Jersey QIF 2022

Jersey QIF 2022

Primary Care IT continues to support Jersey's JQIF for 2022. Updated search and template resources have been deployed to support JQIF 2022.

OneTemplate

Practices have been issued with OneTemplate v5.2 which has been localised to Jersey requirements. There are variants for Prescriber and Non-Prescriber.
The OneTemplate is designed to dynamically change its display based on the coded conditions on the active patient's record.

When the template is opened, the front page displays reference information as well as a link to Primary Care IT's support ticket page if there are any queries or problems.


Practices in Jersey will see a page called JQIF Outstanding which displays sections based on each JQIF indicator which is outstanding for the patient. Each section contains the indicator description, codes to achieve the indicator, but also certain 'exception' codes. Exception codes can be used by the clinician to document a decision for future reference, such as a patient being on the maximal tolerated dose for a treatment, or that they declined an activity such as a blood pressure check. Coding exceptions has no effect on reducing the denominator. 

Condition specific pages contain a lot of information and have been updated compared to the previous OneTemplate version deployed to Jersey. Codes which are part of a JQIF indicator are marked with an asterisk (*).

Every effort has been made to localise the template as much as possible to Jersey policies, but there may still be references to English policies and QOF.

JQIF Alert 'Red dot'

The red dot serves as a useful reference to clinicians during a consultation to identify which indicators can be actioned.


Hovering over the red dot will display a detailed information pane listing all outstanding QIF indicators. For certain annual review indicators (AST007, COPD010, JLD005, RA002), incomplete reviews will list which elements have not been done.


.JQIF 2022 Searches

We hope Practices will find the folder structure for the JQIF 2022 searches easy to navigate. Each disease area has been separated into its own folder, and each folder uses the same layout. 


At the top of each folder is a sub-folder named [...] Reference Populations. This contains denominators for the indicators which are shown with square brackets such as [AST007], and NEGATED reports to support recall of patients who have not yet met the indicator criteria. Several Reference Populations folders also contain reports for partially completed indicators where some elements have been completed but not all elements required to achieve the indicator. These are found as *AST007*; *COPD010*; *JLD005*; *RA002*, while *AF007* and *OB002* are provided to help identify patients who are not included in the denominator but could be eligible.


The main disease register has been marked with an asterisk, so it will always appear as the first search underneath the Reference Populations folder. Indicators within the folder are based on this register, so it is essential that patients are included on the register to be eligible for the payment indicators. See JQIF 2022 register attention needed (bottom of this article) to ensure the disease register is as accurate as possible.

Payment indicators are listed below the register search. Users may wish to have a view of the payment indicators as well as their denominators in the same folder, so pressing Full Hierarchy on the ribbon will have the below effect.






The NEGATED reports found in the Reference Populations folder will list patients who have not achieved the indicator (through no activity, or having too high a blood pressure), as well as those who have exception codes such as maximal tolerated therapy or where the patient declined a review. The exception codes have been provided to help clinicians document decisions, but these have no effect on reducing the denominator.

A quick summary of each indicator is shown below. References to the past 12 months relates to the end date of 31st December 2022.

Asthma

  1. AST007 - patients with asthma having a full review in the past 12 months. Requires a review, ACT score, number of exacerbations in past year, management plan, and inhaler technique all to be documented on the same date. A supporting report *AST007* shows anybody who has had at least 1 of the 5 elements coded, but as everything needs to be on the same day it is essential that clinical staff document everything at the review.
  2. AST008 - patients with asthma aged 6-19 who have had their smoking status documented in the past 12 months. This can be a smoking status code or exposure to second hand smoke, but relating to using electronic cigarettes.

Atrial Fibrillation

  1. AF007 - patients with AF and a coded CHA2DS2-VASc score of 2 or more who are on an anticoagulant (warfarin or DOAC) in the past 6 months. This payment indicator starts to include patients on 1st July. A supporting report *AF007* exists to clinically review patients on anticoagulation who do not have a CHA2DS2-VASc score coded, or have a previous coded score of 1.

Blood Pressure

  1. BP002 - patients over the age of 45 who have had their blood pressure recorded in the past 5 years (since 01/01/2018).

CHD

  1. CHD005 - patients with CHD who are treated with aspirin, clopidogrel, warfarin, or a DOAC in the past 6 months. This payment indicator starts to include patients on 1st July.
  2. CHD008 - patients with CHD aged 79 or younger whose most recent blood pressure (since 01/01/2022) is 140/90 mmHg or lower. The report CHD008 - NEGATED will help to determine who has not had their blood pressure checked, and who has a high BP.
  3. CHD009 - patients with CHD aged 80 or older whose most recent blood pressure (since 01/01/2022) is 150/90 mmHg or lower. The report CHD009 - NEGATED will help to determine who has not had their blood pressure checked, and who has a high BP.

