Business Rules for Indicators No Longer in QOF (INLIQ) 2017/18 Cardiovascular Disease Primary Prevention (CVD-PP)

Transcription

1 Business Rules for Indicators No Longer in QOF (INLIQ) 2017/18 Cardiovascular Disease Primary Prevention (CVD-PP) Author: Primary Care Domain Specification Development Service (SDS), NHS Digital Version Date: 15/08/2017 Version: 37.0

2 Contents 1. Amendment History Background Document Purpose Business Rules Supporting Information Clinical Codes Guidance Dataset specification Qualifying Dates Patient selection criteria GMS registration status Populations Clinical Code Clusters Clinical Data Extraction Criteria Outputs Indicator(s) CVDPP Payment Count(s) Management Information Count(s) Patient-level Extract(s) Appendix - Supporting data for NHS Digital SDS Page 2 of 21

3 This document is produced by NHS Digital on behalf of NHS England. It is published in PDF format. If anyone intends to re-use the information contained within it or publish in another format then they should acknowledge the source document, NHS Digital and NHS England.. Page 3 of 21

4 1. Amendment History Version Date Amendment history The version number starts at 13.1 in order to coincide with existing datasets and business rules February 2009 QOF Review March 2009 Amendments following NHSE review April 2009 Amendments following Four-Country Review May 2009 Sign off following 4 Country review June 2009 April 2009 Read Code Release August 2009 Amendments following 4 Country Review August 2009 Sign off following 4 Country review October 2009 October 2009 Clinical Code Release October 2009 October 2009 Clinical Code Release review December 2009 Sign off following 4 Country review May 2010 Internal NHS IC review May 2010 April 2010 Read Code Release following NHS IC review October 2010 October 2010 Read Code Release following NHS IC review February 2011 Signed off following 4 Country review and further negotiations May 2011 April 2011 Read Code Release following NHS IC review November 2011 October 2011 Read Code Release following NHS IC review December 2011 Signed off following 4 Country review. Page 4 of 21

5 May 2012 April 2012 Read Code Release following HSCIC review October 2012 October 2012 Read Code Release following HSCIC review March 2013 Signed off following consultation. Document name changed from Established Cardiovascular disease primary prevention to Cardiovascular Disease Primary Prevention (CVD-PP) April 2013 Correction made to Rule 4 of indicator CVD-PP June 2013 April 2013 Read Code Release following HSCIC review October 2013 October 2013 Read Code Release following HSCIC review Dates_ January 2014 Review of proposed date changes for QOF 2014/15 Jan14_Review 23 January 2014 Internal review of changes for 2014/15 RETIRED_v July 2014 Following instruction from NHS England Business Rules created for indicators retired from QOF 2013/14 but still to be maintained RETIRED_v July 2014 April 2014 Read Code Release following HSCIC review RETIRED_v November 2014 Update to realign register with live QOF RETIRED_v November 2014 October 2014 Read Code Release following HSCIC review INLIQ_v July 2015 Signed off following review INLIQ_v July 2015 April 2015 Read Code Release following HSCIC review INLIQ_v October 2016 October 2015 and April 2016 Read code releases applied following NHS Digital review INLIQ v August 2017 April 2017 Read Code Release following NHS Digital review.. Page 5 of 21

6 2. Background 2.1. Document Purpose The dataset and business rules documents produced by the NHS Digital Primary Care Domain Specification Development Service are created primarily for the uses of GPES and GP system suppliers. These documents contain specifications to communicate technical details of extracts from Primary Care systems which may be used to provide Practice-level information regarding services and/or allocate rewards, such as payments or QOF points. This document is not intended to be used in place of clinical guidelines, but may be referred to by any individual or organisation to aid understanding of which patients and/or activity are included in each population or output. Non-technical, textual descriptions of business rules can be found in the table columns highlighted in pale blue throughout the document. The business rules registers for QOF and Enhanced Services are constructed solely for the purpose of supporting the practice, GP Suppliers, and NHS England in fulfilling the claims and audit requirements for the indicators. Therefore, while a register may carry the name of a particular disorder for business rules purposes, it may well not be sufficiently precise to encompass all of those patients who might be clinically assessed as requiring follow-up or clinical intervention. It is advised that where a practice wishes to construct a register for the purposes of call, recall and clinical management that it is patient based rather than solely disorder based Business Rules Supporting Information Further information regarding the setup of the business rules, terminology used and the calculation methods can be found in version 1.2 of the supporting information document which can be accessed here: Please note: both hyperlinks above have been provided whilst the NHS Digital website is being updated and these both link to the same location.. Page 6 of 21

