Definition of a Register
Required Properties of a Register
Aspects of Register
Rich Coding
A register is a realizable, accurate list of patients who share a common characteristic, usually a disease entity.
This list need not exist until it is needed. Indeed this is desirable because the dynamic nature of primary care means that any list is out of date very soon after its creation. What is important is that the codes used to generate the list are kept up to date. The list system in primary care ensures that patients are automatically removed from the register when a patient dies or moves away.
Any method of register construction must have the following properties:-
1) Easily maintained
2) Applicable to a wide range of possible conditions
3) Accurately distinguish between patients with the condition and
without it. ie it mustn't pick up patients who haven't got the
condition or miss those with it
1 Disease definition
2 Define dual and mutually exclusive coding for the register (see
below)
3 Patient identification - Miquest searches, secondary care data
4 Procedure for data capture - paper flows and templates
5 Coding of patients - systematically add from list using templates
Procedures for handling incoming information & data entry.
Procedures for handling existing data eg notes summarising
Staff training and responsibilities for data input.
1 Dealing with false negatives i.e. when patient is not identified who should be.
2 Dealing with false positives i.e. when patient is registered who shouldn't be.
i Those coded in error, who will lack dual coding.
ii Those whose condition has changed into another mutually exclusive condition (e.g. people with AF who have now reverted / cardioverted to sinus rhythm).
Performed after housekeeping to identify those patients who require recall.
Procedures will depend on practice arrangements for CHD follow-up.
Possible models include:
Annual recall for all CHD patients to nurse clinic i.e. spaced recall of all registered patients over a year.
Recall of specific targeted patients e.g. no cholesterol check.
No specific recall but system (e.g. repeat prescribing) to ensure all patients reviewed with 'rescue' recall for defaulters / those missed. A typical rescue procedure might be as follows. Define criteria for recall usually using an index code that hasn't been entered within a specified time frame. It is usually best to use a commonly entered code in the condition rather than a special code for the purpose as recall will be more accurate. (People tend to forget to use special codes or treat them as tick boxes without adhering to their true meaning) eg use last BP record in the last year as the index code for IHD follow-up.