CKD

  1. CKD002 - patients with CKD whose most recent blood pressure (since 01/01/2022) is 140/85 mmHg or lower.  The report CKD002 - NEGATED will help to determine who has not had their blood pressure checked, and who has a high BP.
  2. CKD003 - patients with CKD, hypertension, AND proteinuria who are treated with ACEi or ARB in the past 6 months. This payment indicator starts to include patients on 1st July.
  3. CKD004 - patients with CKD who have had an albumin:creatinine result in the past 12 months.

COPD

  1. COPD008 - patients with COPD who have had an MRC score of 3 or more coded in the past 12 months, who have also been offered pulmonary rehabilition. Inclusion for this indicator should naturally occur after a completed COPD010 review.
  2. COPD010 - patients with COPD who have a full review in the past 12 months. Requires a review, MRC score, and number of exacerbations - these do not have to be done on the same date. A supporting report *COPD010* shows anybody who has had at least 1 of the 3 elements coded.

Dementia

  1. DEM004 - patients with dementia who have had a review in the past 12 months. Codes for dementia care plan agreed or reviewed can be used for achieving the indicator.

Diabetes

  1. DM006 - patients with diabetes AND proteinuria or microalbuminuria who are treated with ACEi or ARB in the past 6 months. This payment indicator starts to include patients on 1st July.
  2. DM012 - patients with diabetes whose feet have been checked and classified in the past 12 months. Amputations can be documented, but only coded amputations for both legs/feet will remove a patient from the denominator.
  3. DM014 - patients who have been diagnosed with diabetes since 1st April 2021 who have been referred to a structured education programme.
  4. DM019 - patients with diabetes and not coded as moderately or severely frail whose most recent blood pressure (since 01/01/2022) is 140/80 mmHg or lower. The report DM019 - NEGATED will help to determine who has not had their blood pressure checked, and who has a high BP.
  5. DM020 - patients with diabetes and not coded as moderately or severely frail whose most recent HbA1c (since 01/01/2022) is 58 or lower. The report DM020 - NEGATED will help to determine who has not had a blood test for HbA1c, and who has a high HbA1c.
  6. DM021 - patients with diabetes AND are coded as moderately or severely frail whose most recent HbA1c (since 01/01/2022) is 75 or lower. The report DM021 - NEGATED will help to determine who has not had a blood test for HbA1c, and who has a high HbA1c.
  7. DM022 - patients aged 40 or more with diabetes (excluding any patients with Type 2 diabetes and a CVD risk score of less than 10% coded since 01/01/2020) who do not have a CVD diagnosis and are not coded as moderately or severely frail, who are treated with a statin in the past 6 months. This payment indicator starts to include patients on 1st July. To exclude T2DM patients from the denominator it is important to ensure their diagnosis coding is accurate - the term 'Type 2 diabetes mellitus' is acceptable, but a term such as 'Diabetes mellitus' will mean the patient remains in the denominator.
  8. DM023 - patients aged 40 or more with diabetes AND history of CVD who are treated with a statin in the past 6 months. This payment indicator starts to include patients on 1st July.. 

Heart Failure

For 2022, the requirement for JQIF is to maintain a heart failure register.

Hypertension

  1. HYP003 - patients aged 79 or younger whose most recent blood pressure (since 01/01/2022) is 140/90 mmHg or lower. The report HYP003 - NEGATED will help to determine who has not had their blood pressure checked, and who has a high BP.
  2. HYP007 - patients aged 80 or older whose most recent blood pressure (since 01/01/2022) is 150/90 mmHg or lower. The report HYP007 - NEGATED will help to determine who has not had their blood pressure checked, and who has a high BP.

Learning Disabilities

  1. JLD005 - patients over the age of 18 with a learning disabilty who have had a review in the past 12 months. The review has 4 components; BMI and BP must be recorded within 1 month up to and including the date of the coded learning disabilities assessment/review. A thyroid test result can be done at any time during the 12 months. A supporting report *JLD005* shows anybody who has had at least 1 of the 4 elements coded, so it is important to monitor this report regularly due to the short timeframe for the BMI and BP.

Mental Health

  1. MH003 - patients with a mental health diagnosis (which is not coded in remission) with a blood pressure reading recorded in the past 12 months.
  2. MH007 - patients with a mental health diagnosis (which is not coded in remission) with their alcohol consumption status recorded in the past 12 months.

