CQRS: 6-in-1 searches

CQRS: 6-in-1 searches

The current version of CQRS: 6-in-1 vaccination programme is v4
There are nine 6in1 indicators to report on, which have a complex set of rules. Technically the indicator set looks at vaccines containing diphtheria, tetanus, and polio rather than the indicated hexavalent vaccine.
The 6in1 indicators are extracted automatically from your system approximately 10 days after the end of the monthly reporting period. Practices have a short opportunity to check their data prior to extraction and maximise their income potential. For reviewing data in historic months, the relative run date may be any date in the month following the achievement period (eg: for the achievement period of April, any date in May can be selected).

This article assumes the reader has access to CQRS, and can interpret the descriptions of payment indicators; only payment indicator codes are used below.
Indicator
Description
Lower age limit
Upper age limit (inclusive)
6IN1001
Monthly count of the number of patients who are aged at least 6 weeks old but have not yet attained 10 years old who received a DTaP/IPV/Hib/HepB vaccination administered by the GP practice within the reporting period and this vaccine was their first dose of a Diphtheria, Tetanus, and Polio containing vaccine.
42 days (6 weeks)
Day before 10th birthday
6IN1002
Monthly count of the number of patients who are aged 9 weeks but have not yet attained 10 years old who received a DTaP/IPV/Hib/HepB vaccination administered by the GP practice within the reporting period and this vaccine was their second dose of a Diphtheria, Tetanus, and Polio containing vaccine.
63 days (9 weeks)
Day before 10th birthday
6IN1003
Monthly count of the number of patients who are aged 13 weeks but have not yet attained 10 years old who received a DTaP/IPV/Hib/HepB vaccination administered by the GP practice within the reporting period, and this vaccine was their third dose of a Diphtheria, Tetanus, and Polio containing vaccine.
91 days (13 weeks)

Previous dose must have been at least 56 days prior
Day before 10th birthday
6IN1004
Monthly count of the number of patients who are aged 3 years 4 months old but have not yet attained 10 years old who previously completed the full primary course of Diphtheria, Tetanus and Polio containing vaccines, who received a dose of either DTaP/IPV or dTaP/IPV as their first booster vaccine administered by the GP practice within the reporting period.
40 months (3 years 4 months)
Day before 10th birthday
6IN1005
Monthly count of the number of patients who are aged 10 years and over who received a Td/IPV vaccination administered by the GP practice within the reporting period and this vaccine was their first dose of a Diphtheria, Tetanus, and Polio containing vaccine.
10 years (10th birthday)
No upper age
6IN1006
Monthly count of the number of patients who are aged 10 years and over who received a Td/IPV vaccination administered by the GP practice within the reporting period and this vaccine was their second dose of a Diphtheria, Tetanus, and Polio containing vaccine.
10 years (10th birthday)
No upper age
6IN1007
Monthly count of the number of patients who are aged 10 years and over who received a Td/IPV vaccination administered by the GP practice within the reporting period and this vaccine was their third dose of a Diphtheria, Tetanus, and Polio containing vaccine.
10 years (10th birthday)
No upper age
6IN1008
Monthly count of the number of patients who are aged 10 years and over who received a Td/IPV vaccination administered by the GP practice within the reporting period and this vaccine was their fourth dose (first booster dose) of a Diphtheria, Tetanus, and Polio containing vaccine.
10 years (10th birthday)
No upper age
6IN1009
Monthly count of the number of patients who are aged 10 years and over who received a Td/IPV vaccination administered by the GP practice within the reporting period and this vaccine was their fifth dose (second booster dose) of a Diphtheria, Tetanus, and Polio containing vaccine.
10 years (10th birthday)
No upper age

