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Transcript
Dementia Business Requirements v0.9 (March 2005)
Data Requirement
Patients with dementia should be
diagnosed early in the disease
1 trajectory as possible. For example
75+ health checks routinely offered
should screen for dementia
Simple mental state tests should be
2 used in primary care to assess for
dementia.
Data Item 1
Data Item 2
assessment date
Date of last routine
(memory loss)
over 75 check
(2.97)
assessment date
(memory loss)
(2.97)
Presenting
symptoms at
diagnosis
needs assessor
(memory loss)
(2.98)
date presenting
symptoms first
recorded
Data Item 3
Data Item 4
Data Item 5
Data Item 6
Data Item 7
Document of Origin
needs assessor
(memory loss) (2.98)
Page 36 Clinical
Guidelines book (DoH
in origin)
simple mental state
test score at diagnosis
clinical guidelines
3
Dementia may present with
symptoms other than memory loss.
4
Evidence that a physical exam has
been carried out.
Date of physical
exam
RCP consensus
document
Evidence that tests are carried out as
per local protocol.
The clinical Diagnosis of dementia
6 should be based on a standardised
system such as ICD-10 / read codes
Attempts should be made to specify
clinical subtyping such as
Alzheimer's disease, Vascular
7
Dementia, DLB Frontal Lobe
Dementia, Normal Pressure
Hydrocephalus etc.
Easy early and informative referral
should be made to a specialist
8
service if dementia is suspected or
confirmed
First specialist assessment is carried
out by a suitably qualified
9 professional with access to
multidisciplinary mental health
service (including social services)
date diagnostic
tests completed
Clinical Diagnosis Clinical Diagnosis
Standard system
(Dementia Type) (Dementia Type)
used for diagnosis
ICD
Read
RCP consensus
document
NICE (referred to on
p2: RCP consensus
document)
Clinical Diagnosis Clinical Diagnosis
(Dementia Type) (Dementia Type)
ICD
Read
NICE (referred to on
p2: RCP consensus
document)
5
date presenting
symptoms first
recorded
date of referral to
specialist service
Comments
possible scores are mini
mental test, AMTS,
6CIT other
ERG
date seen by
specialist service
Reason for
Service (type)
referral to
referred to
specialist service
Professional role of
Referral type required referral date (other assessment date
referral source (to person making first
(other relevant
relevant
(other relevant
specialist service) specialist
professional)
professional)
professional)
assessment
not referred to
specialist service
assessment
location (other
relevant
professional)
RCP consensus
document
Date discussed
at MDT
links to primary care tests are commenced
here
Patients referred to a specialist
service should have a
comprehensive assessment including date seen by
10
medical assessment,
specialist service
neuropsychology and social,
supported by neuro imaging
date of physical
exam
date of
neuropsychology
assessment
date of social
assessment
start date
(behaviour
start date (behaviour
management
specialist treatments offered should start date (anti
start date (other
management support
11
support and
be recorded
dementia drugs) drugs)
and advice to
advice to nonprofessional carers)
professional
carers)
date dementia
date dementia
? Something about
There is a record of who has been
diagnosis
diagnosis discussed discussions recorded
12 informed with regard to the
discussed with
with significant
in the patients health
diagnosis
patient
other
record
date patient
Patients should be advised of their date of diagnosis consultation (re
13
responsibility to inform the DVLA (dementia)
DVLA
responsibilities)
date patient
Patients should be given information
date of diagnosis consultation (re
14 about the options of appointing a
(dementia)
appointing power of
Power of Attorney
attorney)
Patients should be given the
date patient
date of diagnosis
15 opportunity to discuss advance
consultation (re
(dementia)
directives
advance directives)
date patient
Patients should be given the
consultation
opportunity to discuss appropriate date of diagnosis
16
(services available
services that are available to them (dementia)
including 24 hr
(including 24 hour crisis support)
support)
Where clinically appropriate patients
prescribing source
assessment date
antidementia drug
start date (anti
17 should have access to anti dementia
of the antidementia
(mini mental state
prescribed
dementia drugs)
drugs
drug(s) prescribed
test)
Patient's full range of medication
reviewed at home visit and
medication support needs assessed
Date of Home
Visit
Profession of
Pharma-ceutical care
person conducting
plan
review
date of brain
scan
Service (type)
referred to
start date
(individual
counselling patient)
start date
(individual
counselling /
support - carer)
John Bamford is a key
link for this.. ?
