Over the last few weeks I have been asked the same question from practices, support service personnel and also seen forum posts as to why they have not achieved or got any patients to achieve CHD006. In the QoF (Quality and Outcomes Framework) CHD006 indicator is: ‘The percentage of patients with a history of myocardial infarction (on or after 1 April 2011) currently treated with an ACE-I (or ARB if ACE-I intolerant), aspirin or an alternative anti-platelet therapy, beta-blocker and statin’ and the 10 available points (Worth £1569.20 to an average practice) are achieved within the threshold 60%-100%. The reasons identified are:
- On Emis Web, InPS Vision and TPP SystmOne CHD006 requires patients to have a New episode of Myocardial Infarction after the 1st April 2011 to be included in the denominator. Not having the correct number of patients in the denominator means that you may have some patients not treated to guidance and may leave you open to investigation as it becomes easier to achieve the target and points. From experience patients missing in the main have been treated to guidance, however there are some who are not. Run a search to find patients with any episode of MI after the 1/4/2011 who have never had a new episode OR any episode of MI after the 1/4/2011 which isn’t new with emergency hospital attendance in the same period. I have searches for EMIS Web, TPP SystmOne an InPS Vision that finds patients that may be missing from these registers and are available by contacting firstname.lastname@example.org
- To Achieve CHD006 a patient must be on all 4 medications (ACE inhibitor (or ARB if ACE-I intolerant) and an aspirin or alternative anti-platelet and a beta-blocker and a statin). If the patient is excepted from one or more of the medications and treated with the others they will be removed from the denominator. Because some practices have very few patients in the new MI (See point 1) the exceptions often result in no patients being available to achieve (Practice last week had 3 patients with new MI but all 3 have been excepted for Beta Blocker so shows 0/0). Running DQA search above resulted in 8 missing patients identified and should have been showing 5/7
- If you have used a top level exception for your CHD patients this does not apply to CHD006 indicator. The code hierarchy 9h0..% Exception reporting: CHD quality indicators only applies to CHD002, CHD005 and CHD007. To except the patients from CHD006 they must have one of the 9 reasons for exception and the code hierarchy 9hM..% Exception reporting: myocardial infarction quality indicators. It is important that any letters sent to a patient inviting them for screening include all conditions that they may have as you can only except from those indicators invited (e.g. smoking)
The importance of correct denominators is as important as correct registers. Whereas correct registers ensure patient inclusion and prevalence payments the correct denominators ensure patients are treated or monitored to guidance.