Frequently asked questions – CQUIN mental health 2018/19 (indicator 3a)
1. Is my Trust/service registered for the 2018/19 CQUIN?
2. How do I find out who the registered lead in my trust is?
Contact the CQUIN team: firstname.lastname@example.org
3. What happens after the CQUIN ends in 2019?
CQUIN is a financial lever intended to improve the quality of care over a given period of time. This CQUIN measured performance from 2014/2015 and has led to improvements in the quality of physical health screening and interventions for people with SMI who are at risk of developing a preventable disease.
2018/19 is the final year of ‘The Improving Physical Health for People with SMI’ CQUIN and providers and commissioners should work to ensure the improvements made during the CQUIN implementation are sustained and implemented.
To support this, NHS England has included a new requirement in the NHS Standard Contract which can be found here, and NHS England will continue to monitor the delivery of physical health checks and interventions for people with severe mental illness through the Physical healthcare for people with SMI: Primary care data collection.
4. Will the community patients sample be collected across all services in the trust (e.g. Adult, Children’s, Learning Disability, Older people, forensic)?
All services are included with the exception of EIP, Learning Disability, and secure services. Data collection for the EIP component of the CQUIN is via the National Clinical Audit of Psychosis (NCAP).
5. Are there any age restrictions on either the community or inpatient samples?
Patients should be included if they are 18 years of age or over on 1 August 2017.
6. Is there a minimum length of stay for patients to be eligible for inclusion in this CQUIN?
For inpatient setting the patient must have stayed in a ward for at least 7 nights. For community setting, patients must have been on the caseload for 12 months to be eligible.
7. Does the patient need to have been admitted during the set period (1 August – 30 September 2018)?
No, patients could have been admitted before the set period but need to have been an inpatient (or on the caseload if community patient) at any point during the set period.
8. If the patient was admitted more than once during the set period (1 August – 30 September 2018) should they be included twice?
No, only the first admission should be included
9. If a patient has an equal length of stay on two wards do we count these twice – once for each ward?
No, please include the patient only once, choose one of the two wards.
10. In the guidance documents, it states 'Please include only patients on their first admission.' Does this mean we should only include patients on their first ever admission to the Trust?
No, if a patient has more than one admission between 1 August – 30 September 2018 then this means you would audit the first admission.
11. Should patients with a secondary diagnosis be included in this CQUIN?
Yes, patients with a primary or secondary diagnosis should be included.
12. If a patient has >1 diagnosis in the same ICD10 code category do we list these only once per category?
No, only include each patient once.
13. Our sample sizes will be significantly less than what is required – does this affect our ability to engage with this CQUIN?
No. Services with fewer than 100 community or 50 inpatient eligible patients for inclusion in the CQUIN will be asked to include all patients. Even if we will not need to randomise your sample, please do submit the list of eligible patients so that we have a record of this.
14. Should we send separate lists of patients for different services if monies are issued separately?
No, only one list is required. The data collection tool includes the type of ward, so data can be separated by NHS England as required.
15. If a patient is eligible to be included in both the community and inpatient sample lists, should we include them in both?
No. If the patient has been both an inpatient and a community patient during the sampling timeframe, the patient should be included in the relevant sample per the sample they were eligible for first. For example, if they had been on a community team caseload for over one year until being discharged on 10 August 2018, and then admitted as an inpatient for over 7 nights on the 14 August 2018, they should be included in your community sample as this is the sample they were eligible for first.
16. Which ICD10 codes should be included in the sample?
Patients with SMI for the purpose of this CQUIN are all patients with psychoses, including schizophrenia and bipolar affective disorder with the relevant ICD-10 diagnostic codes: F10.5, F11.5, F12.5, F13.5, F14.5, F15.5, F16.5, F19.5, F20-29, F30.2, F31.2,
F31.5, F32.3 and F33.3. Please note F20-29 refers to all ICD10 codes between F20 and F29 (e.g. F20, F21, F22….F29).
17. Our sample size will be less than what is required (100 for community and 50 for inpatient setting), after submitting our list. Given that we already know what our list is now, should / could we make a start then?