7 2.3. Clinical Codes Any part of the dataset specification which uses clinical codes will have the relevant code cluster ID and version specified. The expanded code lists for each cluster can be accessed from the following location: Please note: both hyperlinks above have been provided whilst the NHS Digital website is being updated and these both link to the same location. Clinical code clusters are applied to the April 2017 release of clinical terms version 3 (CTV3) for this ruleset. As of April 2016 there were no further releases of Read V2 codes therefore Read V2 codes are as at April Guidance Guidance for all Quality Services can be found on the NHS Employers website through the following link: Page 7 of 21

8 3. Dataset specification 3.1 Qualifying Dates The dataset and rules in this document refer to various dates, which may include any number of the dates from the table below. Further information regarding how to use these dates within calculations can be found in the supporting information document (see section 2.2). Term Definition Timeframe for this Service Quality Service Start Date (QSSD) Quality Service End Date (QSED) The first day of the period during which a GP Practice provides the Quality Service. 01/04/2017 The last day of the period during which a GP Practice provides the Quality Service. 31/03/2018 Quality Service Period Quality Service Data Extract Frequency Quality Service Payment Period Payment Period Start Date (PPSD) Payment Period End Date (PPED) The period during which a GP Practice provides the Quality Service specified in this document. The frequency of data extracts associated with the Quality Service. The frequency of payments associated with the Quality Service. In any given Quality Service Period there may be one, multiple or no payment periods. The first day of each period for which payments are made for the Quality Service. (i.e. for monthly payment periods, the PPSD will be the 1 st of the month in question). Where there are no payment periods (e.g. where payments are made as part of core contract) the PPSD denotes the first day of the extract period in question. The last day of each period for which payments are made for the Quality Service. (i.e. for monthly payment periods, the PPED will be the last day of the month in question). Where there are no payment periods (e.g. where payments are made as part of core contract) the PPED denotes the last day of the extract period in question. The time period between the QSSD and the QSED (inclusive). Annual N/A there are no payments associated with this Quality Service. Date not used in this ruleset. 31/03/2018. Page 8 of 21

9 Term Definition Timeframe for this Service Achievement Date (ACHV_DAT) Reporting Period Reporting Period Start Date (RPSD) Reporting Period End Date (RPED) The date up to which pertinent patient information is considered when determining the output for each extraction. This is usually the same as the RPED; however, where interim extracts are made the achievement date will vary for each extraction. The full period which data is being extracted for. The date from which pertinent patient information is considered for the reporting period in question: For non-cumulative* data extracts this relates to the extract frequency (e.g. for a monthly data extract the RPSD will be the 1 st of the month in question). For cumulative* data extracts the time period will usually equal the QSSD or PPSD (e.g. for a within quarter cumulative count the RPSD is the first day of the quarter, for an annual cumulative count the RPSD is the QSSD). The last date of the period the extract relates to (usually the last day of a month e.g. 30 th April, 31 st May, etc.). The last day of each Quality Service Data Extract Frequency period. The time period between the RPSD and the ACHV_DAT (inclusive). Date not used in this ruleset. Date not used in this ruleset. * For the purposes of the business rules Cumulative data collections are extracts which have varying incremental end dates but where groups of extracts or all extracts have a single start date e.g. each extract across the year starts at the QSSD and is taken up the achievement date. Due to the fact that patients may change practice during the year this is not a true cumulative data collection as patients may drop out of counts or enter counts at a later stage; however, this is the terminology used in this document to describe these kinds of counts. Non-cumulative refers to data collections which are discrete extracts between two dates. These non-cumulative data collections do not overlap.. Page 9 of 21

