Business Rules for Quality and Outcomes Framework (QOF) 2017/18 Heart failure

Transcription

1 Business Rules for Quality and Outcomes Framework (QOF) 2017/18 Heart failure Author: Primary Care Domain Specification Development Service (SDS), NHS Digital Version Date: 09/06/2017 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) HF HF HF HF Payment Count(s) Management Information Count(s) Patient-level Extract(s) Appendix - Supporting data for NHS Digital SDS The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 2 of 26

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. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 3 of 26

4 1. Amendment History Version Date Amendment history The version number starts at 7.1 in order to coincide with existing datasets and business rules November 2005 From Phil Brown November 2005 Amended following review by Peter Horsfield December 2005 Draft revised for internal review February 2006 Amended following internal & 4 Countries review March 2006 Signed off following 4 Country review May 2006 Responding to queries raised Amend wording for Note May 2006 Approved by NHSE October November 2006 April Read Code Release April SNOMED CT Release October Read Code Release Corrections and amendments following feedback Response to queries raised by 4 Country Review: Delete Suspected heart failure Reinsert LVD exception codes ECOG_COD: Enter missing. XACE_COD: Add for consistency across different Business Rules sets November 2006 Approved by NHSE April 2007 April 2007 Read Code Release June 2007 Signed off following 4 Country review August 2007 April 2007 SNOMED CT Update September 2007 October 2007 Read Code Release October 2007 SNOMED CT Release The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 4 of 26

5 November 2007 Signed off following 4 Country review June 2008 April 2008 Read Code Release April 2008 SNOMED CT Release QOF Review July 2008 Signed off following 4 Country review October 2008 October 2008 Read Code Release October 2008 SNOMED CT Release December 2008 Signed off following 4 Country review February 2009 QOF Review March 2009 Amendment following NHSE review April 2009 Amendment following Four-Country Review May 2009 Signed off following 4 Country review June 2009 April 2009 Read Code Release August 2009 Signed off following 4 Country review October 2009 October 2009 Clinical Codes 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 December 2010 Signed off following 4 Country review 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 The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 5 of 26

6 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 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/ March 2014 Signed off following review and negotiations. Changes made to incorporate new date terminology June 2014 April 2014 Read Code Release following HSCIC review October 2014 October 2014 Read Code Release following HSCIC review December 2014 Signed off following review and negotiations May 2015 April 2015 Read Code Release following HSCIC review October 2015 October 2015 Read Code Release following HSCIC review March 2016 Signed off following review and negotiations July 2016 April 2016 Read Code Release following NHS Digital review February 2017 Signed off following review and negotiations June 2017 April 2017 Read Code Release following NHS Digital review. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 6 of 26

7 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. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 7 of 26

8 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 the Read V2 codes are as at April Guidance Guidance for all Quality Services can be found on the NHS Employers website through the following links: The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 8 of 26

9 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) Achievement Date (ACHV_DAT) 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 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 time period between the QSSD and the QSED (inclusive). Monthly Annual Date not used in this ruleset. 31/03/2018 The last day of each month. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 9 of 26

10 Term Definition Timeframe for this Service Reporting Period Reporting Period Start Date (RPSD) Reporting Period End Date (RPED) 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 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. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 10 of 26

11 3.2 Patient selection criteria All Populations and Outputs in this Ruleset are to be returned at Practice-level 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) End of rules 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. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 11 of 26

12 3.2.2 Populations Case registers Patients may be included in any one or more of the registers below. Each patient can only be included once per register. Register Name Description Applied to patients defined in: HF1_REG Heart failure register 1: Patients with a diagnosis of heart failure GMS registration status SDS use only: Version 100 Rule number Rule Action if true Action if false Rule description or comments 1 If HF_DAT Null Select Reject End of rules Select patients from the specified population who have a diagnosis of heart failure. Reject the remaining patients. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 12 of 26

13 Register Name Description Applied to patients defined in: HF2_REG Heart failure register 2: Patients with a diagnosis of heart failure due to LVSD GMS registration status SDS use only: Version 100 Rule number 1 End of rules If HF_DAT Null AND If HFLVSD_DAT Null Rule Action if true Action if false Rule description or comments Select Reject Select patients from the specified population who have a diagnosis of heart failure and where the heart failure is due to Left Ventricular Systolic Dysfunction (LVSD). Reject the remaining patients. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 13 of 26

