DM037 - Diabetic 8 Key Care Processes
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.
The information contained within this article is from version 50 of the Business Rules for Quality and Outcomes Framework (QOF).
Indicator definition
Indicator ID | Description |
The percentage of patients with diabetes who have had the following care processes performed in the preceding 12 months: BMI measurement, BP measurement, HbA1c measurement, cholesterol measurement, record of smoking status, foot examination, albumin:creatinine ratio, and eGFR creatinine measurement. |
What do the business rules mean?
What makes a patient eligible?
How to achieve the indicator?
To meet the criteria for DM037, eligible patients must have had:
- BMI measurement
- BP measurement
- HbA1c measurement
- Cholesterol measurement
- Record of smoking status which can be:
- Current smoker in the contract year
- Never smoked code ever after their 25th birthday
- Never smoked in the contract year if before 25th birthday
- Ex smoker recorded in the contract year
- Ex smoker recorded for 3 consecutive years and no current smoker during or after this 3 year period
- A foot risk classification in the contract year
- Albumin:creatinine ratio
- eGFR creatinine measurement
What will remove patients from eligibility?
- Patients have both of the following:
- Right foot amputation or congenital absence of right foot codes
- Left foot amputation or congenital absence of left foot codes
- Patients for whom diabetes quality indicator care was unsuitable in the contract year
- Patients who have chosen not to receive diabetes quality indicator care in the contract year
- Patients who have been invited twice (at least 7 days apart) for review
- Patient who were diagnosed with diabetes in the last 3 months of the contract year
- 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.BMI codes (BMI_COD)
| Code | Display |
|---|---|
| 920231000000103 | Child body mass index on 9th centile |
| 60621009 | Body mass index |
| 914741000000103 | Obese class III (body mass index equal to or greater than 40.0) |
| 427090001 | Body mass index less than 16.5 |
| 921031000000102 | Child body mass index 98.1st-99.6th centile |
| 920201000000109 | Child body mass index 3rd-8th centile |
| 443381000124105 | Obese class II |
| 412768003 | Body mass index 20-24 - normal |
| 788996008 | Obesity in adolescence |
| 920841000000108 | Child body mass index 51st-74th centile |
| 1153596006 | Body mass index for age z-score |
| 920251000000105 | Child body mass index 10th-24th centile |
| 443371000124107 | Obese class I |
| 846931000000101 | Baseline body mass index |
| 48499001 | Increased body mass index |
| 920311000000101 | Child body mass index on 50th centile |
| 920971000000105 | Child body mass index on 91st centile |
| 920141000000102 | Child body mass index less than 0.4th centile |
| 310252000 | Body mass index less than 20 |
| 914731000000107 | Obese class II (body mass index 35.0 - 39.9) |
| 414915002 | Obese |
| 162864005 | Body mass index 30+ - obesity |
| 920161000000101 | Child body mass index 0.4th-1.9th centile |
| 921011000000105 | Child body mass index on 98th centile |
| 920931000000108 | Child body mass index on 75th centile |
| 920271000000101 | Child body mass index on 25th centile |
| 408512008 | Body mass index 40+ - severely obese |
| 190966007 | Extreme obesity with alveolar hypoventilation |
| 162863004 | Body mass index 25-29 - overweight |
| 920291000000102 | Child body mass index 26th-49th centile |
| 301331008 | Finding of body mass index |
| 1153602009 | Body mass index for age percentile |
| 35425004 | Normal body mass index |
| 921051000000109 | Child body mass index greater than 99.6th centile |
| 914721000000105 | Obese class I (body mass index 30.0 - 34.9) |
| 162690006 | O/E - obese |
| 819948005 | Obese class III |
| 920991000000109 | Child body mass index 92nd-97th centile |
| 722595002 | Overweight in adulthood with body mass index of 25 or more but less than 30 |
| 6497000 | Decreased body mass index |
| 920181000000105 | Child body mass index on 2nd centile |
| 920951000000101 | Child body mass index 76th-90th centile |
Blood pressure codes (BP_COD)
165 codes so truncated:
| Code | Display |
|---|---|
| 81010002 | Systolic arterial pressure below reference range |
| 1034131000000105 | Post-operative blood pressure measurement |
