Improving the identification of people with dementia in primary care: evaluation of the impact of primary care dementia coding guidance on identified prevalence

Abstract

ObjectiveImproving 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.DesignThe 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.SettingLondon primary care.Participants23 (85%) of 27 practices participated, covering 79 312 (19 562 over 65 s) participants.OutcomesThe number on dementia QOF registers; time taken.ResultsThe 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.ConclusionsThese 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.

Comparison of dementia recorded in routinely collected hospital admission data in England with dementia recorded in primary care

“…Rates of clinically diagnosed dementia are, as expected, lower than rates recorded in field-based studies based on case finding [16–18], because some people with early dementia found in the case finding studies may not have been clinically diagnosed and thus would not have been recorded as having dementia in primary care data. Those diagnosed with dementia in primary care would not necessarily be admitted to hospital, and not all those admitted would have had dementia coded in their hospital records.…”

Targeted case finding for dementia in primary care: Surrey Downs dementia diagnosis project

“…(20) A common element of health strategies to improve the quality of care of people with dementia is that diagnosis should be "early" or "timely". (21) In the Surrey Downs area, the diagnosis rate was 43% at the beginning of the study. an abnormal clock drawing test), and a score of more than 9 in the FAQ.…”

Variations in dementia diagnosis in England and association with general practice characteristics

“…The potential for these and other unknown structural factors to have an impact on our results cannot be ruled out. Fourth, data coding in clinical systems for dementia is variable and in some cases quite poor (Russell et al, 2013). Our study analyses the number of patients who have a recorded diagnosis of dementia on GP electronic patient records.…”