title: Improving the identification of people with dementia in primary care: evaluation of the impact of primary care dementia coding guidance on identified prevalence.
abstract: OBJECTIVE
  Improving 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.
  
  
  METHODS
  The 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.
  
  
  METHODS
  London primary care.
  
  
  METHODS
  23 (85%) of 27 practices participated, covering 79 312 (19 562 over 65 s) participants.
  
  
  RESULTS
  The number on dementia QOF registers; time taken.
  
  
  RESULTS
  The number of people with dementia on QOF registers increased from 1007 to 1139 (χ(2)=8.17, p=0.004), raising identification rates by 8.8%. It took 4.7 h per practice, on an average.
  
  
  CONCLUSIONS
  These 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.
authors.affiliation: General Practice, Waltham Forest CCG, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Russell
authors.forename: Sube
authors.initials: S
authors.lastname: Banerjee
authors.forename: Jen
authors.initials: J
authors.lastname: Watt
authors.forename: Rosalyn
authors.initials: R
authors.lastname: Adleman
authors.forename: Belinda
authors.initials: B
authors.lastname: Agoe
authors.forename: Nerida
authors.initials: N
authors.lastname: Burnie
authors.forename: Alex
authors.initials: A
authors.lastname: Carefull
authors.forename: Kiran
authors.initials: K
authors.lastname: Chandan
authors.forename: Dominie
authors.initials: D
authors.lastname: Constable
authors.forename: Mark
authors.initials: M
authors.lastname: Daniels
authors.forename: David
authors.initials: D
authors.lastname: Davies
authors.forename: Sid
authors.initials: S
authors.lastname: Deshmukh
authors.forename: Martin
authors.initials: M
authors.lastname: Huddart
authors.forename: Ashrafi
authors.initials: A
authors.lastname: Jabin
authors.forename: Penelope
authors.initials: P
authors.lastname: Jarrett
authors.forename: Jenifer
authors.initials: J
authors.lastname: King
authors.forename: Tamar
authors.initials: T
authors.lastname: Koch
authors.forename: Sanjoy
authors.initials: S
authors.lastname: Kumar
authors.forename: Stavroula
authors.initials: S
authors.lastname: Lees
authors.forename: Sinan
authors.initials: S
authors.lastname: Mir
authors.forename: Dominic
authors.initials: D
authors.lastname: Naidoo
authors.forename: Sylvia
authors.initials: S
authors.lastname: Nyame
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Sasae
authors.forename: Tushar
authors.initials: T
authors.lastname: Sharma
authors.forename: Clare
authors.initials: C
authors.lastname: Thormod
authors.forename: Krish
authors.initials: K
authors.lastname: Vedavanam
authors.forename: Anja
authors.initials: A
authors.lastname: Wilton
authors.forename: Breda
authors.initials: B
authors.lastname: Flaherty
keywords: PRIMARY CARE; PUBLIC HEALTH