Making the most of your disease registers is key to quality points
Practices will have disease registers set up by now for most if not all of the 10 areas covered in the quality and outcomes framework of the new GMS contract. But setting up registers is only the first step maintaining and using them effectively will be the key to improve standards of care and earn quality points.
It is important as a starting point to check the quality of the register. Is everyone on the register who needs to be? Are there any on who are not supposed to be? Various tools are available to practices to assist them in this process of investigation. It may be, for example, that a facilitator has been employed from the Primary Care Information Services (PRIMIS), a free service to PCOs to help them improve patient care through the effective use of clinical computer systems.
If so, the facilitator can help by running a suitable software tool to check the quality of the data on the clinical system. Individual patients with missing or incorrect diagnoses can be identified using a tool from PRIMIS known as Rush for Practices, which produces graphs that help to analyse their own data based on specific clinical topics.
An effective recording protocol will ensure potentially important data is not missed. This is best achieved by direct data entry by the clinician either during or immediately after the consultation. Some practices may still be relying on indirect data entry by clerical staff, and in that case it is important that such staff have adequate training and support.
There also needs to be a plan in place for transferring new patients joining the practice on to existing disease registers. Maintenance of the registers is vital and practice staff must have a system for updating and adding to the registers as needed.
A useful exercise to undertake is to map the flow of information through the practice. It is important to understand how information is received and used, not only from inside the practice but also from outside. What information is put on to the computer? Who enters it and at what stage of the journey? This process may highlight previously unrecognised duplication and redundant information flows and is another way of ensuring the accuracy of registers.
Another useful action is a 'template health check' to make sure the new Read codes needed for the quality and outcomes indicators are included in the templates used.
Once the practice is confident of the accuracy of its registers, robust call and recall systems should be set up to monitor patients who have not attended for a review within 15 months for a particular disease category. In order to meet the criteria for the quality framework, information must be recorded to show not only what treatment has been given but also to demonstrate why care has not been given. Examples of this would be patients who have refused to attend review, having been invited on at least three occasions during the preceding 15 months, or patients for whom it is not appropriate to review the chronic disease parameters due to particular circumstances such as terminal illness or extreme frailty.
Patients who are newly diagnosed or have recently registered should have measurements made within three months and delivery of clinical standards within nine months, such as blood pressure or cholesterol measurements within target levels. Exception reporting should include contraindications, informed dissent and cases where an investigative or secondary care service is unavailable.
What is clear is that maintaining disease registers involves everyone in the practice, and training and support is often needed.