CQRS: RSV for pregnant women
The current version of CQRS: RSV for pregnant women is v1.0. This search folder is available in 001 CQRS v5.4 and above
Introduction:
Unlike most other indicators on CQRS which are extracted automatically from your system approximately 10 days after the end of the monthly reporting period, this RSV for pregnant women service is a manual claim. Practices should 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).
For more information on identifying eligible patients, refer to this article.
For more information on identifying eligible patients, refer to this article.
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 |
RSVP001 | Monthly count of the number of registered patients from 28 weeks of pregnancy who have a record of receiving a dose of RSV carried out by the GP practice within the reporting period. | 10 years (PCIT defined age) | Day before 55th birthday (PCIT defined age) |
To date (December 2024), there are no business rules to properly reflect the CQRS count which is probably due to the complex nature of validating how far along a pregnancy a patient is, and why this particular service requires Practices to submit a manual submission. Primary Care IT has built a set of searches along the same lines as all other CQRS searches which a particular emphasis on checking coding and where the vaccination was given. A denominator (dependency) search designed by PCIT includes patients who may not qualify a claim under the indicator. These are similarly named, but with square brackets (eg: [RSVP001] ).
Primary Care IT has defined a minimum and maximum age for this service of 10 years and 55 years which is intended to include any patient of likely childbearing age. The lower limit of 10 years should ensure that young patients who are vaccinated are not inadvertently picked up, while the upper limit of 55 years appears in several PCIT searches as an upper age of childbearing potential.
A key feature of the searches is that they will only pick up activity which has been recorded by Practice staff; coded vaccinations received electronically from a third party system will not be counted, reducing the burden of reviewing each record to verify where a vaccination was given (eg: elsewhere by the maternity services team).
Actions:
Primary Care IT recommends that all patient records returned by the manual claim search RSVP001 are reviewed to confirm that the vaccination was given on or after 28 weeks of pregnancy.
When reviewing the figures prior to entering a manual count in CQRS, 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. Administration of RSV (respiratory syncytial virus) vaccine and the identically named legacy EMIS code does not count. We recommend using an up-to-date template to minimise the chances of this occurring.
- A RSV vaccination has been given in the previous 6 months. The recommendation is for pregnant patients to be vaccinated once for each pregnancy, so double vaccinations or double coding across consecutive months will not be counted in the main RSVP001 claim search.
- Patient was too old or too young. PCIT has defined an expected age range of 10 years to 55 years, but patients between 55 and 64 years old may be picked up if they have been vaccinated.
The main claim search will only identify patients registered as female on their registration page. Patients recorded as male who have been vaccinated will appear in RSVP001X, and Practices should review individual records to confirm pregnancy. If a pregnant male or FTM transgender patient is found, add them to the total number to be submitted on CQRS.
Valid codes
Administration of RSV (respiratory syncytial virus) vaccine [1303503001]
Missed Activity
Having run the top folder, check that the report RSVP00X - medication issued but no codes is empty; all of the claiming searches have been built 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.
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.
Missed activity data offers some opportunities for learning. Hopefully most entries highlighted by the Missed Activity reports are due to coding which can easily be fixed. Whilst it isn't possible to 'fix' where a vaccination has been given to an ineligible patient, there is an opportunity for reflection and learning to ensure the same scenario is not repeated.
Version History
v1.0.0 - new release
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