14 Cohorts N/A - there are no cohorts for this service. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 14 of 26

15 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 lists for each cluster can be found on the NHS Digital website (see section 2.3). Cluster Name Description Read V2 CTV3 Cluster Version ACE_COD Ace inhibitor prescription codes bi...%, ba...%, bk6..% bi...%, ba...% 101 AII_COD AII antagonist prescription codes bk3..-bk5z., bk7..-bk9z., bkb..%, bkc..%, bkd..%, bkh..%, bki..%, bkj..%, bkl.., bkl1., bkl2., bkl3., bkl4., bkl5., bkl6., x03j2%, x03ls%, bkd..%, bkh..%, bki..%, bkj..% 101 ECEXC_COD Codes for Echo declined 56F1., 5534., 8IBF. XaJIC, XaJHZ, Xab0e 100 ECOG_COD Echocardiogram codes 5853., 58531, 585f., 585g., 5C20., 33BD., 8HQ7., R1320, R1322, 5531., 5533., 5538., 79380, 79382, 8H4R., 8HVJ., 8H44., 8H7o0, 7P0H6, 8A544, 8HTL0, 8HTL., 79352, 7P0H., 7P0H0, 7P0H1, 7P0H4 X77c1% (excluding X70mc), XaJ98, XaJ99, 58531, XaIx9, XaION, XaJKz, R1320, R1322, 5531., 5533., XaJi7, X77cC% (excluding XE0Ep%), XaLFu, 8H44., XaBTR%, XaXBj, XaZle, XaaH6, XaILD 100 HFEXC_COD Heart failure exception reporting codes 9hH..% XaMJ9% 100 HF_COD Heart failure codes G58..%, G1yz1, 662f.-662i. G58..% (excluding G5y4.%) 101 LBB_COD TXACE_COD TXAII_COD Licensed Beta-blocker prescription codes Ace inhibitor contraindications; expiring AII antagonist contraindications: expiring bdf..%, bdl..%, bdm..% x01c1%, bdl..%, bdm..% 100 8I28., 8I3D., 8I64., 8I74. XaG2W, XaIIm, XaIIf, XaJ5e 100 8I2H., 8I3P., 8I6C., 8I75. XaInW, XaIyw, XaJ5m, XaJ5f 100 The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 15 of 26

16 Cluster Name Description Read V2 CTV3 Cluster Version TXLBB_COD Beta-blocker contraindications: expiring 8I26., 8I2g.-8I2i., 8I36., 8IAS.- 8IAV., 8I62., 8I6i.-8I6k., 8I73., 8I7K.-8I7M. XaFt0%, XaFsB%, XaFvr%, XaJ5d% 100 XACE_COD Ace inhibitor contraindications; persistent 14LM., U60C4, TJC77-TJC79, ZV14D, K0430 XaJ5y, XaJ8Y, Xa60w%, Xa5cT%, XaIrq, U60C4, TJC77, TJC78, TJC79, X70wH, XaZ6J 100 XAII_COD AII antagonist contraindications: persisting 14LN., U60CB, ZV14E XaJ5z, XaJ8o, XaIzK, XaJ8W, Xa619, Xa5cg 100 XLBB_COD Beta-blocker contraindications: persisting 14LL., TJC6.%, U60B7, U60B9- U60BB, ZVu6i, ZVu6o, ZVu6q, ZV14C, TJC00, TJC02 XaJ5x, TJC6.%, Xa5LL%, XaQad, XaQac, XaQab, U60B7, XaQaf, XaQag, XaQah, XaJ8U, Xa5jo%, TJC00, TJC HFLVSD_COD Codes for LVSD 585f., G5yy9 XaIIq, XaJ ULBB_COD UnLicensed Beta-blocker prescription codes bd...% (excluding bdf..%, bdl..%, bdm..%) bd...% (excluding k832.%, k83z.%, k83y.%, bd4.., k83.., k85y.%, k85z.%, x01c8%, k8b..%, x03hf%, x01c1%, bdl..%, bdm..%, k8fh., k8fi.) 103 End of clusters. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 16 of 26

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 HF_DAT HF_COD Earliest <= ACHV_DAT 5 HFLVSD_DAT HFLVSD_COD Earliest <= ACHV_DAT 6 HFEXC_DAT HFEXC_COD Latest <= ACHV_DAT 7 ECOG_DAT ECOG_COD 8 ECEXC_DAT ECEXC_COD Earliest <= ACHV_DAT AND >= (HF_DAT 93 days) Earliest <= ACHV_DAT AND >= (HF_DAT) 9 XACE_DAT XACE_COD Latest <= ACHV_DAT 10 TXACE_DAT TXACE_COD Latest <= ACHV_DAT 11 XAII_DAT XAII_COD Latest <= ACHV_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. Date of the first heart failure diagnosis up to and including the achievement date. Date of the first heart failure due to LVSD diagnosis up to and including the achievement date. Date of the most recent heart failure exception reporting code up to and including the achievement date. Date of the first echocardiogram code recorded at any point within the period from 93 days before the patient s heart failure diagnosis up to and including the achievement date. Date of the first echo declined code recorded on or after the date of the patient s heart failure diagnosis and up to and including the achievement date. Date of the most recent persisting ACE inhibitor contraindication up to and including the achievement date. Date of the most recent expiring ACE inhibitor contraindication up to and including the achievement date. Date of the most recent persisting AII antagonist contraindication up to and including the achievement date. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 17 of 26