| 314456006 | Minimum 24 hour diastolic blood pressure |
| 100161000000107 | Sitting diastolic blood pressure |
| 413606001 | Average home systolic blood pressure |
| 407555005 | Sitting diastolic blood pressure |
| 945881000000109 | Baseline systolic blood pressure |
| 95311000000107 | Lying diastolic blood pressure |
| 213061000000100 | Ambulatory diastolic blood pressure |
| 337061000000109 | Self measured blood pressure reading |
| 163036009 | O/E - blood pressure decreased |
| 990251000000103 | Measurement of blood pressure using small adult size blood pressure cuff |
| 147850007 | Borderline blood pressure |
HbA1c codes (IFCCHBAM_COD)
| Code | Display |
|---|---|
| 6181000237109 | Haemoglobin A1c monitoring range molar concentration in blood |
| 1107481000000106 | HbA1c (haemoglobin A1c) substance concentration in blood |
| 1971000237103 | haemoglobin A1c diagnostic reference range molar concentration in blood |
| 1049321000000109 | HbA1c (haemoglobin A1c) level (monitoring ranges) - IFCC (International Federation of Clinical Chemistry and Laboratory Medicine) standardised |
| 999791000000106 | Haemoglobin A1c level - International Federation of Clinical Chemistry and Laboratory Medicine standardised |
| 1049301000000100 | HbA1c (haemoglobin A1c) level (diagnostic reference range) - IFCC (International Federation of Clinical Chemistry and Laboratory Medicine) standardised |
Cholesterol codes (CHOL2_COD)
| Code | Display |
|---|---|
| 853681000000104 | Total cholesterol level |
| 1083761000000106 | Serum fasting total cholesterol level |
| 994351000000103 | Serum total cholesterol level |
| 1106531000000105 | Cholesterol molar concentration in plasma |
| 1005671000000105 | Serum cholesterol level |
| 850981000000101 | Cholesterol level |
| 1017161000000104 | Plasma total cholesterol level |
| 1106541000000101 | Cholesterol molar concentration in serum |
Current smoker (LSMOK_COD)
| Code | Display |
|---|---|
| 134406006 | Smoking reduced |
| 56578002 | Moderate smoker (20 or less per day) |
| 394871007 | Thinking about stopping smoking |
| 413173009 | Minutes from waking to first tobacco consumption |
| 394872000 | Ready to stop smoking |
| 225934006 | Smokes in bed |
| 160613002 | Admitted tobacco consumption possibly untrue |
| 160604004 | Moderate cigarette smoker (10-19 cigs/day) |
| 266920004 | Trivial cigarette smoker (less than one cigarette/day) |
| 230065006 | Chain smoker |
| 401159003 | Reason for restarting smoking |
| 230064005 | Very heavy cigarette smoker |
| 160606002 | Very heavy cigarette smoker (40+ cigs/day) |
| 160603005 | Light cigarette smoker (1-9 cigs/day) |
| 230063004 | Heavy cigarette smoker |
| 56771006 | Heavy smoker (over 20 per day) |
| 65568007 | Cigarette smoker |
| 449868002 | Smokes tobacco daily |
| 160619003 | Rolls own cigarettes |
| 77176002 | Smoker |
| 160605003 | Heavy cigarette smoker (20-39 cigs/day) |
| 230056004 | Cigarette consumption |
| 266929003 | Smoking started |
| 394873005 | Not interested in stopping smoking |
| 230058003 | Pipe tobacco consumption |
| 59978006 | Cigar smoker |
| 230060001 | Light cigarette smoker |
| 836001000000109 | Waterpipe tobacco consumption |
| 230062009 | Moderate cigarette smoker |
| 446172000 | Failed attempt to stop smoking |
| 308438006 | Smoking restarted |
| 230059006 | Occasional cigarette smoker |
| 266918002 | Tobacco smoking consumption |
| 203191000000107 | Wants to stop smoking |
| 230057008 | Cigar consumption |
| 428041000124106 | Occasional tobacco smoker |
| 82302008 | Pipe smoker |
| 160616005 | Trying to give up smoking |
| 160612007 | Keeps trying to stop smoking |
Never smoked codes (NSMOK)
| Code | Display |
|---|---|
| 221000119102 | Never smoked any substance |
| 266919005 | Never smoked tobacco |
Ex smoker codes (EXSMOK_COD)
| Code | Display |
|---|---|
| 266921000 | Ex-trivial cigarette smoker (<1/day) |
| 266922007 | Ex-light cigarette smoker (1-9/day) |
| 1092041000000104 | Ex-very heavy smoker (40+/day) |
| 266928006 | Ex-cigarette smoker amount unknown |
| 266925009 | Ex-very heavy cigarette smoker (40+/day) |
| 1092131000000107 | Ex-trivial smoker (<1/day) |
| 266924008 | Ex-heavy cigarette smoker (20-39/day) |
| 360890004 | Intolerant ex-smoker |
| 160617001 | Stopped smoking |
| 160621008 | Ex-cigar smoker |
| 1092071000000105 | Ex-heavy smoker (20-39/day) |