10 3.2 Patient selection criteria All Populations and Outputs are to be returned at Practice-level for this service GMS registration status Qualifying criteria Action if true Action if false Non-technical Description (If REG_DAT Null AND If DEREG_DAT = Null) OR (If REG_DAT Null AND If DEREG_DAT > ACHV_DAT) Select Reject Select patients who meet either of the criteria below: Registered for GMS prior to or on the achievement date and did not subsequently deregister from GMS (Currently registered for GMS). Registered for GMS prior to or on the achievement date and subsequently deregistered from GMS after the achievement date (Previously registered for GMS). (i.e. patients who were registered for GMS on the achievement date) Reject the remaining patients. End of rules. Page 10 of 21

11 3.2.2 Populations Case registers Each patient can only be included once per register. Register Name Description Applied to patients defined in: CVDPP_REG CVD PP register: Register of patients with a new (unresolved) diagnosis of hypertension who do not have a pre-existing diagnosis of any of CHD, stroke, TIA, unresolved diabetes, PAD, familial hypercholesterolemia and/or unresolved CKD 3-5 diagnosis not superceded by a CKD 1-2 diagnosis. GMS registration status SDS use only: Version 101 Rule number 1 If HYP_DAT Null AND If HYPRES_DAT = Null If CHD_DAT Null OR Rule Action if true Action if false Rule description or comments Next rule Reject Pass to the next rule all patients from the specified population who have an unresolved hypertension diagnosis in the current quality service period. Reject the remaining patients. Reject patients passed to this rule who had any of the following prior to the latest hypertension diagnosis: 2 If STRK_DAT Null OR If TIA_DAT Null OR (If DM_DAT Null AND If DMRES_DAT = Null) Reject Select CHD diagnosis. Stroke diagnosis. TIA diagnosis. Unresolved diabetes diagnosis. PAD diagnosis. Familial Hypercholesterolemia diagnosis. Unresolved CKD 3-5 diagnosis not superceded by a CKD 1-2 diagnosis. Select the remaining patients.. Page 11 of 21

12 End of rules OR If PAD_DAT Null OR If FHYP_DAT Null OR (If CKD_DAT Null AND If CKD1AND2_DAT = Null AND If CKDRES_DAT = Null). Page 12 of 21

13 Cohorts N/A - there are no cohorts for this service.. Page 13 of 21

14 3.2.3 Clinical Code Clusters The dataset may include dates and values associated with the presence of clinical codes in a patient s record. All clinical code clusters referred to in the clinical data extraction criteria are detailed below. The expanded cluster list for each cluster can be found on the NHS Digital website (see section 2.3). Cluster Name Description Read V2 CTV3 Cluster Version HYP_COD Hypertension diagnosis codes G2..., G20..%, G24..-G2z.., (excluding G24z1, G2400, G2410, G27..), Gyu2., Gyu20 XE0Ub, XE0Uc%, G24..%, excluding (61462, G2400, G2410, G24z1, Gyu21, L1282, Xa0kX), G2...%, Xa0Cs, XSDSb, G202., Xa3fQ, XaZWn, XaZb, XaZWm, Xab9M, Xab9L 100 HYPRES_COD Codes for hypertension resolved 21261, 212K CHD_COD Coronary Heart Disease diagnosis codes G3... G309., G30B.-G330z (excluding G310.), G33z.- G3401, G342.-G35X., G38.. G3z.., Gyu3.% (excluding Gyu31) XE2uV% (excluding Xa07j%, G341.%, X200B%, X200c, G363., Gyu31, X200d, X200e), Ua1eH, Xa1dP%, XaYYq, XM0rN 100 STRK_COD Stroke diagnosis codes G61..% (excluding G617.), G63y0-G63y1, G64..%, G66..% (excluding G669.), G6760, G6W.., G6X.., Gyu62 Gyu66, Gyu6F Gyu6G X00D1% (excluding XE1Xs%, F21y2), G660., G661., G662., Gyu6F, G641., Xa6YV, Gyu62, Gyu65, Gyu TIA_COD TIA diagnosis Codes G65..-G654., G656.-G65zz, ZV12D, Fyu55 XE0VK% (excluding F4236, G660., G661., G662.), XaX16, G65z0, G65z Page 14 of 21

