NDH003 - HbA1c monitoring

NDH003 - HbA1c monitoring

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 51 of the Business Rules for Quality and Outcomes Framework (QOF).                                                                                 

Indicator definition

Indicator ID

Description

The percentage of patients with non-diabetic hyperglycaemia or a previous diagnosis of gestational diabetes (GDM) who have had an HbA1c or fasting blood glucose performed in the preceding 12 months.

What do the business rules mean?

What makes a patient eligible?

Patients are eligible for the NDH003 denominator if:
  1. they have a diagnosis of Non-Diabetic Hyperglycaemia (including Pre-Diabetes and Impaired glucose tolerance codes) or Gestational diabetes (GDM)
    or
  2. they had a diagnosis of NDH or Gestational diabetes at the beginning of the contract year, but subsequently have been diagnosed with diabetes during this contract year

How to achieve the indicator

To meet the criteria for NDH003, eligible patients must:
  1. have an HbA1c or fasting plasma glucose result recorded in the contract year

What will remove patients from eligibility?

  1. Patients have NDH diagnosis for whom non diabetic hyperglycaemia quality indicator care was unsuitable in the contract year
  2. Patients have GDM diagnosis for whom gestational diabetes quality indicator care was unsuitable in the contract year
  3. Patients who chose not to have a glucose test in the contract year
  4. Patients who have NDH and chose not to receive non diabetic hyperglycaemia quality indicator care in the contract year
  5. Patients who have GDM who chose not to receive gestational diabetes quality indicator care in the contract year
  6. Patients who were invited twice for review (at least 7 days apart) within the contract year for NDH (if they have this) or GDM (if they have this)
  7. Patients who were diagnosed with non diabetic hyperglyaemia or GDM in the last 3 months of the contract year
  8. 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.

What are the common pitfalls/what do I need to watch out for?

Alert
Patients who have been diagnosed with diabetes during this contract year appear in both the NDH register (NDH_REG) and the Diabetes register. The patient will stay on the NDH register for the remainder of this contract year, and will then drop off on the next 1st April.
Think of this as having monitoring work for NDH recognised, as HbA1c monitoring would have indicated the diabetes diagnosis.

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.

Codes for non diabetic hyperglycaemia (NDH_COD)

CodeDisplay
700449008Non-diabetic hyperglycaemia

Codes for prediabetes (PRD_COD)

CodeDisplay
858301000000107Pre-diabetes
714628002Prediabetes
16896421000119107Prediabetes in mother during pregnancy

Codes for impaired glucose tolerance (IGT_COD)

CodeDisplay
22910008Impaired glucose tolerance in obese
390951007Impaired fasting glycaemia
849171000000106Impaired glucose regulation
88512005Impaired glucose tolerance associated with insulin receptor abnormality
32284009Impaired glucose tolerance in nonobese
1822007Impaired glucose tolerance associated with pancreatic disease
128264007Impaired glucose tolerance with hyperinsulism
73480000Impaired glucose tolerance associated with hormonal aetiology
9414007Impaired glucose tolerance
1310004Impaired glucose tolerance associated with genetic syndrome

Codes for gestational diabetes (GESTDIAB_COD)

CodeDisplay
472699005Uncontrolled gestational diabetes mellitus
75022004Gestational diabetes mellitus class A1
40791000119105Postpartum gestational diabetes mellitus
40801000119106Gestational diabetes mellitus complicating pregnancy
11687002Gestational diabetes mellitus
10753491000119101Gestational diabetes mellitus in childbirth
46894009Gestational diabetes mellitus class A2
472971004Past pregnancy history of gestational diabetes mellitus

Codes for non diabetic hyperglycaemia quality indicator care unsuitable for patient (NDHPU_COD)

CodeDisplay
148551000000106Excepted from non-diabetic hyperglycaemia quality indicators - patient unsuitable

Codes for gestational diabetes quality indicator care unsuitable for patient (GESTIABPU_COD)

Codes not currently available

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

CodeDisplay
698473004Blood glucose test declined

Codes indicating the patient has chosen not to receive non diabetic hyperglycaemia quality indicator care (NDHPCADEC_COD)

CodeDisplay
148541000000108Excepted from non-diabetic hyperglycaemia quality indicators - informed dissent

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

Codes not currently available

Invite for non diabetic hyperglycaemia care review codes (NDHINVITE_COD)

CodeDisplay
148561000000109QOF (Quality and Outcomes Framework) non-diabetic hyperglycaemia quality indicator-related care invitation
1109921000000106QOF (Quality and Outcomes Framework) quality indicator-related care invitation
148571000000102QOF (Quality and Outcomes Framework) non-diabetic hyperglycaemia quality indicator-related care invitation using preferred method of communication

Invite for gestational diabetes care review codes (GESTDIABINVITE_COD)

Codes not currently available
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