| 228486009 | Time since stopped smoking |
| 53896009 | Tolerant ex-smoker |
| 735112005 | Date ceased using moist tobacco |
| 266923002 | Ex-moderate cigarette smoker (10-19/day) |
| 492191000000103 | Ex roll-up cigarette smoker |
| 8517006 | Ex-smoker |
| 1092111000000104 | Ex-light smoker (1-9/day) |
| 160625004 | Date ceased smoking |
| 735128000 | Ex-smoker for less than 1 year |
| 48031000119106 | Ex-smoker for more than 1 year |
| 281018007 | Ex-cigarette smoker |
| 360900008 | Aggressive ex-smoker |
| 160620009 | Ex-pipe smoker |
| 1092031000000108 | Ex-smoker amount unknown |
| 1092091000000109 | Ex-moderate smoker (10-19/day) |
Foot risk classification codes (FRC_COD)
| Code | Display |
|---|---|
| 756381000000100 | O/E - Left diabetic foot at increased risk |
| 980451000000103 | FootSkin scale risk level 3 high risk |
| 394682001 | O/E - Right diabetic foot at moderate risk |
| 394673007 | O/E - Right diabetic foot - ulcerated |
| 394671009 | O/E - Right diabetic foot at low risk |
| 394674001 | O/E - Left diabetic foot - ulcerated |
| 394672002 | O/E - Right diabetic foot at high risk |
| 980471000000107 | FootSkin scale risk level 4 high risk |
| 394675000 | O/E - Left diabetic foot at low risk |
| 756391000000103 | O/E - Right diabetic foot at increased risk |
| 980411000000102 | FootSkin scale risk level 1 |
| 394676004 | O/E - Left diabetic foot at high risk |
| 394681008 | O/E - Left diabetic foot at moderate risk |
| 980431000000105 | FootSkin scale risk level 2 |
Albumin:creatinine codes (APCR_COD)
| Code | Display |
|---|---|
| 1108311000000109 | Protein/creatinine ratio in 24 hour urine |
| 1023491000000104 | Urine albumin:creatinine ratio |
| 1028731000000100 | Urine protein/creatinine ratio |
| 1027791000000103 | Urine microalbumin/creatinine ratio |
| 58201000237103 | Protein/creatinine mass concentration ratio in urine |
| 1006631000000104 | Random urine protein:creatinine ratio |
| 5801000237100 | Albumin/creatinine mass concentration ratio in urine |
eGFR codes (EGFR_COD)
| Code | Display |
|---|---|
| 80274001 | GFR - glomerular filtration rate |
| 963611000000108 | Estimated glomerular filtration rate using cystatin C per 1.73 square metres |
| 1011491000000107 | eGFR (estimated glomerular filtration rate) using cystatin C Chronic Kidney Disease Epidemiology Collaboration equation per 1.73 square metres |
| 963631000000100 | Estimated glomerular filtration rate using serum creatinine per 1.73 square metres |
| 1107411000000104 | Estimated glomerular filtration rate by laboratory calculation |
| 1020291000000106 | GFR (glomerular filtration rate) calculated by abbreviated Modification of Diet in Renal Disease Study Group calculation |
| 996231000000108 | GFR (glomerular filtration rate) calculated by abbreviated Modification of Diet in Renal Disease Study Group calculation adjusted for African American origin |
| 963621000000102 | Estimated glomerular filtration rate using creatinine Chronic Kidney Disease Epidemiology Collaboration equation |
| 857971000000104 | Estimated glomerular filtration rate using Chronic Kidney Disease Epidemiology Collaboration formula |
| 963601000000106 | Estimated glomerular filtration rate using cystatin C Chronic Kidney Disease Epidemiology Collaboration equation |
| 857981000000102 | Estimated glomerular filtration rate using Chronic Kidney Disease Epidemiology Collaboration formula per 1.73 square metres |
| 1011481000000105 | eGFR (estimated glomerular filtration rate) using creatinine Chronic Kidney Disease Epidemiology Collaboration equation per 1.73 square metres |
Right foot amputation codes (AMPR_COD)
| Code | Display |
|---|---|
| 308095002 | O/E - Amputated right above knee |
| 816965000 | Amputated right lower limb above knee |
| 213378007 | Traumatic amputation of both feet |
| 144691000119104 | History of amputation of left and right leg through tibia and fibula |
| 13093003 | Bilateral traumatic amputation of legs at any level with complication |
| 1010684009 | Traumatic amputation of right lower limb through thigh |
| 732212008 | Bilateral lower limb amputation |
| 16207521000119100 | History of amputation of right midfoot |
| 11995601000119103 | Right lower limb amputation stump wound dehiscence |
| 817015003 | Amputated right forefoot |
| 1010227005 | Traumatic amputation of right foot |