15 Cluster Name Description Read V2 CTV3 Cluster Version DM_COD Diabetes diagnostic codes C10.., C109J, C109K, C10C., C10D., C10E.%, C10F.% (excluding C10F8), C10G.%, C10H.%, C10M.%, C10N.%, PKyP., C10P.%, C10Q. C10.., XaOPu, XaOPt, X40J4% (excluding L1805), X40J5% (excluding L1806), X40J6, X40JA% (excluding XSETI%, C11y0%), X40JG% (excluding X40JK), C1010, C1011, C1030, C1031, XaIrf, X40JZ, XSETp, XM1Xk%, X008t, Xaagd%, XSETe% 102 DMRES_COD Diabetes resolved codes 21263, 212H. XaFsp 101 PAD_COD PAD diagnostic codes G73.., G73z.% (excluding G73z1), Gyu74, G734., G73y. XE0VP, G73z., Gyu74, Xa0lV, XE0VR, XaZJa 100 FHYP_COD Familial Hypercholesterolemia diagnostic codes C3200, C3201, C3204, C3205, C3203, C3220 C3200%, XaR4h, XaR4i, X40X5, X40Vm 100 CKD_COD Chronic Kidney Disease codes 3-5 1Z12., 1Z13., 1Z14., 1Z15., 1Z16., 1Z1B. 1Z1L., 1Z1T., 1Z1V., 1Z1W., 1Z1X., 1Z1Y., 1Z1Z., 1Z1a., 1Z1b., 1Z1c., 1Z1d., 1Z1e., 1Z1f., K053., K054., K055. XaLHI%, XaLHJ%, XaLHK%, XacAM, XacAN, XacAO, XacAV, XacAW, XacAX, XacAb, XacAd, XacAe, XacAf, XacAh, XacAi 102 CKD1AND2_COD Chronic Kidney Disease codes 1-2 1Z10., 1Z11., 1Z17. 1Z1A., 1Z1M., 1Z1N., 1Z1P., 1Z1R., 1Z1S., 1Z1Q., K051., K052. XaLHH%, XaLHG%, Xac9y, Xac9z,XacA2, XacA6, XacA9, XacA4 102 CKDRES_COD Chronic kidney disease resolved codes 2126E XabuQ 100. Page 15 of 21

16 Cluster Name Description Read V2 CTV3 Cluster Version CVDEXC_COD Cardio Vascular Disease Risk Assessment exception codes 9hJ0., 9hJ1. XaPx1, XaPx0 100 LSADV_COD Lifestyle Advice codes 67H.., 67H8. XaEFY, XaQaV 100 End of clusters. Page 16 of 21

17 3.2.4 Clinical Data Extraction Criteria Field number Field name Code cluster (if applicable) Qualifying criteria 1 PAT_ID n/a Unconditional 2 REG_DAT n/a Latest <= ACHV_DAT 3 DEREG_DAT n/a Earliest > REG_DAT 4 PAT_AGE n/a Unconditional at ACHV_DAT 5 HYP_DAT HYP_COD 6 HYPRES_DAT HYPRES_COD 7 CHD_DAT CHD_COD 8 STRK_DAT STRK_COD 9 TIA_DAT TIA_COD 10 DM_DAT DM_COD Latest First or New episode <= ACHV_DAT AND >= 01/04/2009 Latest > HYP_DAT Earliest < HYP_DAT Earliest < HYP_DAT Earliest < HYP_DAT Latest < HYP_DAT Non-technical Description The patients unique ID number for the practice in question. The most recent date that the patient registered for GMS, where this registration occurred on or before the achievement date. The first occurrence of the patient deregistering from GMS following the latest GMS registration. The age of the patient in full years at the achievement date. Date of the most recent first or new episode of hypertension diagnosed from 01/04/2009 up to and including the achievement date. Date of the most recent hypertension resolved code recorded after the latest hypertension diagnosis and up to and including the achievement date. Date of the first coronary heart disease diagnosis recorded before the latest hypertension diagnosis and up to and including the achievement date. Date of the first stroke diagnosis recorded before the latest hypertension diagnosis and up to and including the achievement date. Date of the first TIA diagnosis recorded before the latest hypertension diagnosis and up to and including the achievement date. Date of the most recent diabetes diagnosis recorded before the latest hypertension diagnosis and up to and including the achievement date.. Page 17 of 21