Primary Care IT has built a set of searches to support the 6in1 extraction. The main searches closely mirror the business rules to properly reflect the CQRS count, but each search is also based on a denominator (dependency) search designed by PCIT to include patients who may not be picked up by the extraction. These are similarly named, but with square brackets (eg: [6IN1001] ). When reviewing the figures prior to CQRS extraction, Practices are looking for the searches to show 100%. When the search is not 100%, Practices can refer to the corresponding report in the Missed Activity folder. It is also possible to use the Check Patient feature to try to understand why a patient has been picked up in the denominator search but not for CQRS. There are several reasons why a patient may not be included in a reported CQRS achievement, and these all need to be considered.
  1. The patient is pregnant. Pregnant women will receive a 4-in-1 pertussis containing vaccination which is covered under the separate Pertussis in pregnant women service on CQRS, which picks up the code Pertussis vaccination in pregnancy. For this reason they may be excluded from denominators [005] - [009] unless a 4-in-1 vaccination code has also been added.
  2. The wrong code was added. The business rules are accommodating if 2nd 6-in-1 vaccine has been coded twice, but there are some codes which do not count, including the 5-in-1 vaccine and legacy EMIS codes which have not been mapped to a proper code. We recommend using a template to minimise the chances of this occurring.
    Certain denominator searches will pick up a number of codes based on the schedule (eg: 6IN1001 will identify any 1st dose codes, 6IN1002 will identify any 2nd dose codes), so coding multiple doses on the same day may pull a patient into two or more indicators.
    Using a 4-in-1 (DTaP/IPV) code for the 5th dose 6IN1009 will not count, and likewise a 3-in-1 (Td/IPV) code used for any dose other than the 5th valid dose will be flagged in Missed Activity.
  3. The patient is on a 5-in-1 schedule. Children who had their course interrupted or delayed may be kept on a 5-in-1 vaccine which is not counted for 6IN1001-6IN1003.
  4. Patient was too old or too young. 6IN1001-6IN1004 are exclusively for children under the age of 10; 6IN1005-6IN1009 are for patients aged 10 or older. The older patients should be receiving DT+polio vaccines and not 6-in-1.
  5. The code was added too early. There are some 21 day, 28 day, 1 month, 1 year minimum intervals which must not be breached. The same principle actually applies to other vaccines such as rotavirus, where payment won't be given if the 2nd dose was given at 27 days.
  6. The patient's historical record is incomplete. Where codes are missing, patients may fall into the wrong denominator. This is most likely to happen for patients in denominators [6IN1005]-[6IN1007].
Consider the screenshot below. The numbers reflect those seen on CQRS, but note 6IN1004 is not 100%. Reviewing the Population Excluded list, there was one patient where Check Patient showed they were missing the 3rd 6-in-1 code before they had their pre-school booster. One additional payment could have been received if the search had been reviewed and potentially fixed prior to the CQRS extraction date.

The searches have been built around codes, while the business rules allow for codes OR medication issues. Using codes helps to offer a more complete coded vaccination history. In some situations where a medication issue for the vaccine has been added but a code is incorrect or missing, the patient will appear in Missed Activity. With no action taken to add a code the patient should still be counted in the CQRS submission.

Valid codes

6IN1001 - 6IN1003
1082441000000108 - First diphtheria, tetanus and acellular pertussis, inactivated polio, Haemophilus influenzae type b and hepatitis B vaccination
1082451000000106 - Second diphtheria, tetanus and acellular pertussis, inactivated polio, Haemophilus influenzae type b and hepatitis B vaccination
1082461000000109 - Third diphtheria, tetanus and acellular pertussis, inactivated polio, Haemophilus influenzae type b and hepatitis B vaccination
6IN1004 - requires valid primary dose codes (see above) to qualify. Bearing in mind the limited codes specified for QOF VI003 only use the below codes despite the CQRS indicator having a broader set of valid codes.
247821000000102 - Booster diphtheria, tetanus, acellular pertussis and inactivated polio vaccination
390865008 - Administration of booster dose of diphtheria and acellular pertussis and poliomyelitis and tetanus vaccine
6IN1005 - 6IN1009
868267006 - Administration of first dose of diphtheria, poliomyelitis, and tetanus vaccine 
868266002 - Administration of second dose of diphtheria, poliomyelitis, and tetanus vaccine 
868268001 - Administration of third dose of diphtheria, poliomyelitis, and tetanus vaccine 
866227002 - Administration of booster dose of diphtheria, poliomyelitis, and tetanus vaccine 

Missed Activity

Reports to help review potential data can be found in the Missed Activity folder, named with the indicator code followed by an X. If the searches have run, highlight the report and press View Results from the ribbon or right click for the quick menu.
The missed activity reports for CQRS have been designed in a standard fashion for ease of understanding.
      CHECK - data in the CHECK column means that the codes used are correct, but the patient was either too old or young, or a subsequent dose was given too early or too late. It may be necessary to refer to the ES business rules to confirm appropriate age ranges and intervals between doses.
      INVALID - data in the INVALID column means that activity has been found but with a different code that may indicate claimable activity. This column only focuses on the code and not on the age or the interval, meaning the report may need to be re-run or work out the time criteria yourself offline.
There may be a few scenarios where data appears in both CHECK and INVALID columns due to the way missed activity reports have been configured; prioritise CHECK before considering wither INVALID contains claimable activity.

Always check the 0% searches to ensure that single patients from the denominator are not missed!
The Full Hierarchy button on the ribbon can make checking the parent searches of 0% searches easier.


Review the CQRS article for points to consider when using these searches.

The business rules and code cluster lists for enhanced services can be found on the NHS Digital website.

While the main searches have been built to closely mirror the business rules, there is a creative element to the denominator searches. Where the main search isn't 100%, don't discount that there are other factors which erroneously brought the patient into the denominator search. PCIT is always happy to hear about problems, but is unable to assist with every query why a specific patient is/isn't included.

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