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                                                                                                                                                                                                            

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)

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

Alcohol screening and assessment declined codes (ALCSCRNDEC_COD)

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

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