004C QOF VI searches (Child & Shingles vaccination uptake)

004C QOF VI searches (Child & Shingles vaccination uptake)

The current version of QOF VI is v3
Unlike all other QOF indicators there are no declined codes for childhood vaccination indicators (VI001, VI002, VI003).  There are however exclusion criteria to remove patients recently registered with the surgery within the performance searches.

Here is a screenshot of the search folder:


VI (vaccination & immunisation) contains 4 indicators to track the timely uptake of certain vaccinations.

Indicator
Description
Lower age limit
Upper age limit (inclusive)
VI001
Babies whose third dose of diphtheria, tetanus and pertussis containing vaccine was administered before they reached 8 months of age-
Day before 8 months old
(247 days)
VI002Children whose first MMR vaccine was administered from the date they turned 12 months up until 18 months of age
1 (1st birthday)
18m10d (558 days)
VI003
Children who had two doses of MMR vaccine whilst they were aged at least 1 year and less then 5 years of age, and a booster dose of DTaP/IPV vaccine whilst they were less than 5 years of age
1 (1st birthday)
Day before 5th birthday
VI004
Patients who received a single dose shingles vaccination between 70-79 years

(or)

Patients who received a two dose shingles vaccination between 70-80 years
70 (70th birthday)
Day before 80th birthday

(or)

Day before 81st birthday

The latest business rules and code cluster lists can be found here on the NHS Digital website.

Primary Care IT released some searches to help Practices achieve the target thresholds. While these can be run using today's date, the most effective relative run date for QOF will be the end of the year (eg: 31/03/20**).


At first glance when run the QOF VI folder should look almost identical to the corresponding folder in EMIS Web's QOF section (there may be differences depending on when EMIS last ran the searches), and this is intended to serve as a reassurance that the cohorts are counting the same patients.

Where patients are contraindicated to receiving a particular vaccination, the indicators are accommodating and will remove the patient from the denominator cohort.

Vaccination windows

All 4 indicators have specific vaccination windows. Patients cannot be vaccinated outside of the window - even by 1 day - otherwise they will not be included in the indicator achievement despite having done the work. It becomes critical for all staff involved in the process to ensure patients do not attend early for vaccination; this means before before their 1st birthday (VI002); before their 70th birthday (VI004).  Whilst the nursing team is likely to administer the vaccinations, it may be the reception team who book the patient so they should be equally aware of the window to avoid a difficult conversation when the patient arrives for their vaccination. This is similar logic as for a number of CQRS extractions related to childhood vaccinations. Bear in mind for VI001 there is no lower age limit, but the 6in1 indicators for CQRS have a minimum 6 week age set.

Some patients may be delayed in receiving their vaccinations for a variety of reasons, and this outside of a Practice's control. The achievement thresholds take this into account with targets between 70 and 90%, but this may be an incentive to chase those patients who are behind in their vaccination schedule.

Missed activity

Practices should concentrate on the Missed activity folder, where there are 4 searches and 7 reports. Each search and its associated reports looks at the patients who are excluded from the main indicator; what we may find is that some patients may have been vaccinated, while others been lost to follow up or refused vaccination.



The reports are designed to give as much information as needed to decide which patients to target. They will show when patients have received vaccinations, and any relevant vaccination declined or contraindicated which may be on the record.
The reports only show coding, and not where a prescription alone may have been issued.
Occasionally a report (usually VI004X) may be blank despite the search showing a number of patients; this will be because all of the excluded patients have not been vaccinated and not declined rather than having the wrong vaccination code on their record. It is essential to understand the rules for each of the indicators.
Staff may be aware that many of these vaccinations have a lot of similar codes, or indeed old EMIS codes, which can be used. If a patient appears to have a vaccination entry on the report which was administered within the correct timeframe consider re-coding to a valid QOF code. The codes in the yellow boxes below are examples of valid codes to use and not representative of the entire code cluster.

