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Improving the identification of people with dementia in primary care: evaluation of the impact of primary care dementia coding guidance on identified prevalence
  1. Paul Russell1,
  2. Sube Banerjee2,
  3. Jen Watt3,
  4. Rosalyn Adleman4,
  5. Belinda Agoe5,
  6. Nerida Burnie6,
  7. Alex Carefull7,
  8. Kiran Chandan8,
  9. Dominie Constable9,
  10. Mark Daniels10,
  11. David Davies11,
  12. Sid Deshmukh12,
  13. Martin Huddart1,
  14. Ashrafi Jabin13,
  15. Penelope Jarrett14,
  16. Jenifer King15,
  17. Tamar Koch11,
  18. Sanjoy Kumar1,
  19. Stavroula Lees16,
  20. Sinan Mir17,
  21. Dominic Naidoo6,
  22. Sylvia Nyame18,
  23. Ryuichiro Sasae18,
  24. Tushar Sharma19,
  25. Clare Thormod20,
  26. Krish Vedavanam21,
  27. Anja Wilton22,
  28. Breda Flaherty23
  1. 1General Practice, Waltham Forest CCG, London, UK
  2. 2Brighton and Sussex Medical School, University of Sussex, Brighton, UK
  3. 3UCL Partners, London, UK
  4. 4General Practice, Barnet CCG, London, UK
  5. 5General Practice, Haringey CCG, London, UK
  6. 6General Practice, Kingston CCG, London, UK
  7. 7General Practice, Camden CCG, London, UK
  8. 8General Practice, Bromley CCG, London, UK
  9. 9General Practice, Sutton CCG, London, UK
  10. 10General Practice, Ealing CCG, London, UK
  11. 11General Practice, Islington CCG, London, UK
  12. 12General Practice, Bexley CCG, London, UK
  13. 13General Practice, Tower Hamlets CCG, London, UK
  14. 14General Practice, Lambeth CCG, London, UK
  15. 15General Practice, Hackney CCG, London UK
  16. 16General Practice, Richmond CCG, London, UK
  17. 17General Practice, Hammersmith and Fulham CCG, London, UK
  18. 18General Practice, Greenwich CCG, London, UK
  19. 19General Practice, Southwark CCG, London, UK
  20. 20General Practice, Newham CCG, London, UK
  21. 21General Practice, Brent CCG, London, UK
  22. 22General Practice, Lewisham CCG, London, UK
  23. 23Division of Medical Education, Brighton and Sussex Medical School, Brighton, UK
  1. Correspondence to Professor Sube Banerjee; s.banerjee{at}bsms.ac.uk

Abstract

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 (χ2=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.

  • PRIMARY CARE
  • PUBLIC HEALTH

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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