DM033 - Diabetes, not frail, with BP 140/90mmHg or less

DM033 - Diabetes, not frail, with BP 140/90mmHg or less

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

The percentage of patients with diabetes, on the register, without moderate or severe frailty in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90mmHg or less (or equivalent home blood pressure reading). 

What do the business rules mean?

What makes a patient eligible?

Patients are eligible for the DM033 denominator if they:
  1. are on the Diabetes register 
  2. have not been classified as living with moderate or severe frailty

How to achieve the indicator.

To meet the criteria for DM033, eligible patients must have met one of the following requirements:
  1. a latest blood pressure measured in clinic (ie: one that is not ambulatory or home-based) that was at most 140/90mmHg
  2. a latest blood pressure which was from an ambulatory test that was at most 135/85mmHg
  3. a latest blood pressure measured at home by the patient that was at most 135/85mmHg

What will remove patients from eligibility?

  1. Patients who have been coded as receiving maximal blood pressure therapy in the contract year 
  2. Patients for whom diabetes quality care was coded unsuitable in the contract year
  3. Patients who chose not to have their blood pressure recorded or undertake home blood pressure or ambulatory blood pressure monitoring in the contract year
  4. Patients who chose not to receive diabetes quality indicator care in the contract year
  5. Patients who have been invited twice (at least 7 days apart) for review with no subsequent blood pressure reading
  6. Patients whose most recent BP reading in the contract year was followed by two invites at least 7 days apart (ie: a raised result which needs re-checking)
  7. Patient who were diagnosed with diabetes 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?

Separately coded systolic and diastolic values (especially for a clinic based reading) may not be counted towards the indicator. 
  1. Ensure all clinicians are aware of the coding requirements.
  2. Ensure all clinicians are aware of the blood pressure target thresholds and their impact on the indicator, especially towards the end of the contract year.


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 for clinic blood pressure readings (CLINBP_COD)

SNOMED code

SNOMED code description

163020007

On examination - blood pressure reading

75367002Blood pressure
163034007Standing blood pressure
163035008Sitting blood pressure
163033001Lying blood pressure

Codes for home blood pressure readings (HOMEAMBBP_COD)

SNOMED code

SNOMED code description

1162737008

Self reported systolic blood pressure

1162735000Self reported diastolic blood pressure
413606001Average home systolic blood pressure
413605002Average home diastolic blood pressure
314446007Average day interval systolic blood pressure
314461008Average day interval diastolic blood pressure
314449000Average 24 hour systolic blood pressure
314462001Average 24 hour diastolic blood pressure
198081000000101Ambulatory systolic blood pressure
198091000000104Ambulatory diastolic blood pressure

Codes for maximal blood pressure (BP) therapy (HTMAX_COD)

SNOMED code

SNOMED code description

407567007

Patient on maximal tolerated antihypertensive therapy

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 have blood pressure procedure (BPDEC_COD)

SNOMED code

SNOMED code description

413123006

Blood pressure procedure declined

Codes indicating patient chosen not to undertake home blood pressure measurement (HBPM) (HOMEBPDEC_COD)

SNOMED code

SNOMED code description

1085031000000100

Home blood pressure monitoring declined

Codes indicating patient chosen not to undertake ambulatory blood pressure monitoring (ABPM) (ABPMDEC_COD)

SNOMED code

SNOMED code description

861231000000105

Ambulatory blood pressure recording 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

310425007
Diabetes monitoring invitation
1083111000000108
Diabetes monitoring invitation email
185756006
Diabetes monitoring first letter
185757002
Diabetes monitoring second letter
185758007
Diabetes monitoring third letter
705072004
Diabetes monitoring invitation 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
185760009
Diabetes monitoring telephone invite
185759004
Diabetes monitoring verbal invite
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
1109921000000106
Quality and Outcomes Framework quality indicator-related care invitation


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