Improving the identification of people with dementia in primary care: evaluation of the impact of primary care dementia coding guidance on identified prevalence
Improving the identification of people with dementia in primary care: evaluation of the impact of primary care dementia coding guidance on identified prevalence
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DOI：
10.1136/bmjopen-2013-004023
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发表时间：
2013-01-01
期刊：
影响因子：
2.9
通讯作者：
Flaherty, Breda
中科院分区：
文献类型：
--
作者：
Russell, Paul;Banerjee, Sube;Flaherty, Breda
目的：改善痴呆症护理是国家和国际政策的优先事项;有一个“诊断差距”，只有不到一半的痴呆症病例被诊断出来。英国卫生部的质量和成果框架（QOF）鼓励初级保健承认和记录痴呆症。痴呆症的代码很复杂，可能会因错误编码而导致识别不足。我们制定了痴呆症编码指南;我们报告了应用此指南在实践层面上“清理”痴呆症编码和记录的影响。设计：该指南有五个要素：（1）识别痴呆症的读取代码;（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）将搜索与QOF数据进行比较;（5）审查病例。在每个诊所，都有一名全科医生进行这项工作。在运动前后痴呆症QOF登记的数量与完成运动所花费的时间记录。设置：伦敦初级保健。参与者：27个实践中的23个（85%）参与，覆盖79312（19562 65岁以上）参与者。结果：痴呆症QOF登记人数;所用时间。结果：QOF登记的痴呆症患者人数从1007人增加到1139人（chi（2）=8.17，p=0.004），识别率提高了8.8%。它采取了4.7小时的做法，在averages.Conclusions：这些数据表明，一个简单的初级保健编码练习的潜力，不需要专门的培训，以增加痴呆症的识别率。2011年至2012年期间改善了8.8%，相当于英国第四大改善的初级保健信托基金。从绝对意义上讲，如果这种影响反映在整个英国的初级保健中，那么识别出的痴呆症病例数量将从364329例增加到434488例，识别率从46%提高到54.8%。实施这项工作似乎是一个简单而有效的方法，以提高识别率在初级保健。
Objective: 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.Design: 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.Setting: London primary care.Participants: 23 (85%) of 27 practices participated, covering 79 312 (19 562 over 65 s) participants.Outcomes: The number on dementia QOF registers; time taken.Results: The number of people with dementia on QOF registers increased from 1007 to 1139 (chi(2)=8.17, p=0.004), raising identification rates by 8.8%. It took 4.7 h per practice, on an average.Conclusions: 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.