QoF (Quality and Outcomes Framework) Reporting tools are a great way to identify the work needed to achieve your end of year targets but patients could not be displayed due to the exceptions included within the rules and these patients could catch you out for next year. There are a number of indicators that require you to refer or complete investigations within a period of time since the patient has been diagnosed (for example Diabetes DM014, Dementia DEM003 and Depression DEP003). Within these indicators the patients are automatically excluded if they have not achieved and the time required to complete runs over the end of the QoF year.
In the example a patient is diagnosed with Diabetes on the 1st October 2014 (6 months before the end of the QoF year) and has not been referred to a Structured Education program they would be excluded from the denominator (Eligible) population because there has not been a full 9 month period required to achieve. This is good for this QoF year but do you know who these patients are because they will not appear as work to do until the 1/7/2016 by which time it will be to late.
The important thing is ensuring there is a good process to manage patients with new diagnosis and ensure that initial monitoring is performed. Newly registered patients or newly diagnosed patients are excluded for 3 months if they do not achieve so setting up reports to identify and a robust call and recall program will prevent missed opportunities as well as identify any incorrectly diagnosed or episodicity.
DM014 – Structured education for New Diabetes within 9 months of diagnosis (Automatic Exc if not achieved and diagnosed July – Mar)
DEM003 – Blood tests for new dementia patients between 6 months prior and 6 months after diagnosis (Automatic Exc if not achieved and diagnosed Oct – Mar)
STIA008 – Referral for MRI/CT between 3 months prior and 1 month after diagnosis. (Automatic Exc if not achieved and diagnosed Jan – Mar)
DEP003 – Review within 10 to 56 days of diagnosis (Automatic Exc if not achieved and diagnosed Jan – Mar)
CAN003 – Care review within 6 months of diagnosis (Automatic Exc if not achieved and diagnosed Jan – Mar)
Each clinical system is different and today a practice who had no patients to achieve for DM014 (10 points) had 5 patients with diagnosis since 1st July 2014 of which 2 had declined and 3 had no referral recorded but had been diagnosed more than 4 months previous an had been screened for other indicators.