CQRS: 6-in-1 searches

CQRS: 6-in-1 searches

A new service has recently been added to CQRS to support the reporting of the new QOF vaccination requirements. There are nine 6in1 indicators to report on, which have a complex set of rules.
The 6in1 indicators are extracted automatically from your system 1 full month after the end of the monthly reporting period. This means that the results for April 2021 were not extracted until the first few days of June, theoretically giving Practices an opportunity to check their data prior to extraction and maximise their income potential.

This article assumes the reader has access to CQRS, and can interpret the descriptions of payment indicators; only payment indicator codes are used below.

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 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 an indicator, 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. For this reason they are excluded from denominators [005] - [009].
  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.
  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.

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.

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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