18 Field number Field name Code cluster (if applicable) Qualifying criteria 12 TXAII_DAT TXAII_COD Latest <= ACHV_DAT 13 ACE_DAT ACE_COD Latest <= ACHV_DAT 14 AII_DAT AII_COD Latest <= ACHV_DAT 15 XLBB_DAT XLBB_COD Latest <= ACHV_DAT 16 TXLBB_DAT TXLBB_COD Latest <= ACHV_DAT 17 LBB_DAT LBB_COD Latest <= ACHV_DAT 18 ULBB_DAT ULBB_COD Latest <= ACHV_DAT End of fields Non-technical Description Date of the most recent expiring AII antagonist contraindication up to and including the achievement date. Date of the most recent ACE inhibitor prescription code up to and including the achievement date. Date of the most recent AII antagonist prescription code up to and including the achievement date. Date of the most recent persisting beta-blocker contraindication up to and including the achievement date. Date of the most recent expiring beta-blocker contraindication up to and including the achievement date. Date of the most recent licensed beta-blocker prescription code up to and including the achievement date. Date of the most recent unlicensed beta-blocker prescription code up to and including the achievement date. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 18 of 26

19 4. Outputs 4.1. Indicator(s) Additional supporting information is displayed below each set of indicator tables if required. Indicator ID Description Applied to population: HF001 The contractor establishes and maintains a register of patients with heart failure HF1_REG SDS use only: Version 100 The terms of this indicator will be satisfied if the practice is able to produce a data extraction according to the rules for the population specified above. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 19 of 26

20 Indicator ID Description Applied to population: HF002 The percentage of patients with a diagnosis of heart failure (diagnosed on or after 1 April 2006) which has been confirmed by an echocardiogram or by specialist assessment 3 months before or 12 months after entering on to the register HF1_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 HF_DAT >= 01/04/2006 Next rule Reject 2 If ECOG_DAT <= (HF_DAT + 1 year) AND If ECOG_DAT >= (HF_DAT - 93 days) Select Next rule 3 If REG_DAT > (PPED 3 months) Reject Next rule 4 If HFEXC_DAT > (PPED 12 months) Reject Next rule 5 If ECEXC_DAT <= (HF_DAT + 1 year) Reject Next rule 6 If HF_DAT > (PPED 3 months) Reject Select End of denominator rules Pass to the next rule all patients from the specified population whose earliest heart failure diagnosis was on or after 1 st April Reject the remaining patients. Select patients passed to this rule who have an echocardiogram/specialist assessment recorded within the 93 days before, or within the 12 months after, their heart failure diagnosis. Pass all remaining patients to the next rule. Reject patients passed to this rule who registered with the Practice in the 3 months 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 had a heart failure exception reporting code in the 12 months 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 had a echo exception reporting code up to and including 1 year after their heart failure diagnosis date. Pass all remaining patients to the next rule. Reject patients passed to this rule whose earliest heart failure diagnosis was in the 3 months leading up to and including the payment period end date. Select the remaining patients. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 20 of 26

21 Numerator Rule number 1 If ECOG_DAT <= (HF_DAT + 1 year) AND If ECOG_DAT >= (HF_DAT - 93 days) End of numerator rules Rule Action if true Action if false Rule description or comments Select Reject Select patients from the denominator who have an echocardiogram/specialist assessment recorded within the 93 days before, or within the 12 months after, their heart failure diagnosis. Reject the remaining patients. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 21 of 26

22 Indicator ID Description Applied to population: HF003 In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, the percentage of patients who are currently treated with an ACE-I or ARB HF2_REG SDS use only: Version 100 The numerator is applied to the patients selected into the denominator for this indicator. Denominator Rule number 1 Rule If ACE_DAT > (PPED 6 months) OR If AII_DAT > (PPED 6 months) Action if true Select Action if false Next rule 2 If REG_DAT > (PPED 3 months) Reject Next rule 3 If HFEXC_DAT > (PPED 12 months) Reject Next rule 4 If HF_DAT > (PPED 3 months) Reject Next rule 5 If XACE_DAT = Null AND If TXACE_DAT = Null Select Next rule Rule description or comments Select patients from the specified population who have either of the following in the 6 months leading up to and including the payment period end date: Have been treated with an ACE-I. Have been treated with an ARB. Pass all remaining patients to the next rule. Reject patients passed to this rule who registered with the Practice in the 3 months 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 had a heart failure exception reporting code in the 12 months leading up to and including the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule whose heart failure diagnosis was in the 3 months leading up to and including the payment period end date. Pass all remaining patients to the next rule. Select patients passed to this rule who meet both of the criteria below: Have no persisting contraindication to ACE-Is recorded. Have no expiring contraindication to ACE-Is recorded. Pass all remaining patients to the next rule. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 22 of 26

