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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