MH021 - Completed Physical Health Check for SMI

MH021 - Completed Physical Health Check for SMI

The information contained within this article is from version 49 of the Business Rules for Quality and Outcomes Framework (QOF).                                                                     
This indicator is protected in the contract year 2024/25 and will be paid at 2023/24 performance levels

Indicator definition

Indicator ID

Description

MH021

Percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who received all six elements of the Physical Health Check for people with Severe Mental Illness.

What do the business rules mean?

What makes a patient eligible?

Patients are eligible for the MH021 denominator if:
  1. they are on the Mental Health register (ie: have a diagnosis of psychosis, schizophrenia bipolar affective disorder)
  2. the most recent code relating to the diagnosis does not indicate that the patient is in remission

How to achieve the indicator

To meet the criteria for MH021, eligible patients must have all of the following recorded:
  1. Blood pressure recorded in the contract year (MH003 numerator)
  2. BMI coded in the contract year (MH006 numerator)
  3. Alcohol screening coded in the contract year (MH007 numerator)
  4. Cholesterol testing done in the required time period (see below for detail) (MH011 numerator)
  5. Glucose testing done in the contract year (MH012 numerator)
  6. Smoking status recorded (see below for detail) (SMOK002 numerator)
Cholesterol testing is needed within either 12 or 24 months of the end of the contract year, depending on certain conditions. If the patient meets any of the below reasons, they require a test every contract year; if none of the below are present a cholesterol test is also accepted from the previous contract year:
  1. Prescribed antipsychotics in the 6 months before the end of the contract year
  2. Have pre-existing CHD, unresolved diabetes, STIA, PAD, CKD, familial hypertension
  3. Is a current smoker
  4. Latest BMI is over 23 or has a BMI overweight or obese code

Smoking status can be achieved by the following:
  1. Smoker status recorded in the current contract year
  2. Most recent smoking status is "Never smoked"  which was recorded after the patient's 25th birthday
  3. Most recent smoking status is "Never smoked" in the contract year for patients up to and including 25 years old
  4. Most recent smoking status is "Ex smoker" recorded in the contract year
  5. "Ex smoker" was recorded for 3 consecutive years with no record of being a current smoker during the same period
  6. "Ex smoker" was recorded for 3 consecutive years which occurred after the most recent "current smoker" status

What will remove patients from eligibility?

There are no overarching PCA codes for MH021                                                                                                                                                                                                            
Patients can only be excluded from MH021 if all 6 elements have been attempted, but one or more elements have been declined. 
  1. Blood pressure recorded or declined in the contract year
  2. BMI recorded or declined or unsuitable in the contract year
  3. Alcohol screening recorded or declined in the contract year
  4. Cholesterol testing done in the required time period (see above for detail), or declined in the contract year
  5. Glucose testing done or declined in the contract year
  6. Smoking status achieved (see above for detail), or declined in the contract year

Unlike most indicators, there are no generalised exclusions. Only a declined or unsuitable code can remove a patient as long as every other element has been attempted.

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 has chosen not to have blood pressure procedure (BPDEC_COD)

SNOMED code

SNOMED code description

413123006

Blood pressure procedure declined (situation)

Codes indicating the patient has chosen not to have their body mass index (BMI) measured (BMIDEC_COD)

SNOMED code

SNOMED code description

1037511000000103

Body height measurement declined (situation)

736013005Body weight measurement declined (situation)

Codes for body mass index (BMI) measurement unsuitable for patient (BMIPU_COD)

SNOMED code

SNOMED code description

1046331000000104

Unsuitable for body height measurement (finding)

1046351000000106Unsuitable for body weight measurement (finding)

Alcohol screening and assessment declined codes (ALCSCRNDEC_COD)

SNOMED code

SNOMED code description

1104551000000109

Declined to provide information about alcohol use (situation)

361731000000101
Alcohol assessment declined (situation)
428073005
Alcohol consumption screening test declined (situation)
858861000000101
Declines to state current alcohol consumption (finding)
922471000000101
Alcohol Use Disorders Identification Test declined (situation)

Codes indicating a patient has chosen not to have a cholesterol test (CHOLDEC_COD)

SNOMED code

SNOMED code description

141851000119107

Lipid screening declined (situation)

203151000000104
Cholesterol test declined (situation)
301111000000107
Lipid disorder monitoring declined (situation)
9471000175101
Hyperlipidemia screening test declined (situation)

Codes indicating the patient has chosen not to receive a blood glucose test (GLUCDEC_COD)

SNOMED code

SNOMED code description

698473004

Blood glucose test declined (situation)

Codes indicating the patient has chosen not to give their smoking status (SMOKSTATDEC_COD)

SNOMED code

SNOMED code description

1098881000000103

Declined to give smoking status (situation)

11351000175103Tobacco use screening declined (situation)

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