We would recommend you wait until 7 January 2019 to start collecting data purely because that is when we will send you further guidance on how to complete the tool and information on how to submit the data online.
18. Should we include service users who were inpatients or on the caseload during the set time period but who are now deceased?
It would depend on when the patient died - if this was before the last date an intervention could have been given then they should be excluded.
19. Could we have a copy of the revised tool for this year’s CQUIN?
The CQUIN tool will be provided by 30 November 2018. If you have not received a copy by then, please contact the CQUIN team: email@example.com.
20. Please, can you confirm that taking antipsychotic medication is not a criterion for inclusion?
The only criteria for inclusion are diagnosis and setting.
21. Does this CQUIN look at primary diagnosis or primary and secondary diagnosis?
The CQUIN looks at both primary and secondary diagnosis. The eligible ICD 10 codes can be for either primary or secondary diagnosis.
22. Do all measures have to take place within the set period (1 August 2018 – 30 September 2018)?
No, screening could have been carried out at any time during the inpatient stay, from the point of admission up to 30 September 2018 (for patients who were admitted between 25-30 September 2018, completion of screening/ assessments can be extended to 5 working days from date of the admission, i.e. 05/10 if admitted on 29/09).
Interventions could have been carried out from the point of admission up to 18 January 2019.
23. If screening was carried out more than once for the same measure during the same admission, which result should be included?
Please include the result of the first screening which was carried out when the patient was admitted to the hospital.
24. What should be input for screenings that could not be carried out?
If screenings have not been carried out, the options are ‘not documented’ or ‘documented evidence of refusal’.
25. What happens if there is evidence that tests have been completed immediately prior to admission or inclusion into the caseload, as it is not always clinically justifiable to repeat measures which this CQUIN tool looks at?
Clinicians should be aware that relapses in mental health prompting an admission frequently coincide with deteriorations in physical health.
In the instance, that very recent blood tests (e.g. in the preceding week) leading up to admission have been performed, admitting teams should carefully consider based on the clinical status of the patient which tests need repeating in the inpatient environment.
a) ensure a robust assessment of overall physical health
b) identification of any acute needs
c) opportunity for opportunistic identification and intervention in cardiometabolic disease or risk factors whilst applying appropriate clinical judgement to avoid unnecessary duplication of clinical tests that would not alter management if already recently performed e.g. cholesterol and lipids.
Admitting clinicians should ensure all recent tests are reviewed and entered into case notes if they are not clinically indicated to be repeated in the inpatient environment and in these instances appropriate immediate prior tests can be included in the audit.
26. In the data collection form, is the second part of Q1 (Smoking status): number of cigarettes smoked per day, mandatory?
The number of cigarettes smoked per day is not mandatory. This information will be collected for information only.
27. For Q2 (Alcohol), if the patient does not drink, do I tick “no” or “not documented”?
If the patient does not drink, tick “No”. “Not documented” means that information about that screening measure has not been documented in the patient’s clinical records.
28. For Q4 (Weight), the clinician has entered the BMI but has no information about “change in weight gain of over 3 month period”. Do I also tick “not documented”?
No, enter the BMI only. “Not documented” means that information about that screening measure has not been documented in the patient’s clinical records. Only one result per measure is needed for this CQUIN, however, you can enter more than one if the results are available.
29. For Q4 (Weight), some older people’s wards do not use BMI as it might not always be suitable especially with bed-bound patients. We use demi-span index. Can we enter the measurement for this index instead?
It is possible to extract the BMI from the demi-span index. Please get in touch with us if you need assistance with this.
30. For Q6 (Glucose) I have test results for fasting plasma glucose, glycated haemoglobin but not random plasma glucose. Do I tick “not documented” on the data collection tool?
No, for the purposes of this CQUIN you are only required to enter at least one test result. You are not required to enter all test results for one measure to meet the CQUIN if these are not available from the patient’s clinical record. “Not documented” only applies if there are no results documented for that screening measure in the patient’s clinical records.
31. Is finger prick testing by trained healthcare workers permitted for the cholesterol and glucose measurements?
No, the diagnosis must follow WHO recommendations and use venous samples measured in laboratories, not POCT. POCT HbA1c is recommended only to follow response to an intervention, e.g. following HbA1c response after the introduction of treatment for Type 2 diabetes, not for a diagnosis. This would be the same for Fasting Plasma Blood Glucose of HbA1C testing.
