QOF

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For patients with a new diagnosis of Dementia in the preceding 1 April and 31 March

Codes for blood test declined (In last 12 months)
41M.. Blood test declined (v28)

To fulfil this indicator the patients record must contain one of each of the following groups recorded 6 months before or after the diagnosis, but not necessarily on the same day.

Full Blood count codes

423.. Haemoglobin estimation
426.. Red blood cell (RBC) count
42A.. Mean corpuscular volume (MCV)
42H.. Total white cell count

AND

Calcium test recording Codes

44h4. Blood calcium level
44I8. Serum calcium
44h7. Plasma calcium level
44IE. Serum ionized calcium (pH 7.4) level
44ID. Serum ionised calcium level
44IC. Corrected serum calcium level
44h9. Plasma corrected calcium level
44hD. Blood ionised calcium level
4Q721 Calcium adjusted level (v26)
44h90 Plasma adjusted calcium concentration (v30)
44IC0 Serum adjusted calcium concentration (v30)

AND

Glucose Testing Codes

44TM. Blood glucose series
44f..%
44g..%
44T1. Random blood sugar
44T10 Random blood sugar normal
44T11 Random blood sugar low
44T12 Random blood sugar raised
44T2. Fasting blood sugar
44T3. 2 hours post food blood sugar
44TA. Plasma glucose
44TE. 30 minute blood glucose level - 44TK. Fasting blood glucose level (Excluding 44TJ0, 44TJ1, 44TJ2, 44TJ3, 44TJ4, 44TJ5, 44TJ6, 44TJ7, 44TJ9, 44TJA)
44U..% (Excluding 44Uz)
44V.. Glucose tolerance test
44V1. Glucose tolerance test normal
44V2. Glucose tol. test impaired
44V3. Glucose tol. test diabetic
44V6. Extended glucose tolerance test
R102. [D]Glucose tolerance test abnormal
R10D. [D]Elevated blood glucose level
R1057 [D]Glucose, blood level abnormal
7P172 Glucose tolerance test (v26)
OR IFCC HbA1c code
42W5. Haemoglobin A1c level - International Federation of Clinical Chemistry and Laboratory Medicine standardised
OR
8IEG. Blood glucose test declined

AND

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Renal test recording Codes

44J9. Serum urea level
44JA. Plasma urea level
44J3. Serum creatinine
44JF. Plasma creatinine level
44JC. Corrected plasma creatinine level
44JD. Corrected serum creatinine level

AND

Liver test Recording Codes

44GA. Plasma alanine aminotransferase level
44GB. Serum alanine aminotransferase level
44E.. Serum bilirubin level
44EC. Serum total bilirubin level
44E9. Plasma total bilirubin level
44G7. Plasma gamma-glutamyl transferase level
44G9. Serum gamma-glutamyl transferase level

AND

Thyroid function tests recording codes

442A. TSH - thyroid stim. hormone
442W. Serum TSH level
442X. Plasma TSH level

AND

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B12 Level test recording codes

42T.. Serum vitamin B12
44Le. Plasma vitamin B12 level

AND

Folate Level Tests recording Codes

42U5. Serum folate
42U4. Red blood cell folate
42UE. Plasma folate level

Dementia Read Codes

Eu02.[X]Dementia in other diseases classified elsewhere
Eu020 [X]Dementia in Pick's disease
Eu021 [X]Dementia in Creutzfeldt-Jakob disease
Eu022 [X]Dementia in Huntington's disease
Eu023 [X]Dementia in Parkinson's disease
Eu024 [X]Dementia in human immunodef virus [HIV] disease
Eu025 [X]Lewy body dementia
Eu02y [X]Dementia in other specified diseases classif elsewhere
Eu02z [X] Unspecified dementia
E00.. Senile and presenile organic psychotic conditions
E000. Uncomplicated senile dementia
E001. Presenile dementia
E0010 Uncomplicated presenile dementia
E0011 Presenile dementia with delirium
E0012 Presenile dementia with paranoia
E0013 Presenile dementia with depression
E001z Presenile dementia NOS
E002. Senile dementia with depressive or paranoid features
E0020 Senile dementia with paranoia
E0021 Senile dementia with depression
E002z Senile dementia with depressive or paranoid features NOS
E003. Senile dementia with delirium
E004. Arteriosclerotic dementia
E0040 Uncomplicated arteriosclerotic dementia
E0041 Arteriosclerotic dementia with delirium
E0042 Arteriosclerotic dementia with paranoia
E0043 Arteriosclerotic dementia with depression
E004z Arteriosclerotic dementia NOS
E00y. Other senile and presenile organic psychoses
E00z. Senile or presenile psychoses NOS
Eu01.% [X]Vascular dementia
E02y1 Drug-induced dementia
E012.% Other alcoholic dementia
Eu00.% Senile and presenile organic psychotic conditions
E041. Dementia in conditions EC
Eu041 [X]Delirium superimposed on dementia
F110.% Alzheimer's disease
F111. Pick's disease
F112. Senile degeneration of brain
F116. Lewy body disease

Dementia exception reporting codes (In last 12 months)

9hD0. Excepted from dementia quality indicators: Patient unsuitable
9hD1. Excepted from dementia quality indicators: Informed dissent

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Dementia 003.1 Rationale

There is no universal consensus on the appropriate diagnostic tests that should be undertaken in those with suspected dementia. However, a review of 14 guidelines and consensus statements found considerable similarity in recommendations. The main reason for undertaking investigations in a patient with suspected dementia is to exclude a potentially reversible or modifying cause for the dementia and to help exclude other diagnoses (e.g. delirium). Reversible or modifying causes include metabolic and endocrine abnormalities (e.g. vitamin B12 and folate deficiency, hypothyroidism, diabetes and disorders of calcium metabolism).

The NICE clinical guideline on dementia states that a basic dementia screen should be performed at the time of presentation, usually within primary care. It includes:

Dementia 003.2 Reporting and verification

See indicator wording for requirement criteria.

For the purpose of this indicator, if a test for HbA1c has been carried out within the timeframe permitted by this indicator, then a test for glucose would not be required. All tests are required to be carried out (with the exception of glucose in the above scenario) to meet the requirements of this indicator. Where the test is declined by the patient, then the patient may be exception reported.

This indicator only applies to patients with a new diagnosis of dementia in the QOF year. However the workload has the potential to span more than one QOF year. Therefore the associated Business Rules cover 18 months to capture patients whose care could span more than one QOF year e.g. six months before or after a new diagnosis is recorded.

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Prepared By Jean Keenan