18 Field number Field name Code cluster (if applicable) 11 DMRES_DAT DMRES_COD 12 PAD_DAT PAD_COD 13 FHYP_DAT FHYP_COD 14 CKD_DAT CKD_COD 15 CKD1AND2_DAT CKD1AND2_COD 16 CKDRES_DAT CKDRES_COD Qualifying criteria Latest > DM_DAT Earliest < HYP_DAT Earliest < HYP_DAT Latest < HYP_DAT Latest > CKD_DAT Latest > CKD_DAT 17 CVDEXC_DAT CVDEXC_COD Latest <= ACHV_DAT 18 LSADV_DAT LSADV_COD Latest <= ACHV_DAT End of fields Non-technical Description Date of the most recent diabetes diagnosis resolved code recorded after the latest diabetes diagnosis and up to and including the achievement date. Date of the first PAD diagnosis recorded before the latest hypertension diagnosis and up to and including the achievement date. Date of the first familial hypercholesterolemia diagnosis recorded before the latest hypertension diagnosis and up to and including the achievement date. Date of the most recent chronic kidney disease (3-5) diagnosis recorded before the latest hypertension diagnosis and up to and including the achievement date. Date of the most recent chronic kidney disease (1-2) diagnosis recorded after the latest chronic kidney disease (3-5) diagnosis and up to and including the achievement date. Date of the most recent chronic kidney disease resolved code recorded after the latest chronic kidney disease (3-5) diagnosis and up to and including the achievement date. Date of the most recent CVD risk assessment exception up to and including the achievement date. Date of the most recent lifestyle advice recorded up to and including the achievement date.. Page 18 of 21

19 4. Outputs 4.1. Indicator(s) Indicator ID Description Applied to population: CVDPP002 The percentage of patients diagnosed with hypertension (diagnosed on or after 1 April 2009) who are given lifestyle advice in the preceding 12 months for: smoking cessation, safe alcohol consumption and healthy diet. CVDPP_REG SDS use only: Version 100 The numerator is applied to the patients selected into the denominator for this indicator. Denominator Rule number Rule Action if true Action if false Rule description or comments 1 If LSADV_DAT > (PPED 12 months) Select Next rule 2 If REG_DAT > (PPED 3 months) Reject Next rule 3 If CVDEXC_DAT > (PPED 12 months) Reject Next rule 4 If HYP_DAT > (PPED 3 months) Reject Select Select patients from the specified population who have received lifestyle advice in the 12 month period leading up to and including the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule have recently registered at the practice (patient registered for GMS in the 3 month period leading up to and including the payment period end date). Pass all remaining patients to the next rule. Reject patients passed to this rule who have a CVD exception recorded in the 12 month period leading up to and including the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who are recently diagnosed (first hypertension diagnosis recorded in the 3 months leading up to and including the payment period end date). Select the remaining patients.. Page 19 of 21

20 End of denominator rules Numerator Rule number Rule Action if true Action if false Rule description or comments 1 If LSADV_DAT > (PPED 12 months) Select Reject End of numerator rules Select patients from the denominator who have received lifestyle advice in the 12 month period leading up to and including the payment period end date. Reject the remaining patients.. Page 20 of 21

21 4.2. Payment Count(s) N/A - there are no payment counts for this service Management Information Count(s) N/A - there are no management information counts for this service Patient-level Extract(s) N/A - Not applicable for this service. 5. Appendix - Supporting data for NHS Digital SDS Category Database value TRUD version V23_0_0 Document version 37.0 Ruleset Database ID CVD PP Database Service ID INLIQ QSR Reference if applicable QSR Page 21 of 21