23 6 If XACE_DAT = Null AND If TXACE_DAT <= (PPED 12 months) Select Next rule Select patients passed to this rule who meet both of the criteria below: Have no persisting contraindication to ACE-Is recorded. Have an expiring contraindication to ACE-Is recorded but the latest record of this was greater than 12 months before the payment period end date i.e. recorded in a previous QOF year. Pass all remaining patients to the next rule. 7 If XAII_DAT = Null AND If TXAII_DAT = Null Select Next rule Select patients passed to this rule who meet both of the criteria below: Have no persisting contraindication to ARBs recorded. Have no expiring contraindication to ARBs recorded Pass all remaining patients to the next rule. 8 If XAII_DAT = Null AND If TXAII_DAT <= (PPED 12 months) Select Reject Select patients passed to this rule who meet both of the criteria below: Have no persisting contraindication to ARBs recorded. Have an expiring contraindication to ARBs recorded but the latest record of this was greater than 12 months before the payment period end date i.e. recorded in a previous QOF year. Reject the remaining patients. End of denominator rules Numerator Rule number Rule Action if true Action if false Rule description or comments 1 If ACE_DAT > (PPED 6 months) OR If AII_DAT > (PPED 6 months) Select Reject Select patients from the denominator who have either of the following in the 6 months leading up to and including the payment period end date: Have been treated with an ACE-I. have been treated with an ARB. Reject the remaining patients. End of numerator rules The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 23 of 26

24 Indicator ID Description Applied to population: HF004 In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction who are currently treated with an ACE-I or ARB, the percentage of patients who are additionally currently treated with a beta-blocker licensed for heart failure HF2_REG SDS use only: Version 100 The numerator is applied to the patients selected into the denominator for this indicator. Denominator Rule number 1 Rule If ACE_DAT > (PPED 6 months) OR If AII_DAT > (PPED 6 months) Action if true Next rule Action if false Reject 2 If LBB_DAT > (PPED 6 months) Select Next rule 3 If ULBB_DAT >= (HF_DAT 186 days) Reject Next rule 4 If REG_DAT > (PPED 3 months) Reject Next rule 5 If HFEXC_DAT > (PPED 12 months) Reject Next rule Rule description or comments Pass to the next rule all patients from the specified population who have either of the following in the 6 months leading up to and including the payment period end date: Have been treated with an ACE-I. Have been treated with an ARB. Reject the remaining patients. Select patients passed to this rule who were treated with a licensed beta-blocker in the 6 months 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 were treated with an unlicensed beta-blocker in the period from 186 days before the patient s heart failure diagnosis up to and including the achievement date. Pass all remaining patients to the next rule. Reject patients passed to this rule who registered with the Practice in the 3 months 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 had a heart failure exception reporting code in the 12 months leading up to and including the payment period end date. Pass all remaining patients to the next rule. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 24 of 26

25 6 If HF_DAT > (PPED 3 months) Reject Next rule 7 8 If XLBB_DAT = Null AND If TXLBB_DAT = Null If XLBB_DAT = Null AND If TXLBB_DAT <= (PPED 12 months) End of denominator rules Select Select Next rule Reject Reject patients passed to this rule whose earliest heart failure diagnosis was in the 3 months leading up to and including the payment period end date. Pass all remaining patients to the next rule. Select patients passed to this rule who meet both of the criteria below: Have no persisting contraindication to licensed betablockers recorded. Have no expiring contraindication to licensed betablockers recorded. Pass all remaining patients to the next rule. Select patients passed to this rule who meet both of the criteria below: Have no persisting contraindication to licensed betablockers recorded. Have an expiring contraindication to licensed betablockers recorded but the latest record of this was greater than 12 months before the payment period end date i.e. recorded in a previous QOF year. Reject the remaining patients. Numerator Rule number Rule Action if true Action if false Rule description or comments 1 If LBB_DAT > (PPED 6 months) Select Reject End of numerator rules Select patients from the denominator who were treated with a licensed beta-blocker in the 6 months leading up to and including the payment period end date. Reject the remaining patients. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 25 of 26

26 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 Heart failure Database Service ID QOF QSR Reference if applicable n/a The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 26 of 26