QOF VI searches

QOF VI searches

The current version of QOF VI is v1
A new area was introduced to QOF in April 2021, although it only appeared on EMIS in September when the QOF searches were updated to v46.
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)
VI002
Children 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

Primary Care IT has produced 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: 31/03/2022).

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.

Practices should concentrate on the Excluded patients folder, where there are 4 searches and 4 reports. Each search and its associated report 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.
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.

Exception Reporting

Where patients are contraindicated to receiving a particular vaccination, the indicators are accommodating and will remove the patient from the denominator cohort. Declined or no consent codes are only considered in the 'adult' indicator VI004 for shingles. The reports contain declined codes which are not considered by QOF, generally old EMIS codes which were available for selection at the time, and action to re-code these may help the overall achievement.
Since 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.

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.

Coding

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 blue boxes are examples of valid codes to use and not representative of the entire code cluster.

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

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

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

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

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 is excluded due to the use of a code which had not been specified at the time.
If time permits, it may be worth making copies of the searches and modify the date parameter to check younger patients who will appear in future QOF years. As an example, change the date of birth in VICX003 so it is simply After or on 01/04/2016. Use the VI003X report to find younger patients where codes can be updated. 


It is worth checking any Practice-created templates to ensure old codes found during review of the reports do not remain available for selection.

The business rules and code cluster lists can be found within the v46 business rules on the NHS Digital website.

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