32. The patient was offered medication as an intervention and advice about their diet, so I ticked “Pharmacological intervention for obesity commenced” and “Advice or referral about the diet”. But the patient refused to be referred to a specialist service, do I also tick “Documented evidence of refusing intervention”?
No, "Documented evidence of refusing intervention" should only be ticked if the patient has refused ALL interventions offered. In this case please only tick “pharmacological intervention” and “advice or referral about the diet”.
33. We indicated that a patient needed an intervention at the point of screening but then the intervention was never delivered for sound clinical reasons. If we select “no intervention needed” on the form we will be penalised. How can this be prevented?
We invite trusts to email us during the data collection period to flag up those instances where an intervention was not delivered for sound clinical reasons so that a decision could be made about whether to exclude those patients all together from the sample.
34. I cannot find what the threshold for requiring intervention are for blood lipids, it is not on the Lester tool?
Information on blood lipid thresholds for intervention are detailed on the amber section of the Lester tool. These have been detailed for clarity below:
Intervention is required if test results for any of the following are:
- Total cholesterol > 9 mmol/l or
- Non-HDL cholesterol > 7.5 mmol/l or
- QRISK-2 score > 10%
35. What is the threshold for intervention for Alcohol intake and Substance misuse?
Harmful or hazardous use of alcohol.
Identification of harmful or hazardous use of alcohol is described in NICE guideline CG115. It may be assessed using structured measures such as the ‘AUDIT’ or based on enquiring about quantity, frequency and any health or social consequences of alcohol consumption.
Where there is a record of drinking that is neither harmful nor hazardous e.g. ‘rarely drinks’/ ‘drinks in moderation’ this should be recorded as ‘Alcohol use that is NOT harmful or hazardous’.
Use of any substance (i.e. ‘yes’ on data collection form)
36. What happens where a patient’s results for BMI just exceed the threshold in the Lester tool but their Consultant/Medical team have determined that no intervention(s) is needed? During the data, collection phase services are required to report the patients’ data in the same way as last year for this parameter and deliver the interventions as much as possible in accordance with the thresholds provided.
37. We have submitted forms for all sample patients, however, there are multiple partially completed forms showing. Do we need to do anything about these?
No, once you have submitted forms for all patients you can ignore partially completed forms still showing on the system. Only data in the forms that have been submitted are received by the CQUIN team.
38. We are not able to complete the data collection tool for one of the patients in our sample. What should we do?
Please contact the CQUIN team and we will provide you with an alternative patient.
39. What if I notice an error in the results we after submission, how do we go about rectifying this?
For the community and inpatient CQUIN, Trusts will be able to submit data between 21st January and 15th March 2019. In the first week of April 2019, RCPsych will provide Trusts with Excel spreadsheets containing their submitted data for them to check. Trusts will have an opportunity to amend and return any amendments to RCPsych between 8th and 26th April. The final data, incorporating amendments, will be used to perform the analysis. After this, we regret that no further amendments to the data are possible. Trusts should receive their CQUIN results in June/July 2019.
For the EIP CQUIN (measured through NCAP) Trusts will collect data in October 2018. In November 2018 trusts will submit data. Data cleaning will take place between December 2018 and January 2019. Trusts should receive their CQUIN results in June/July 2019.
40. There is a statement that the CQUIN Team is managing data collection only. Does this mean each participating Trust will be responsible for data analysis and reporting?
No, we will be also carrying out the data analysis as per NHS England specifications. We will analyse the data and submit the results to NHS England. The results will be made available in June 2019.
41. How will compliance and payment be calculated?
The final Commissioning for Quality and Innovation (CQUIN) Guidance 2018/19 can be downloaded from our website. Further information about the 2017/19 NHS Standard Contract is available on the NHS
Early intervention services
42. How will data be collected for EIP services 2018/19 CQUIN?
CQUIN data for EIP services will be collected via the National Clinical Audit of Psychosis (NCAP). For more information please see the NCAP web pages.