DM034 - Diabetes (with no history of CVD or frailty) on a statin or other lipid lowering therapy

DM034 - Diabetes (with no history of CVD or frailty) on a statin or other lipid lowering therapy

Info
The information contained within this article is from version 50 of the Business Rules for Quality and Outcomes Framework (QOF).                                                                                     
IdeaThis indicator is new in the contract year 2025/26, replacing DM022 to include wider lipid lowering therapies similar to those in the cholesterol indicators                                                  

Indicator definition

Indicator ID

Description

The percentage of patients with diabetes, on the register, aged 40 years or over, with no history of CVD and without moderate or severe frailty, who are currently treated with a statin (excluding patients with type 2 diabetes and a CVD risk score of <10% recorded in the preceding 3 years), or where a statin is declined or clinically unsuitable, another lipid lowering therapy

What do the business rules mean?

What makes a patient eligible?

Patients are eligible for the DM034 denominator if they:
  1. are on the Diabetes register
  2. are aged 40 years old or over
  3. without a diagnosis of any of:
    1. CHD
    2. STIA
    3. PAD
    4. Familial hypercholesterolaemia
    5. Unresolved CKD
  4. are not living with moderate or severe frailty
  5. do not have type 2 diabetes and a QRISK of <10% recorded in the preceeding 3 years

How to achieve the indicator

To meet the criteria for DM034, eligible patients must have had:
  1. an issue of a statin in the 6 months before the end of the QOF year
  2. Any of the criteria in Group 1 and be prescribed a drug from Group 2 in the last 6 months of the contract year
    Group 1:
    1. Patient has a statin intolerance code recorded ever (or)
    2. Patient has chosen not to receive a statin during the contract year (or)
    3. Patient has a persisting statin contraindication recorded ever (or)
    4. Patient has an expiring statin contraindication recorded during the contract year
     Group 2 (drugs):
    1. Bempedoic acid
    2. Ezetimibe
    3. Inclisiran

    4. PCSK9 inhibitor

What will remove patients from eligibility?

  1. Patients who are coded for receiving maximal tolerated cholesterol lowering treatment in the contract year
  2. do not have allergies (any time), adverse reaction (any time), contraindication (in contract year), not indicated (in contract year) or chosen not to have (in contract year) for every one of the following:
    1. bempedoic acid
    2. ezetimibe
    3. inclisiran
    4. PCSK9 inhibitor
  3. Patients who are coded for lipid lowering adverse reaction at any time
  4. Patients who have a lipid lowering therapy contraindicated or lipid lowering therapy not indicated in the contract year
  5. Patients who chose not to receive lipid lowering therapy in the contract year
  6. Patients for whom diabetes quality indicator care was unsuitable in the contract year
  7. Patients who chose not to receive diabetes quality indicator care in the contract year
  8. Patients who have been invited twice (at least 7 days apart) for review
  9. Patients who were diagnosed with diabetes in the last 3 months of the contract year
  10. Patients who were newly registered with the practice in the last 3 months of the contract year

Notes
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

Warning
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.

Moderate frailty diagnosis codes (MODFRAIL_COD)

SNOMED code

SNOMED code description

1129381000000102

Canadian Study of Health and Aging Clinical Frailty Scale level 6 - moderately frail

925831000000107
Moderate frailty

Severe frailty diagnosis codes (SEVFRAIL_COD)

SNOMED code

SNOMED code description

1129401000000102
Canadian Study of Health and Aging Clinical Frailty Scale level 8 - very severely frail
925861000000102
Severe frailty

Cardiovascular disease (CVD) risk assessment codes (CVDASS2_COD)

SNOMED code

SNOMED code description

1085871000000105

QRISK3 cardiovascular disease 10 year risk calculator score

450759008
Framingham coronary heart disease 10 year risk score
718087004
QRISK2 cardiovascular disease 10 year risk score
752451000000100
Cardiovascular disease risk assessment by third party
763244005
QRISK cardiovascular disease 10 year risk calculator score
809311000000105
Joint British Societies cardiovascular disease risk score

Codes for intolerance to statins (STATININTOL_COD)

SNOMED code
SNOMED code description
117241000000100
Statin not tolerated
121981000000104
Statin not tolerated
413174003
Statin not tolerated (situation)

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

SNOMED code
SNOMED code description
134396000
Statin declined

Statin contraindications (persisting) (XSTAT_COD)

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

Statin contraindications (expiring) (TXSTAT_COD)

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

Maximum tolerated cholesterol lowering treatment (CHOLMAX_COD)

SNOMED code
SNOMED code description
407568002
Patient on maximal tolerated lipid lowering therapy (finding)

Codes indicating allergy to bempedoic acid (BEMPACIDALL_COD)

SNOMED code

SNOMED code description

1326571000000106

Allergy to bempedoic acid

Codes indicating adverse reaction to bempedoic acid (BEMPACIDADV_COD)

