
CQRS Introduction
Generic calculating tool that is quick to change
Go Live – Financial Year 2013/14
Training on CQRS will be provided through a variety of
routes – see CQRS website for more details
QMAS will remain operational until the end of July 2013
5 years historic QMAS data archived on CQRS
GPES goes live Jan 2013
Data from GPES to CQRS at least monthly
All EMIS practices must be streaming to EMIS Web to
populate GPES
Future Business Needs
– Why change (1 of 3)
The Health and Social Care Act
• NHS Commissioning Board (NHSCB or NCB)
• Clinical Commissioning Groups (CCGs)
• Commissioning Outcomes Framework to hold CCGs to account
(COF)
• Make the QOF more related to achieving quality outcomes
• Allow the NCB to commission services from GP practices
• Allow CCGs to commission services themselves
The existing arrangements to calculate performance and payments do
not support these proposals.
Future Business Needs
– Why change (2 of 3)
NICE development of Quality Indicators
NICE are now responsible for the development of clinical
indicators for the QOF and the COF.
The NHS Information Centre (NHS IC) will be involved in
their development.
Any NICE recommended indicators not negotiated into the
national QOF will be available to be used locally as local
quality indicators = LQIs
Future Business Needs
– Why change (3 of 3)
• Opportunities provided by GPES
• GPES being introduced by the NHS IC will
extract and aggregate patient based data from
GP systems in a more flexible way than at
present. GPES may be used to provide data for
the calculation of other payments to GPs and
CCGs. May support more complex quality
indicators.
• The NHS IC will provide additional information
for the COF from e.g. Hospital systems.
Financial Year 13/14: replace QMAS and manual
systems with a flexible system that calculates
achievement and related payments to GPs and
CCGs for:
• QOF
• LQIs
• COF
• national & local enhanced services (ESN & ESL)
Where:
• the data is available in GP clinical systems (via
GPES) or can be collected and provided via NHSIC
• flexible means it can be changed relatively easily
and quickly in response to changes
What are the benefits for users?
Substantial time savings for both COs and Service
Provider organisations in the automation of
recording, checking, submitting and approving
achievement for the services supported by CQRS.
Potential, if all present clinical LESs are supported
to save each CCG and GP practice 50 and 100
days respectively.
What are the benefits for users?
If a CO created a service to improve local health
inequalities and it used CQRS to support it, a
CO in another part of the country could re-use
or adjust that service.
The system is available for longer periods of
time –at the beginning of the financial year.
In addition, we have listened to user comments
about QMAS service and have incorporated
them into the requirements of CQRS.
User story - overview
The screens have been kindly
supplied by the CQRS
supplier, Vangent.
These screens are currently in
development. World exclusive!
8 April, 2015
76
Log-In Page: Displays news & alerts and allows for Help on forgotten
password or User ID, also CQRS Help Desk contact information.
77
Logged-in. Displays any new tasks and messages related to that user. Can
click on link in Summary column to jump directly to the task / message detail.
78
Participation Management – My Services. Allows the Provider to view
the services they are participating in. Status = “Offered”. Can Accept
79
or Reject each one.
The Achievement tab displays service current, max & forecast and can drilldown to indicator level. Can display in Points or Pounds. Link top right allows
the user to automatically generate a detailed achievement report
80
The Reports tab allows the user to view and generate reports within
multiple categories. The Reports category defaults to Achievement
and displays the various reports available to run.
81
CQRS Achievement Reports – currently in Mock-up format
Aspiration
Exception/Exclusion
Report Run Date: dd/mm/yyyy
PMCS: QOF 2011/2012
Clinical
Domain
Asthma
Cancer
CHD
COPD
Diabetes
Epilepsy
Population
Patient Set Prevalence
Achievement
Exception/Exclusion Report
Service Provider Name
Payment Year: <xxxx>
Payment Type: <xxx>
PMCS: <xxx>
Disease
Register
200
143
275
118
178
98
Total # of
Exceptions
11
8
12
4
6
0
Exception
Rate
0.5%
1.2%
0.7%
0.6%
0.8%
0.0%
Composite Achievement
Page # of #
Total # of
Exclusions
21
12
15
18
9
5
Exclusion
Rate
1.2%
1.5%
0.9%
1.3%
1.1%
0.4%
The Exception/Exclusion Report allows the user to view, by clinical
domain, the disease register, number of exceptions and exclusions
and the rates. Can drill down to indicator level to display charts.
Drill down to indicator level on next slide →
82
CQRS Achievement Reports
Aspiration
Exception/Exclusion
Report Run Date: dd/mm/yyyy
Population
Patient Set Prevalence
Achievement
Exception/Exclusion Report
Service Provider Name
Payment Year: <xxxx>
Payment Type: <xxx>
PMCS: <xxx>
Composite Achievement
Page # of #
PMCS: QOF 2011/2012 Domain: Clinical
CHD
Indicator/Description
CHD 01
CHD 02
CHD 03
CHD 04
Disease
Register
112
143
275
118
Total
Denom
80
95
188
97
Total # of
Exceptions
11
8
12
4
Exception
Rate
0.5%
1.2%
0.7%
0.6%
Total # of
Exclusions
21
12
15
18
Exclusion
Rate
1.2%
1.5%
0.9%
1.3%
The Exception/Exclusion Report allows the user drill down to the
indicator level with the option to display the data in graphic format.
83
CQRS Achievement Reports
Aspiration
Exception/Exclusion
Report Run Date: dd/mm/yyyy
Population
Patient Set Prevalence
Service Provider Name
Payment Year: <xxxx>
Payment Type: <xxx>
PMCS: <xxx>
Contractor Registered Population: <xxx>
Achievement
Composite Achievement
Page # of #
Example of a Registered Population report in graphical format
84
CQRS Achievement Reports
Aspiration
Patient Exception
Population
Patient Set Prevalence
Achievement
Composite Achievement
Example of a practice level achievement report drilled down to
indicator level. Can display in data or graph form & points or pounds.
85
CQRS Achievement Reports
Primary Medical Care & NHS Connecting for Health
Aspiration
Patient Exception
Population
Patient Set Prevalence
Achievement
Composite Achievement
Example of a practice level achievement report drilled down to
indicator level. Can display in data or graph form & points or pounds.
86
QOF updates
• PCT clusters
• 5% audits
• QOF Management Guides vols 3 & 4
recently updated:
www.pcc.nhs.uk/qof-management-guide
EMIS Web problem: the pop-ups only calculate to 3m look
ahead when most practices want them set to end of year.
Thank you
dave.jeffery@nhs.net