CHOL004 - LDL cholesterol less than or equal to 2.0

CHOL004 - LDL cholesterol less than or equal to 2.0

The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF).                                                                     

Indicator definition

Indicator ID

Description

Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), or Stroke/Transient Ischaemic Attack (TIA) Register, who have a recording of LDL (Low-density Lipoprotein) cholesterol in the preceding 12 months that is 2.0 mmol/L or lower or where LDL cholesterol is not recorded a recording of non-HDL (High-density Lipoprotein) cholesterol in the preceding 12 months that is 2.6 mmol/L or lower.

What do the business rules mean?

What makes a patient eligible?

Patients are eligible for the CHOL004 denominator if:
  1.  they have a diagnosis of at least one of:
    1. coronary heart disease (CHD)
    2. peripheral arterial disease (PAD)
    3. stroke or TIA
  2. and they do not have a history of haemorrhagic stroke

How to achieve the indicator

To meet the criteria for CHOL004, eligible patients must have:
  1. their most recent LDL cholesterol result during the contract year was 2.0 or lower
    or
  2. in the absence of a LDL cholesterol result during the contract year, the most recent non-HDL cholesterol result (during the contract year) was 2.6 or lower

What will remove patients from eligibility?

  1. Patients who have maximal tolerated cholesterol lowering therapy in the contract year
  2. Patients for whom the cholesterol quality indicator care was unsuitable in the contract year
  3. Patients who have chosen not to have a cholesterol test in the contract year
  4. Patients who have chosen not to receive cholesterol quality indicator care in the contract year
  5. Patients who have been invited twice for review
  6. Patients whose most recent (LDL) cholesterol reading in the contract year was followed by two invites at least 7 days apart (ie: a raised result which needs re-checking)
  7. Patients who were diagnosed with CHD, PAD or TIA in the last 9 months of the contract year
  8. Patients who were newly registered with the practice in the last 9 months of the contract year

If a patient achieves the indicator at any point during the year, any exclusions that have also been added are ignored.

What are the common pitfalls/what do I need to watch out for?

Some laboratories may not be sending results with a code for LDL cholesterol attached.
Ensure early on in the contract year that LDL cholesterol results are being correctly being coded back to the clinical system.

SNOMED codes used in this indicator

The codes referenced in this article are taken from the NHS Technology Reference Update Distribution (TRUD).  Not all of these may be present or selectable in all clinical systems.

Codes indicating the patient is on maximal tolerated cholesterol lowering treatment (CHOLMAX_COD)

SNOMED code

SNOMED code description

407568002

Patient on maximal tolerated lipid lowering therapy

Codes indicator the cholesterol quality indicator care was unsuitable (CHOLPCAPU_COD)

SNOMED code

SNOMED code description

135807000

Lipid lowering therapy not indicated

Patients who chose not to have a cholesterol test (CHOLDEC_COD)

SNOMED code

SNOMED code description

141851000119107

Lipid screening declined

203151000000104
Cholesterol test declined
301111000000107
Lipid disorder monitoring declined
9471000175101
Hyperlipidemia screening test declined

Patients who chose not to receive cholesterol quality indicator care (CHOLPCADEC_COD)

SNOMED code

SNOMED code description

135826008

Lipid lowering therapy declined

182981008
Cholesterol reduction program declined

Cholesterol invite codes (CHOLINVITE_COD)

SNOMED code

SNOMED code description

1109921000000100

Quality and Outcomes Framework quality indicator-related care invitation

310879007
Cholesterol reduction program - invited
711471000000106
Lipid disorder monitoring invitation
716001000000100
Lipid disorder monitoring first letter
716461000000106
Lipid disorder monitoring verbal invitation
716741000000100
Lipid disorder monitoring telephone invitation
716751000000102
Lipid disorder monitoring second letter




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