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Practice trajectory
-26%
JD
Dr John Dolittle
Ashford Vale Medical Group
QOF/DM020
QOF · DM020

Diabetes (CKD)

Patients with diabetes and CKD currently treated with an ACE inhibitor or ARB — trajectory-qualifying set surfaces patients the model says are already on this trajectory but not yet coded.
Achievement
100%
Numerator / denominator
2 / 2
Points earned
5 / 5
Trajectory-qualifying
+2

On register · achievement criterion met2

Coded and counted in the numerator.
  • Margaret Chen
    67F · SH-10284
    Positive
    On ACEi/ARB; coded E11 + CKD.
    Achieved
  • Thomas Brennan
    78M · SH-10331
    Gray zone
    On ACEi/ARB; coded E11 + CKD.
    Achieved

On register · not yet achieved0

Coded but falling short — the gap the practice can directly close.
No patients in this bucket.

Trajectory-qualifying · not yet coded2

Patients the model says belong on the register based on their forward trajectory, even though conventional coding hasn't placed them there yet. The Sapio difference.
  • Marcus Lindsay
    28M · SH-10367
    Gray zone
    Forward trajectory crosses diagnostic threshold within 24 months; flag for proactive review.
    Qualifying
  • Carlos Hirano
    55M · SH-10402
    Gray zone
    Forward trajectory crosses diagnostic threshold within 24 months; flag for proactive review.
    Qualifying