DM023 - Diabetes (with a history of CVD) on a statin

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
DM023	The percentage of patients with diabetes, on the register, and a history of CVD (excluding haemorrhagic stroke) who are currently treated with a statin.

What do the business rules mean?

What adds patients in to eligibility?

Patients are eligible for the DM022 denominator if they:

1. are on the Diabetes register
2. have one of:
   
1. CHD
   
2. STIA
   
3. PAD
   
4. Familial hypercholesterolaemia
   
5. Unresolved CKD
3. do not have a coded history of a haemorrhagic stroke

How to achieve the indicator

To meet the criteria for DM023, eligible patients must have had:

1. an issue of a statin in the 6 months before the end of the contract year

What will remove patients from eligibility?

1. Patients who are coded for maximal tolerated cholesterol lowering therapy in the contract year
   
2. have persisting statin contraindications ever or expiring statin contraindications in the contract year
3. Patients for whom diabetes quality indicator care was unsuitable in the contract year
   
4. Patients who chose not to receive a statin in the contract year
5. Patients who chose not to receive diabetes quality indicator care in the contract year
6. Patients who have been invited twice (at least 7 days apart) for review 
   
7. Patients who were diagnosed with diabetes in the last 3 months of the contract year
   
8. Patients who were newly registered with the practice in the last 3 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.

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

Statin contraindications (persisting) (XSTAT_COD)

SNOMED code	SNOMED code description
293432006	3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor adverse reaction
293434007	Adverse reaction caused by fluvastatin
293435008	Adverse reaction caused by pravastatin
293433001	Adverse reaction caused by simvastatin
294970008	Allergy to 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor
294972000	Allergy to fluvastatin
294973005	Allergy to pravastatin
294971007	Allergy to simvastatin
16524331000119104	History of rhabdomyolysis due to statin
787206005	Rhabdomyolysis due to statin

Statin contraindications (expiring) (TXSTAT_COD)

SNOMED code	SNOMED code description
134391005	Statin not indicated
413174003	Statin not tolerated
315363002	Statins contraindicated

Codes for diabetes quality indicator care unsuitable for patient (DMPCAPU_COD)

SNOMED code	SNOMED code description
717421000000100	Excepted from diabetes quality indicators - patient unsuitable

Codes indicating the patient has chosen not to receive a statin prescription (STATINDEC_COD)

SNOMED code	SNOMED code description
134396000	Statin declined

Codes indicating the patient has chosen not to receive diabetes quality indicator care (DMPCADEC_COD)

SNOMED code	SNOMED code description
716031000000106	Excepted from diabetes quality indicators - informed dissent

Invite for diabetes care review codes (DMINVITE_COD)

SNOMED code	SNOMED code description
1109921000000106	Quality and Outcomes Framework quality indicator-related care invitation
1110921000000100	Quality and Outcomes Framework diabetes mellitus quality indicator-related care invitation
143401000000102	Quality and Outcomes Framework diabetes mellitus quality indicator-related care invitation using preferred method of communication
705072004	Diabetes monitoring invitation by short message service text messaging
1066911000000100	Diabetes monitoring short message service text message first invitation
1066921000000106	Diabetes monitoring short message service text message second invitation
1066931000000108	Diabetes monitoring short message service text message third invitation
1083111000000108	Diabetes monitoring invitation email
185756006	Diabetes monitoring first letter
185757002	Diabetes monitoring second letter
185758007	Diabetes monitoring third letter
185759004	Diabetes monitoring verbal invite
185760009	Diabetes monitoring telephone invite
310425007	Diabetes monitoring invitation

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