 VI001X) Babies without three doses of DTP before 8 months of age

This search includes patients who didn't receive 3 doses of DTP before 8 months of age.
VI001 - the specification calls for 3 DTP containing vaccinations at least 1 day apart which may be a quadrivalent, pentavalent, or hexavalent type. EMIS created their own codes prior to the official hexavalent vaccine SNOMED codes being introduced, so these may appear.
1082441000000108 - First diphtheria, tetanus and acellular pertussis, inactivated polio, Haemophilus influenzae type b and hepatitis B vaccination
1082451000000106 - Second diphtheria, tetanus and acellular pertussis, inactivated polio, Haemophilus influenzae type b and hepatitis B vaccination
1082461000000109 - Third diphtheria, tetanus and acellular pertussis, inactivated polio, Haemophilus influenzae type b and hepatitis B vaccination

 VI001X) Babies without three doses of DTP before 8 months of age

This report will show  babies without three doses of DTP given before 8 months of age. The report is sorted in age order and can be reviewed to check the included patients. Some doses may have been given too early, too late, or are using codes not valid for QOF. Patients excluded from the denominator due to recent registration are included to support identification of vaccination needs. Declined codes are available for this vaccination, however, coding declined will not help gain QOF points for this indicator.

 VI001Xe QOF) Babies without three doses of DTP before 8 months of age

This report has the same inclusion criteria as the above report, however, it includes more detail/columns and runs in line with our monitoring tools. You can view the support article for PCIT's monitoring tools here.

 VI002X) Children without first dose of MMR between 12 and 18 months of age

This search identifies children who didn't have their first dose of MMR between ages 12-18 months old. This criteria has a vaccination window, patients vaccinated outside of the vaccination window (e.g. before their 1st birthday) .
VI002 - historically there are a lot of MMR codes, so these need to be checked carefully to use one that is correct. Remember that there are booster/catch-up codes which are not appropriate to use for the first vaccination. 
38598009 - Administration of measles and mumps and rubella vaccine

 VI002X) Children without first dose of MMR between 12 and 18 months of age

This report includes children without a first dose of MMR given between 12 and 18 months of age. The report is sorted in age order. Some children may have been given the vaccination too early or too late and some vaccinations may be coded incorrectly for QOF. Patients excluded from the denominator due to recent registration are included to support identification of vaccination needs. The QOF indicator does not consider MMR declined, however it is shown in the report to help the user to identify which patients to target.

 VI002Xe QOF) Children without first dose of MMR between 12 and 18 months of age

This report has the same inclusion criteria as the above report, however, it includes more detail/columns and runs in line with our monitoring tools. You can view the support article for PCIT's monitoring tools here.

 VI003X) Children without DTaP/IPV and 2 doses of MMR between 1 and 5 years

VI003 looks at both MMR and DTaP/IPV, the report contains declined MMR codes as well as contraindicated codes for both vaccinations. Practices should consider that the coding in the report may be correct, and that 2 contraindicated codes (or one vaccine plus one contraindicated code) are required to remove the patient from the indicator.

VI003 - in testing we found this indicator to yield the most coding errors, not so much in MMR, but with DTaP/IPV. As a completed course will show 3 vaccinations, remember that not all codes are incorrect. Unfortunately the Repevax option on EMIS' own Childhood Immunisations template uses a code which is not included in the business rules.
38598009 - Administration of measles and mumps and rubella vaccine
170431005 - Administration of booster dose of measles and mumps and rubella vaccine
390865008 - Administration of booster dose of diphtheria and acellular pertussis and poliomyelitis and tetanus vaccine

 VI003X) Children without DTaP-IPV and 2 doses of MMR between 1 and 5 years

This report shows children who have not had DTaP/IPV AND 2 doses of MMR between 1 and 5 years. The report is sorted in age order. Some patients may have been given the vaccination too early, too late, or are using codes not valid for QOF. Patients excluded from the denominator due to recent registration are included to support identification of vaccination needs. The indicator does not consider MMR or DTaP declined codes, however these are shown in the report to help refine which patients to target. Patients who have had a DTaP but MMR contraindicated are excluded from the denominator [VI003]. VI003 looks at both MMR and DTaP/IPV. The reports contains declined MMR codes as well as contraindicated codes for both vaccinations. Practices should consider that the coding in the report may be correct, and that 2 contraindicated codes (or one vaccine plus one contraindicated code) are required to remove the patient from the indicator.

