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Diabetes mellitus (DM) QOF tips

Dr Gavin Jamie offers advice on meeting diabetes targets in 2013/14, plus details of current indicators, points and achievement thresholds.

Almost one in eight of the points available in the 2013/14 QOF are for diabetes
Almost one in eight of the points available in the 2013/14 QOF are for diabetes

Tips for meeting targets in this domain

GP Dr Gavin Jamie writes:

Almost one in eight of the points available in the 2013/14 QOF are for the treatment of diabetes with just over half of these for hitting treatment targets. Full details of the indicators for diabetes can be found below.

Blood pressure and blood sugar control both have stepped targets. There are multiple indicators at different levels of outcomes with patients qualifying for more of the indicators as control improves.

Blood pressure has two steps with eight points at 150/90 and eleven points at 140/80. HbA1c level is the measure of blood sugar control and has 59, 64 and 75mmol/L - approximately equivalent to 7.5%, 8% and 9% in the old units. These carry 17, 8 and 10 points respectively.

Cholesterol has a single threshold of 5mmol/L with six points available.

Urine testing for evidence of microalbuminuria has always been part of the diabetes area. From April 2013 only an albumin to creatinine ratio (ACR) will be valid for this indicator.

For those patients diagnosed with microalbuminuria a further indicator requires that they should be prescribed either an ACE inhibitor or an angiotensin 2 antagonist. This is not automatic after an abnormal ACR and microalbuminuria needs to be specifically coded - e.g. R1103.

Several of the processes from the National Diabetes Audit are included in the QOF. Influenza vaccination carries three points, although most of the funding for the flu vaccine programme with come through the national DES.

Risk assessment of the patients feet gets four points and there are five points for retinal screening, although the latter is likely to take place outside the practice. It is important that you get the data from retinal screeners and enter it into the practice system. Data on both outcomes and patients who do not attend is needed so that patients can be correctly exception reported.

From April 2013 there are several new indicators.

Patient newly diagnosed from April 2013 should be referred to a formal structured education programme such as DESMOND. This needs to be done within nine months of the date of diagnosis and there are 11 points available. If no service is available they may be exception reported but if all patients are exception reported then the practice will not get any points.

There are a fairly measly three points for dietary review. The guidelines in England specify that this should be to Diabetes UK level one, although this is pretty basic.

Current indicators

Diabetes mellitus (DM) indicators

Points

Achievement thresholds

DM001: The practice contractor establishes and maintains a register of all patients aged 17 or over with diabetes mellitus, which specifies the type of diabetes where a diagnosis has been confirmed.

6

 

DM002: The percentage of patients with diabetes, on the register,  in whom the last blood pressure reading (measured in the preceding 12 months - 15 months in Wales and N Ireland) is 150/90 mmHg or less.

8

England: 53-93%*

Wales: 51-91%*

Scotland: 45-71%

N Ireland: 65-75%

DM003: The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months - 15 months in Wales and N Ireland) is 140/80 mmHg or less.

 10

England: 38-78%*

Wales: 40-72%*

Scotland 40-65%

N Ireland: 40-65%

DM004: The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months - 15 months in Wales and N Ireland) is 5mmol/l or less.

 6

40-75%

N Ireland: 60-80%*

DM005: The percentage of patients with diabetes, on the register, who have a record of albumin:creatinine ratio test in the preceding 12 months (15 months in Wales and N Ireland).

 3

 50-90%

 

DM006: The percentage of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who are currently treated with a ACE-I (or ARBs).

 3

England: 57-97%*

Wales: 51-91%*

Scotland: 50-90%*

N Ireland: 45-80%

DM007: The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 59 mmol/mol or less in the preceding 12 months (15 months in Wales and N Ireland).

 17

England: 35-75%*

Wales: 40-72%*

Scotland& N Ireland: 40-50%

DM008: The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months (15 months in Wales and N Ireland).

 8

England: 43-83%*

Wales: 45-81%*

Scotland: 45-70%

N Ireland: 65-70%*

DM009: The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 75 mmol/mol or less in the preceding 12 months (15 months in Wales and N Ireland).

10

England: 52-92%*

Wales: 51-91%*

Scotland & N Ireland: 50-90%

DM010: The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 September to 31 March

 3

England: 55-95%*

Wales: 52-92%*

Scotland: 50-90%

N Ireland: 65-90%*

DM011: The percentage of patients with diabetes, on the register, who have a record of retinal screening in the preceding 12 months (15 months in Wales and N Ireland).

 5

50-90%

DM012: The percentage of patients with diabetes, on the register, with a record of a foot examination and risk classification: 1) low risk (normal sensation, palpable pulses), 2) increased risk (neuropathy or absent pulses), 3) high risk (neuropathy or absent pulses plus deformity or skin changes in previous ulcer) or 4) ulcerated foot within the preceding 12 months (15 months in Wales and N Ireland).

 4

50-90%

New indicator DM013: The percentage of patients with diabetes, on the register, who have a record of a dietary review by a suitably competent professional in the preceding 12 months (15 months in Wales and N Ireland).

 3

40-90%

New indicator DM014: The precentage of patients newly diagnosed with diabetes, on the register, in the preceding 1 April to 31 March who have a record of being referred to a structured education programme within nine months after entry on to the diabetes register.

 11

40-90%

New indicator DM015: The percentage of male patients with diabetes, on the register, with a record of being asked about erectile dysfunction in the preceding 12 months (15 months in Wales and N Ireland).

 4

40-90%

New indicator DM016: The percentage of male patients with diabetes, on the register, who have a record of erecetile dysfunction with a record of advice and assessment of contrbituory factors and treatment options in the preceding 12 months (15 months in Wales and N Ireland).

 6

40-90%

*Indicates thresholds which have changed for 2013/14 

 

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