Non-Diabetic Hyperglycaemia

  1. NDH001 - patients with non-diabetic hyperglycaemia (pre-diabetes) who have had an HbA1c or fasting glucose in the past 12 months. The HbA1c result must be coded an an IFCC value. The report NDH001 - NEGATED will help to determine who has not had an HbA1c result, and who has a high HbA1c.
    Patients on the NDH register who are subsequently diagnosed with diabetes remain on this register until the end of the year. 

Obesity

  1. OB002 - inclusion on the obesity register requires a coded BMI of at least 30 in the past 12 months. *OB002* will help to identify patients whose most recent BMI was at least 30 but recorded before 01/01/2022.

Palliative Care

For 2022, the requirement for JQIF is to maintain a palliative care register.

Rheumatoid Arthritis

  1. RA002 - patients with rheumatoid arthritis who have had a review in the past 12 months. The review has 4 components; a QRISK2 or QRISK3 score must be recorded within 1 month up to and including the date of the coded RA review. BP and a lipid blood test can be done at any time during the 12 months. A supporting report *RA002* shows anybody who has had at least 1 of the 4 elements coded, so it is important to monitor this report regularly due to the short timeframe for the QRISK assessment.

Smoking

  1. SMOK004 - anybody coded as a smoker who has been offered smoking support in the past 12 months. A code relating to using electronic cigarettes is not a valid inclusion.

Stroke & TIA

  1. STIA010 - patients aged 79 or younger whose most recent blood pressure (since 01/01/2022) is 140/90 mmHg or lower.  The report STIA010 - NEGATED will help to determine who has not had their blood pressure checked, and who has a high BP.
  2. STIA011 - patients aged 80 or older whose most recent blood pressure (since 01/01/2022) is 150/90 mmHg or lower. The report STIA011 - NEGATED will help to determine who has not had their blood pressure checked, and who has a high BP.

At the bottom of the main JQIF 2022 search folder is a summary report of all indicators and their denominators.


JQIF 2022 register attention needed

A separate folder of searches has been deployed which requires attention as soon as possible for all Practices to ensure that patient care is not compromised, and that Practices can maximise their JQIF income. This is a one-time activity which should not have to be repeated.

In summer 2021, EMIS in Jersey finally migrated from Read v2 coding system to SNOMED CT. Prior rollout across England had highlighted several areas where some SNOMED codes had been mapped from Read codes with a slightly different context, resulting in some patients suddenly being included on some QOF registers when they were otherwise healthy. PCIT was prepared for this, and in fact some of the unusual mappings had been fixed by SNOMED and EMIS.
During testing of JQIF 2022 PCIT identified discrepancies in some of the disease registers between previous JQIF years and 2022. The cause of this was found to be in the choice of codes historically used for the disease registers, some added into JQIF and others which had had been removed from the QOF codelists upon which JQIF has been based.

To ensure patients remain on disease registers, Practices MUST act on any results appearing in the above reports. The first 14 reports list the earliest code (diagnosis) which qualified patients for a particular register in previous years. Each of these should be clinically reviewed and a valid code added with the same date as the earliest code. There are too many valid codes to list for each condition, so it is recommended to look at the definition of the JQIF register for appropriate codes. In the example below for AF, double click on the bottom line "the Clinical Code is".... to see a list of codes. Ensure that the code chosen for the record has the same Concept ID.
                  

The final report 'Recode Recurrent wheezy bronchitis' will correct an ongoing issue where a patient may have had a wheezing episode in the past and is otherwise fine but with SNOMED now appears on the COPD register. This may lead to patients being recalled unnecessarily, causing wasted appointments. The offending SNOMED code term is "Chronic asthmatic bronchitis" (Concept ID 195949008) but it may appear as "Chronic wheezy bronchitis" or "Recurrent wheezy bronchitis."
The report has been built to find all patients who are not on the COPD register (with a code other than Chronic asthmatic bronchitis), and lists the date of every code requiring attention - there may be more than one per patient - plus columns to highlight the use of COPD review codes.
After clinical review, all code entries need to be deleted and replaced with a different code. The terms Wheezing (56018004) and Acute bronchitis co-occurrent with wheeze (785745000) are two examples that have been used by Practices. Note that choosing "Asthmatic bronchitis" may still have the effect of adding a patient to the asthma register!

    • Related Articles

    • Flu protocols for Jersey

      For the 2023/2024 flu vaccination season, Primary Care IT has again supported the GoJ Primary Care team to review and deploy flu resources for general practice. Flu searches are also provided as folder 016 Seasonal influenza 2023/24 to facilitate the ...

    • Polypharmacy for SMR review (HP279)

      This is a localised protocol for Jersey. An organisational indicator was introduced to JQIF for 2024 covering polypharmacy. Practices are expected to review patients who are taking 8 or more medications. Practices are then required to conduct and ...