 VI003Xe QOF) Children without DTaP-IPV and 2 doses of MMR between 1 and 5 years

This report has the same inclusion criteria as the above report, however, it includes more detail/columns and runs in line with our monitoring tools. You can view the support article for PCIT's monitoring tools here.

 VI004X) Patients who turned 80 without a shingles vaccine between 70 and 79

This search includes patients who have turned 80 but did not have a shingles vaccination between the ages of 70-79.

VI004 - until recently only a single dose vaccine (Zostavax) has been available and there was also an EMIS code for it which doesn't count for QOF. Similarly there was an EMIS version of the Herpes Zoster vaccination declined code. The new two dose vaccination (Shingrix) has a different set of vaccine administration codes, so if Herpes zoster vaccination is used for the first dose then the second dose won't be counted as part of a two dose schedule.
859641000000109 - Herpes zoster vaccination
1326101000000105 - Administration of first dose of Varicella-zoster vaccine for shingles
1326111000000107 -  Administration of second dose of Varicella-zoster vaccine for shingles

 VI004X) Patients who turned 80 without a shingles vaccine between 70 and 79

This report shows patients aged 80 without evidence of a shingles vaccination between 70 and 79 years. The report is sorted in age order. Some patients may have been given a vaccination too early or too late, and some may have invalid QOF codes added either for administering the vaccination or an invalid declined code. Code entries appearing in the Shingles declined column are not valid for QOF. Therefore we would suggest working through these patients and replacing codes with valid QOF codes.



Missed Activity (QOF future years)



This search folder is located within the 004C QOF VI heading folder. The folder includes searches and reports to highlight younger patients whose coding may be affected by the coding differences, giving Practices a chance to run a one-off exercise to amend vaccination coding where appropriate. The age ranges have been modified from the Missed Activity searches to identify all patients who might be affected by the indicators, who would otherwise appear in the Population Excluded lists in future QOF years. Remember the reports are sorted in age order, so the patients at the bottom may have only recently become old enough to receive certain vaccines. Alongside the exercise to amend codes it is imperative that coding practices are changed in consultations; use templates as much as possible to ensure coding is correct.  It is worth checking any Practice-created templates to ensure old codes found during review of the reports do not remain available for selection.

Vaccination data originally added in Vision or SystmOne which has been migrated to EMIS due to a system migration or via GP2GP will appear correct to a human but may not count for QOF. This is often because Vision recorded combined vaccinations as separate components (eg: Measles and Mumps and Rubella instead of MMR); or SystmOne's vaccination code is degraded (eg: Repevax instead of DTaP/IPV). All of these must be corrected to meet the coding requirements for QOF. Individual Practices can decide whether they want to simply add another code (thereby showing double amounts of vaccine), or keep the record tidy by deleting the original entries.
Due to the long timescales of these indicators - in particular VI003 - incorrect coding may go way beyond the cohort seen in QOF. Vaccination activity which was completed months or years before QOF VI existed appears in the excluded due to the use of a code which had not been specified at the time.

Payment thresholds

The payment thresholds for the Vaccination & Immunisation indicators are very high and a lack of points may surprise Practices who haven't quite achieved the indicator but aren't too far off. Taking the childhood VI indicators 1-3, the upper payment threshold (full points) is 95% for all three, while the lower payment threshold is 90% for VI001 and VI002, while VI003 has a slightly lower figure of 87%. There is clearly an expectation that high uptake is essential, leaving less than 10% of the denominator population to decline vaccination or be lost to follow up. Without declined or no consent codes, it is very important to ensure that as many patients as possible receive the vaccinations.
VI004 for shingles has a better set of payment thresholds at 50% for the lower, and 60% for the higher and allows for patients to decline, so it should feel achievable.

The spread of the payment thresholds is incredibly narrow for QOF, highlighting the importance of inviting as many patients as possible.



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