SNOMED code

SNOMED code description

1326581000000108

Adverse reaction to bempedoic acid

Bempedoic acid contraindicated codes (BEMPACIDCON_COD)

SNOMED code

SNOMED code description

1326611000000102

Bempedoic acid contraindicated

Bempedoic acid not indicated codes (BEMPACIDNIND_COD)

SNOMED code

SNOMED code description

1326601000000104

Bempedoic acid not indicated

Codes indicating the patient has chosen not to receive bempedoic acid (BEMPACIDDEC_COD)

SNOMED code

SNOMED code description

1326631000000105

Bempedoic acid refused

Codes indicating allergy to ezetimibe (EZETIMIBEALL_COD)

SNOMED code

SNOMED code description

1326121000000101

Allergy to ezetimibe

Codes indicating adverse reaction to ezetimibe (EZETIMIBEADV_COD)

SNOMED code

SNOMED code description

1326131000000104

Adverse reaction to ezetimibe

Ezetimibe contraindicated codes (EZETIMIBECON_COD)

SNOMED code

SNOMED code description

1326711000000108

Ezetimibe contraindicated

Ezetimibe not indicated codes (EZETIMIBENIND_COD)

SNOMED codeSNOMED code description
1326701000000106Ezetimibe not indicated

Codes indicating the patient has chosen not to receive ezetimibe (EZETIMIBEDEC_COD)

SNOMED codeSNOMED code description
1326721000000102Ezetimibe refused

Codes indicating allergy to inclisiran (INCLISIRANALL_COD)

SNOMED code

SNOMED code description

1362871000000100

Allergy to inclisiran

Codes indicating adverse reaction to inclisiran (INCLISIRANADV_COD)

SNOMED code

SNOMED code description

1362881000000103

Adverse reaction to inclisiran

Inclisiran contraindicated codes (INCLISIRANCON_COD)

SNOMED code

SNOMED code description

1362051000000103

Inclisiran contraindicated

Inclisiran not indicated codes (INCLISIRANNIND_COD)

SNOMED code

SNOMED code description

1362041000000101

Inclisiran not indicated

Codes indicating the patient has chosen not to receive inclisiran (INCLISIRANDEC_COD)

SNOMED code

SNOMED code description

1362061000000100

Inclisiran refused

Codes indicating allergy to PCSK9 inhibitors (PCSK9IALL_COD)

SNOMED code

SNOMED code description

1326141000000108

Allergy to proprotein convertase subtilisin/kexin type 9 inhibitor 

1365331000000104
Allergy to evolocumab
1365431000000106
Allergy to alirocumab

Codes indicating adverse reaction to PCSK9 inhibitors (PCSK9IADV_COD)

SNOMED code

SNOMED code description

1326151000000106

Adverse reaction to proprotein convertase subtilisin/kexin type 9 inhibitor

1365341000000108
Adverse reaction to evolocumab
1365441000000102
Adverse reaction to alirocumab

PCSK9 inhibitors contraindicated codes (PCSK9ICON_COD)

SNOMED code

SNOMED code description

1326751000000107

Proprotein convertase subtilisin/kexin type 9 inhibitor contraindicat800ed

1365371000000102
Evolocumab contraindicated
1365411000000103
Alirocumab contraindicated

PCSK9 inhibitors not indicated codes (PCSK9ININD_COD)

SNOMED code

SNOMED code description

1326741000000109

Proprotein convertase subtilisin/kexin type 9 inhibitor not indicated

1365361000000109
Evolocumab not indicated
1365401000000100
Alirocumab not indicated

Codes indicating the patient has chosen not to receive PCSK9 inhibitors (PCSK9IDEC_COD)

SNOMED code

SNOMED code description

1326761000000105

Proprotein convertase subtilisin/kexin type 9 inhibitor refused

1365381000000100
Evolocumab declined
1365421000000109
Alirocumab declined

Adverse reaction to lipid lowering drug codes (LIPIDTHERADV_COD)

SNOMED code

SNOMED code description

293417004

Lipid-lowering drug adverse reaction

Lipid therapy contraindicated codes (LIPIDTHERCON_COD)

SNOMED code

SNOMED code description

135822005

Lipid lowering therapy contraindicated

Lipid therapy not indicated codes (LIPIDTHERNIND_COD)

SNOMED code

SNOMED code description

135807000

Lipid lowering therapy not indicated

Lipid therapy declined codes (LIPIDTHERDEC_COD)

SNOMED code

SNOMED code description

135826008

Lipid lowering therapy declined

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

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

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

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

Invite for diabetes care review codes (DMINVITE_COD)

SNOMED codeSNOMED code description
1109921000000106Quality and Outcomes Framework quality indicator-related care invitation
1110921000000100Quality and Outcomes Framework diabetes mellitus quality indicator-related care invitation
143401000000102Quality and Outcomes Framework diabetes mellitus quality indicator-related care invitation using preferred method of communication
705072004Diabetes 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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