Organisational rather
than patient related data
working group
look at cancer items
clinical guidelines /
DVLA
ERG
ERG
generic issue for older
peoples datasets
NICE (referred to on
p2: RCP consensus
document)
NSF / Medicines
"Even where the person
does not live alone,
carers appreciate this
type of review" Jayne
Lingard Service
Development
Consultant
Cholinesterase inhibitors should be
prescribed by a specialist in elderly
care / old age psychiatry / neurology
date assessed in
18 for mild and moderate AD where the
specialist clinic
mini mental state examination is
above 12 points, following full
assessment in a specialist clinic
Patients prescribed cholinesterase
start date
inhibitors should be reviewed 2 to 4
19
(cholinesterase
months after the initiation of
inhibitors)
treatment
Patients who continue on
cholinesterase inhibitors should be
start date
reviewed by MMSE score and
20
(cholinesterase
global and functional and
inhibitors)
behavioural assessment every 6
months
Cholinesterase inhibitors should be end date
21 discontinued as per national
(cholinesterase
guidance
inhibitors)
All patients on 4 or more
antipsychotics or benzodiazepines
drugs should be reviewed every 6
months.
There should be access to inpatient
23 and day treatment facilities if
required
antidementia drug
prescribed
professional role held
person prescribing
mini mental state
the antidementia
test score
drugs
Clinical guidance book
/ NICE
review date (patient
mini mental state test
on cholinesterase
score
inhibitors)
Clinical guidance book
/ NICE
review date (patient
assessment date
mini mental state test
on cholinesterase
(mini mental state
score
inhibitors)
test)
Clinical guidance book
/ NICE
mini mental state
test score
needs assessor
assessment date
(memory loss)
(memory loss) (2.97)
(2.98)
cholinesterase restart date
inhibitors not
(cholinesterase
stopped (reason) inhibitors)
review date
(general drug
review)
professional role of
person completing
general drug review
referral date (for
for hospital
provider spell)
start date (hospital end date (hosptial
provider spell)
provider spell)
referral date (day start date (day
treatment)
treatment)
end date (day
treatment)
There should be access both planned
referral date
24 and emergency respite facilities if
(planned respite)
required
start date (planned end date (planned
respite)
respite)
referral date
(emergency
respite)
end date
(emergency
respite)
22
Intermediate care (emergency and
planned), and 24 hour access to
25
crisis support services should be
available to patients and carers
26
There should be access to benefits
advice and benefits as required
restart reason
(cholinesterase
inhibitors)
the threshold for
discontinuing is
Clinical guidance book
currently a mini mental
/ NICE
score of 12 but may
change
NSF
start date
(emergency
respite)
working group
date patient
consultation
(services available
including 24 hr
support)
date of diagnosis
(dementia)
this business
requirement also needs
to be monitored via
organisational audit
attendance
allowance (2.12)
disability living
allowance (care)
(2.13)
disability living
parking badge
allowance
(2.15)
(mobility) (2.14)
invalid care
allowance
NSF
these chosen as an
indicator. Not meant to
be all inclusive
An individual care package is
developed that reflects both health
27 and social care needs of the patient
according to the Single assessment
process
Carers of patients with dementia
28 should undergo individual carers
assessment
An individual care package is
developed that reflects both health
29 and social care needs of the carers
according to the Single assessment
process
Numbers of older people with
30 dementia in the locality living alone
and with family carers
Numbers of older people from
minority ethnic communities with
31
dementia in the locality living alone
and with family carers
Proportion of GPs with copies of
32 care plans for all their patients who
should have one
Proportion of CPA care plans for
33 people with severe mental illness
signed by user
Proportion of carers on enhanced
34 CPA that have had their own written
care plan
Proportion of carers of people on
35 enhanced CPA having had a needs
assessment
Best practice is followed in the last
36
days and hours of life
Patients with Young Onset
37
Dementia
health and social
date of review
Date care package
managed under SAP
care resources made
(patient care
agreed (patient)
or CPA
available
package)
NSF
(e.g. day care. Respite,
personal care help)
Date carers needs
assessment
Carers act
? SAP data item
health and social
Date care package
date of review (carers
care resources made
agreed (carer)
care package)
available
should also identify
Page 36 Clinical
medical co-morbidity
Guidelines book (DoH
(e.g. day care. Respite,
in origin) NSF
personal care help)
Clinical Diagnosis person lives alone
(Dementia Type) (1.17)
lives with family
carers
?? Is a carer?
Page 36 Clinical
Guidelines book (DoH
in origin). Carers act?
Clinical Diagnosis ethnic category
(Dementia Type) (1.21)
person lives alone
(1.17)
lives with family
?? Is a carer?
carers
Page 36 Clinical
Guidelines book (DoH
in origin)
Clinical Diagnosis Copy of care plan
(Dementia Type) on GP files
Draft NHS
performance indicators
CPA care plan
signed by the
patient
Clinical Diagnosis
(Dementia Type)
Draft NHS
performance indicators
CPA type
patient has own
written care plan
Draft NHS
performance indicators
CPA type
date of needs
assessment (carer)
Draft NHS
performance indicators
will be the same for all older people datasets and will follow the palliative and supportive care (cancer) work.
areas for more specialist consultation