QOF Dataset and Business Rules Workshop

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QOF Dataset and Business Rules Workshop

• 25th June 2008
• Rachel Foskett-Tharby

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Learning Objectives

• Understand the structure of a rule set and the
  logical principles underpinning them
• Gain confidence in the use of the rule sets
• Successfully navigate a rule set to identify key
  information
• Apply the logical principles to a number of
  hypothetical patient records to calculate
  numerators and denominators

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Purpose and Structure of the Rule Sets
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Purpose

• The primary purpose of the rule sets is to
  support the accurate, consistent and timely
  payment of practice achievement in the QOF
• Produced bi-annually

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Structure

• Each rule set is divided into three main parts
• Patient selection criteria
• Clinical data extraction criteria
• Indicator rule sets

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Identifying the Target Population
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Registration Status

• Registration status identifies those patients who
  are registered at the practice for GMS care at
  the point at which the data extraction is made
• It seeks to ensure that patients are only
  considered for QOF payment purposes at a single
  practice at any one time

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Registration Status
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Diagnostic Code Status

• This determines the current patient population
  for a specified clinical condition i.e. it
  identifies those to be included in the disease
  register
• Three pieces of information are required to
  determine eligibility
• Code criteria
• Qualifying diagnostic codes
• Time criteria

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(No Transcript)
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Worksheet 1
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Answers

• Diabetes Mellitus
• Patient 1
• Would not be included
• Aged less than 17 years
• Patient 2
• Would be included
• Would this be true if the diagnostic code had not
  been amended from C10..?

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Answers

• Depression
• Patient 1
• Would be included in both depression registers
• Active diagnosis of both depression and CHD

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Clinical Data Extraction Criteria
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Purpose and Structure

• Used to identify those patients in whom certain
  activities have been recorded as occurring or to
  identify those in whom the activity need not be
  completed
• Comprised of four primary information fields
• Field number
• Field name
• Data item
• Qualifying criteria

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(No Transcript)
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Worksheet 2
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Answers (1)

• Field names
• DEPAS_COD - Depression assessment tool codes
• EPEXC_COD - Depression exception reporting codes
• RET_COD - Retinal screening codes
• RET_DAT - Date of RET_COD
• Data items
• DEPR_COD - Depression diagnosis codes
• HBA_VAL - Value 1 of HBA_COD
• HTMAX_COD - Code for maximal BP therapy

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Answers (2)

• Accepted V2 Codes
• DEPEXC_COD
• 9hC0., 9hC1.
• DEPAS_COD
• 338f., 338g., 338p.
• EGFR_COD
• 451E., 451F., 451G.
• Time criteria
• Instructed to look for the latest recording
  before the reference date, therefore should
  select option a (18/03/2008)

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Reading a Rule Set
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Purpose and Structure

• Rule sets enable the identification of the
  numerator and denominator for a given indicator
• They are expressed as a series of logical
  statements to which the answer is either true or
  false
• Depending upon the answer the patient record will
  be selected, rejected or require the next rule to
  be applied

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Denominator Rule Set BP4
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Rule 1

• the date of the latest recording of an accepted
  blood pressure recording code is greater than or
  equal to the reference date minus nine months

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Rule 2

• the date of the latest recording of an accepted
  blood pressure recording exception reporting code
  is greater than or equal to the reference date
  minus 15 months

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Rule 3

• the date of the latest patient registration is
  greater than or equal to the reference date minus
  three months

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Rule 4

• the date of the latest recording of an accepted
  hypertension exception reporting code is greater
  than or equal to the reference date minus 15
  months

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Rule 5

• the date of the earliest recording of an
  accepted hypertension diagnosis code is greater
  than or equal to the reference date minus 3
  months

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• Once these rules have been applied to all those
  on the register the records will have been sorted
  into three piles
• Those for inclusion in the denominator
• Those who are to be excluded
• Those who have been exception reported

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Exceptions and Exclusions

• Exception reporting
• A feature of the QOF which allows practices to
  remove patients who would otherwise be eligible
  for the care described, from the denominator for
  an indicator
• Exclusions
• Patients who are removed from the denominator of
  an indicator because they are ineligible for the
  care described e.g. CHD2

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Numerator Rule Set BP4

• the date of the latest recording of an accepted
  blood pressure recording code is greater than or
  equal to the reference date minus nine months

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Worksheet 3
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Depression 1 Indicator Set
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Answers

• Denominator 3
• Numerator 2
• Exclusions 1
• Exceptions 1

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Questions and Queries