The current version of CQRS: 6-in-1 vaccination programme is v5

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

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].
   

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

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

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

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

Having run the top folder, check that the report 6IN1000X - medication issued but no codes is empty; all of the claiming searches have been built primarily around codes rather than medication issues, and this search/report will identify any patients who had a medication issue last month but there was no corresponding clinical code in the same period. The reason for this is to support good practice of coding vaccinations; not only does this make future reporting easier, it ensures whenever the patient requests their vaccination history that everything is included from the vaccination filter in Care History.

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.

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.