General Practice, Waltham Forest CCG, London, UK.
BMJ Open. 2013 Dec 23;3(12):e004023. doi: 10.1136/bmjopen-2013-004023.
Improving dementia care is a policy priority nationally and internationally; there is a 'diagnosis gap' with less than half of the cases of dementia ever diagnosed. The English Health Department's Quality and Outcomes Framework (QOF) encourages primary care recognition and recording of dementia. The codes for dementia are complex with the possibility of underidentification through miscoding. We developed guidance on coding of dementia; we report the impact of applying this to 'clean up' dementia coding and records at a practice level.
The guidance had five elements: (1) identify Read Codes for dementia; (2) access QOF dementia register; (3) generate lists of patients who may have dementia; (4) compare search with QOF data and (5) review cases. In each practice, one general practitioner conducted the exercise. The number of dementia QOF registers before and after the exercise was recorded with the hours taken to complete the exercise.
London primary care.
23 (85%) of 27 practices participated, covering 79 312 (19 562 over 65 s) participants.
The number on dementia QOF registers; time taken.
The number of people with dementia on QOF registers increased from 1007 to 1139 (χ(2)=8.17, p=0.004), raising identification rates by 8.8%. It took 4.7 h per practice, on an average.
These data demonstrate the potential of a simple primary care coding exercise, requiring no specific training, to increase the dementia identification rate. An improvement of 8.8% between 2011 and 2012 is equivalent to that of the fourth most improved primary care trust in the UK. In absolute terms, if this effects were mirrored across the UK primary care, the number of cases with dementia identified would rise by over 70 000 from 364 329 to 434 488 raising the recognition rate from 46% to 54.8%. Implementing this exercise appears to be a simple and effective way to improve recognition rates in primary care.
改善痴呆症护理是国内外的政策重点；只有不到一半的痴呆症病例得到诊断，存在“诊断差距”。英国卫生部的质量和结果框架（QOF）鼓励初级保健机构识别和记录痴呆症。痴呆症的代码很复杂，通过错误编码可能导致识别不足。我们制定了痴呆症编码指南；我们报告了在实践层面应用该指南来“清理”痴呆症编码和记录的影响。
该指南有五个要素：（1）确定痴呆症的 Read 代码；（2）访问 QOF 痴呆症登记册；（3）生成可能患有痴呆症的患者列表；（4）比较搜索结果与 QOF 数据；（5）审查病例。每个实践都由一名全科医生进行该练习。记录练习前后的痴呆症 QOF 登记册数量以及完成练习所需的时间。
伦敦初级保健。
27 个实践中有 23 个（85%）参与，涵盖了 79312 名（65 岁以上 19562 名）参与者。
痴呆症 QOF 登记册的数量；所花费的时间。
QOF 登记册中痴呆症患者的数量从 1007 人增加到 1139 人（χ(2)=8.17，p=0.004），识别率提高了 8.8%。每个实践平均需要 4.7 小时。
这些数据表明，简单的初级保健编码练习具有提高痴呆症识别率的潜力，且不需要特定的培训。2011 年至 2012 年之间提高 8.8%，与英国第四大改善的初级保健信托机构相当。从绝对数量来看，如果这一效果在英国整个初级保健系统中得到体现，那么被诊断为痴呆症的病例数将从 364329 例增加到 434488 例，识别率从 46%提高到 54.8%。实施这一练习似乎是提高初级保健机构识别率的一种简单有效的方法。
