CQRS: HPV completing dose (booster) searches
The current version of CQRS: HPV completing dose vaccination is v4The HPV completing dose vaccination indicators are a manual submission to CQRS following the end of the monthly reporting period. Unlike other vaccination indicators found on CQRS, there are no established business rules. Instead NHS Digital suggests Practices "decide the best mechanism for reporting the figures, either by developing their own template or by working with their system to create a template." In other words, Practices can theoretically report based on any searches they choose to write. The caveat is that the bulk of HPV jabs are expected to be done in the schools programme so the activity in general practice should be small.
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) |
| HPV003 | Monthly count of the number of patients who achieved 14 years of age and who have not achieved the age of 25 years who have received a first dose of HPV at the GP practice as a result of missing the provision by the Schools programme for school aged patients. | 14 years (14th birthday) | Day before 25th birthday |
| HPV004 | Monthly count of the number of patients who achieved 14 years of age and who have not attained the age of 25 years who have received a second dose of HPV at the GP practice as a result of missing the provision by the Schools programme for school aged patients. | 14 years (14th birthday) | Day before 25th birthday |
| HPV005 | Monthly count of the number of patients who achieved 15 years of age and who have not yet attained 25 years who have received a third dose of HPV, at the GP practice as a result of missing the provision by the Schools programme for school aged patients; and who had their first dose aged 15 years and above. | 15 years (15th birthday) | Day before 25th birthday |
The searches have been built from scratch and take the form of the simplest ruleset possible; that is, the code term (eg: 1st HPV vaccination dose) is not important for the order of doses. Each indicator has a denominator like other CQRS searches to pick up additional patients, but these are intended more to identify activity where EMIS codes have been used. These are similarly named, but with square brackets (eg: [HPV003] ). When reviewing the figures prior to CQRS submission, Practices are looking for the searches in the top folder 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 an indicator, and these all need to be considered.
- The wrong code was added. This only means that the code used last month was an EMIS code.
- Patient was too old or too young. Patients must be at least 14 but younger than 25 when they received the dose.
- The code was added too early or late. HPV004 differs from the other searches in that there is a distinction of the interval between 1st and 2nd doses based on the patient's age when they received the first dose. Technically the reporting does not distinguish dose interval, but it is important to flag early 2nd dose vaccination to remind clinical staff of the Green Book guidance.
- If a patient received their first dose under the age of 15, their schedule of two doses should have a second dose administered between 6-24 months after the first.
- If a patient received their first dose aged 15 or more, their schedule of three doses recommends a second dose at least 1 month after the first dose, and a third dose at least 3 months after the second dose.
Valid codes
The codes below are suggested based on historic business rules, but many other codes exist.
428741008 - Administration of first dose of human papilloma virus vaccine
429396009 - Administration of first dose of human papilloma virus vaccine
428931000 - Administration of first dose of human papilloma virus vaccine
Missed Activity
Having run the top folder, check that the report HPV000X - 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
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.
For some indicators there are additional columns denoting first dose or qualifying conditions for eligibility. First dose is always shown on the left hand side of the report; qualifying conditions are shown on right hand side of the report.
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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