| 16207601000119105 | History of amputation of right forefoot |
| 15669321000119104 | Congenital absence of right lower limb |
| 16207081000119105 | Bilateral amputation stump pain of lower limbs |
| 11996161000119100 | Infection of amputation stump of right lower limb |
| 11007531000119105 | History of amputation through right ankle joint |
| 773819005 | Amputation of right forefoot |
| 772058008 | Amputation of entire right lower limb and ipsilateral hemipelvis |
| 73600009 | Bilateral traumatic amputation of legs at any level without complication |
| 11995791000119103 | Edema of amputation stump of right lower limb |
| 16087851000119103 | History of amputation of bilateral ankle joints |
| 11995441000119103 | Contracture of amputation stump of right lower limb |
| 445498009 | Bilateral traumatic amputation of lower limbs |
| 723312009 | Amputation of right foot |
| 286541000119108 | History of bilateral above knee amputation of lower limbs |
| 15636891000119105 | History of bilateral foot amputation |
| 11007691000119108 | History of bilateral through-the-knee amputations |
| 308097005 | O/E - Amputated right below knee |
| 733287003 | Traumatic amputation at right hip joint |
| 11995991000119101 | Right lower limb amputation stump haematoma |
| 89824004 | Bilateral traumatic amputation of feet with complication |
| 723840008 | Amputation of bilateral lower limbs above knee |
| 787399008 | Bilateral foot amputation |
| 308093009 | O/E - Amputated right leg |
| 816964001 | Amputated right lower limb below knee |
| 723689001 | Amputation of bilateral lower limbs through tibia and fibula |
| 1010312007 | Traumatic amputation of right lower limb at level between knee and ankle |
| 1010211003 | Traumatic amputation of right lower limb |
| 11007571000119108 | History of amputation of right foot |
| 787161009 | Amputation of right midfoot |
| 210767003 | Traumatic bilateral amputation of leg with complication |
| 1055306001 | Traumatic amputation of right lower limb through knee |
| 119751000119105 | History of bilateral lower limb amputation |
| 735668000 | Bilateral traumatic amputation of legs through hip joints |
| 11996641000119105 | Pain of amputation stump of right lower limb |
| 816963007 | Amputated right lower limb |
| 10996691000119108 | History of disarticulation of right knee |
| 36211009 | Bilateral traumatic amputation of feet without complication |
Congenital absence of right foot codes (CONABR_COD)
| Code | Display |
|---|---|
| 1003644007 | Agenesis of both feet |
| 716249009 | Tetraamelia with multiple malformation syndrome |
| 92504008 | Bilateral congenital absence of feet |
| 1201776003 | Congenital complete absence of right lower limb |
| 177504007 | Acheiropodia |
| 304971000119107 | Congenital absence of right lower leg and foot |
| 702313004 | Tetra-amelia syndrome |
| 890222006 | Congenital complete absence of bilateral lower limbs |
| 45420007 | Acheiropodia |
| 15669321000119104 | Congenital absence of right lower limb |
| 767000001 | Congenital absence of right foot |
| 371191006 | Bilateral congenital absence of feet |
| 890401002 | Bilateral congenital absence of both lower leg and foot |
Left foot amputation codes (AMPL_COD)
| Code | Display |
|---|---|
| 772057003 | Amputation of entire left lower limb and ipsilateral hemipelvis |
| 723689001 | Amputation of bilateral lower limbs through tibia and fibula |
| 10996731000119101 | History of amputation through left ankle joint |
| 1010683003 | Traumatic amputation of left lower limb through thigh |
| 10996571000119108 | History of amputation of left foot |
| 16207561000119105 | History of amputation of left midfoot |
| 210767003 | Traumatic bilateral amputation of leg with complication |
| 10996771000119103 | History of disarticulation of left knee |
| 11995691000119109 | Edema of amputation stump of left lower limb |
| 144691000119104 | History of amputation of left and right leg through tibia and fibula |
| 213378007 | Traumatic amputation of both feet |
| 11996561000119108 | Pain of amputation stump of left lower limb |
| 11995521000119108 | Left lower limb amputation stump wound dehiscence |
| 13093003 | Bilateral traumatic amputation of legs at any level with complication |
| 308096001 | O/E - Amputated left above knee |
| 816113001 | Amputated left lower limb |
| 16207681000119102 | History of amputation of left forefoot |
| 787399008 | Bilateral foot amputation |
| 817014004 | Amputated left forefoot |
| 11007691000119108 | History of bilateral through-the-knee amputations |
| 723840008 | Amputation of bilateral lower limbs above knee |
| 11995361000119109 | Contracture of amputation stump of left lower limb |
| 816114007 | Amputated left lower limb above knee |
| 119751000119105 | History of bilateral lower limb amputation |
| 733288008 | Traumatic amputation at left hip joint |
| 16207081000119105 | Bilateral amputation stump pain of lower limbs |
| 1010309009 | Traumatic amputation of left lower limb at level between knee and ankle |
| 308094003 | O/E - Amputated left leg |
| 73600009 | Bilateral traumatic amputation of legs at any level without complication |
| 15669241000119104 | Congenital absence of left lower limb |
| 11996081000119108 | Infection of amputation stump of left lower limb |
| 1055305002 | Traumatic amputation of left lower limb through knee |
| 445498009 | Bilateral traumatic amputation of lower limbs |
| 16087851000119103 | History of amputation of bilateral ankle joints |
| 732212008 | Bilateral lower limb amputation |
| 308098000 | O/E - Amputated left below knee |
| 36211009 | Bilateral traumatic amputation of feet without complication |
| 11995891000119108 | Left lower limb amputation stump haematoma |
| 89824004 | Bilateral traumatic amputation of feet with complication |
| 723311002 | Amputation of left foot |
| 286541000119108 | History of bilateral above knee amputation of lower limbs |
| 816116009 | Amputated left lower limb below knee |
| 1010210002 | Traumatic amputation of left lower limb |
| 787159000 | Amputation of left midfoot |
| 735668000 | Bilateral traumatic amputation of legs through hip joints |
| 773821000 | Amputation of left forefoot |
| 15636891000119105 | History of bilateral foot amputation |
| 1010228000 | Traumatic amputation of left foot |
Congenital absence of left foot codes (CONABL_COD)
| Code | Display |
|---|---|
| 45420007 | Acheiropodia |
| 702313004 | Tetra-amelia syndrome |
| 371191006 | Bilateral congenital absence of feet |
| 1003644007 | Agenesis of both feet |
| 304961000119101 | Congenital absence of left lower leg and foot |
| 92504008 | Bilateral congenital absence of feet |
| 890401002 | Bilateral congenital absence of both lower leg and foot |
| 1201777007 | Congenital complete absence of left lower limb |
| 177504007 | Acheiropodia |
| 15669241000119104 | Congenital absence of left lower limb |
| 890222006 | Congenital complete absence of bilateral lower limbs |
| 716249009 | Tetraamelia with multiple malformation syndrome |
| 766999004 | Congenital absence of left foot |
Codes for diabetes quality indicator care unsuitable for patient (DMPCAPU_COD)
| Code | Display |
|---|---|
| 717421000000100 | Excepted from diabetes quality indicators - patient unsuitable |
Codes indicating the patient has chosen not to receive diabetes quality indicator care (DMPCADEC_COD)
| Code | Display |
|---|---|
| 716031000000106 | Excepted from diabetes quality indicators - informed dissent |
Invite for diabetes care review codes (DMINVITE_COD)
| Code | Display |
|---|---|
| 185758007 | Diabetes monitoring third letter |
| 185760009 | Diabetes monitoring telephone invite |
| 1109921000000106 | QOF (Quality and Outcomes Framework) quality indicator-related care invitation |
| 185757002 | Diabetes monitoring second letter |
| 1066911000000100 | Diabetes monitoring SMS (short message service) text message first invitation |
| 143401000000102 | QOF (Quality and Outcomes Framework) diabetes mellitus quality indicator-related care invitation using preferred method of communication |
| 1083111000000108 | Diabetes monitoring invitation email |
| 1066921000000106 | Diabetes monitoring SMS (short message service) text message second invitation |
| 310425007 | Diabetes monitoring invitation |
| 1110921000000100 | QOF (Quality and Outcomes Framework) diabetes mellitus quality indicator-related care invitation |
| 185756006 | Diabetes monitoring first letter |
| 705072004 | Diabetes monitoring invitation by short message service text messaging |
| 1066931000000108 | Diabetes monitoring SMS (short message service) text message third invitation |
| 185759004 | Diabetes monitoring verbal invite |
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