Business Rules for Quality and Outcomes Framework (QOF) 2016/17 Chronic Obstructive Pulmonary Disease (COPD)

Business Rules for Quality and Outcomes Framework (QOF) 2016/17 Chronic Obstructive Pulmonary Disease (COPD) Author: Primary Care Domain Specification Development Service (SDS), NHS Digital Date: 29/07/2016 Version: 35.0

Contents 1. Amendment History... 4 2. Background... 8 2.1. Document Purpose...8 2.2. Business Rules Supporting Information...8 2.3. Clinical Codes...8 2.4. Guidance...9 3. Dataset specification... 10 3.1 Qualifying Dates... 10 3.2 Patient selection criteria... 12 3.2.1 GMS registration status... 12 3.2.2 Populations... 13 3.2.3 Clinical Code Clusters... 15 3.2.4 Clinical Data Extraction Criteria... 17 4. Outputs... 19 4.1. Indicator(s)... 19 COPD001... 19 COPD002... 20 COPD003... 22 COPD004... 24 COPD005... 26 COPD007... 29 4.2. Payment Count(s)... 31 4.3. Management Information Count(s)... 31 4.4. Patient-level Extract(s)... 31 NHS Digital is the trading name of the Health and Social Care Information Centre. Page 2 of 31

5. Appendix - Supporting data for NHS Digital SDS... 31 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. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 3 of 31

1. Amendment History Version Date Amendment history Draft 0.3 21 June 2003 From Peter Horsfield 1 24 September 2003 Standard Headers and footers Applied and set to approved. 1.1 03 November 2003 Added headers and footers to Version 0.4 received from Pete Horsfield on 03/11/03. 2 12 November 2003 Amended following 4 Country review 3 20 January 2004 Amended following January READ Code Release 4 04 February 2004 Amended following 4 Country, GPSS and internal review 4.1 09 April 2004 SNOMED-CT codes added, 4-byte Read codes removed 4.2 09 July 2004 Amended following July READ code release 5 27 September 2004 Amended following 4 Country Review 5.1 18 January 2005 Amended following January READ Code Release 5.2 21 June 2005 Amended following 4 Country Review 6 21 July 2005 Signed off following 4 Country review 6.1 21 July 2005 Amended following July 2005 Read Code release and January 2005 SNOMED CT release 6.2 21 August 2005 Amended following 4 Country review 7 23 September 2005 Signed off following 4 Country review 7.1 21 November 2005 From Phil Brown 7.2 22 November 2005 Amended following review by Peter Horsfield 7.3 03 December 2005 Draft revised for internal review 7.4 26 February 2006 Amended following internal & 4 Countries review NHS Digital is the trading name of the Health and Social Care Information Centre. Page 4 of 31

8 15 March 2006 Signed off following 4 Country review 8.1 04 May 2006 Responding to queries raised. a) Amend wording for Note 3, b) Remove <=12 month check in Rule 1 (COPD9) 8.5 18 May 2006 Approved by NHSE 8.6 20 October 2006 April Read Code Release. April SNOMED CT Release. October Read Code Release. Corrections and amendments following feedback. 8.7 15 November 2006 INDR_COD: Correct typo and ensure ranges are not split over lines 9 30 November 2006 Approved by NHSE 9.1 11 April 2007 April 2007 Read Code Release 10 18 June 2007 Signed off following 4 Country review 10.1 21 August 2007 April 2007 SNOMED CT Release 10.2 23 September 2007 October 2007 Read Code Release. October 2007 SNOMED CT Release. 10.3 27 November 2007 Following the 4-Country review 11 28 November 2007 Signed off following 4 Country review 11.1 30 June 2008 11.2 21 July 2008 April 2008 Read Code Release. April 2008 SNOMED CT Release. QOF Review 2007 (Replace COPD9 with COPD12). Following the 4-Country review: Amend COPDSPIR cluster, Denominator rule 2 and Numerator Rule 1 corrected for COPD12. 12 24 July 2008 Signed off following 4 Country review 12.1 06 October 2008 October 2008 Read Code Release. October 2008 SNOMED CT Release. 13 05 December 2008 Signed off following 4 Country review 13.1 05 February 2009 QOF 2008 Review 13.2 09 March 2009 Amendments following NHSE review 13.3 16 April 2009 Plain English comments added to indicator rules and amendments following Four-Country Review 14 01 May 2009 Signed off following 4 Country review NHS Digital is the trading name of the Health and Social Care Information Centre. Page 5 of 31

14.1 25 June 2009 April 2009 Read Code Release 15 17 August 2009 Sign off following 4 Country review 15.1 12 October 2009 October 2009 Clinical Code Release 15.2 28 October 2009 October 2009 Clinical Code Release review 16 02 December 2009 Sign off following 4 Country review 16.1 05 May 2010 Internal NHS IC review 17 07 May 2010 April 2010 Read Code Release following NHS IC review 18 29 October 2010 October 2010 Read Code Release following NHS IC review 19 03 February 2011 Signed off following 4 Country review and further negotiations 20 13 May 2011 April 2011 Read Code Release following NHS IC review 21 10 November 2011 October 2011 Read Code Release following NHS IC review 22 12 December 2011 Signed off following 4 Country review 23 31 May 2012 April 2012 Read Code Release following HSCIC review 24 31 October 2012 October 2012 Read Code Release following HSCIC review 25 28 March 2013 Signed off following consultation 26 01 June 2013 April 2013 Read Code Release following HSCIC review 27 25 October 2013 October 2013 Read Code Release following HSCIC review 27.1 02 December 2013 Update to FLU_COD and TXFLU_COD Dates_1415 17 January 2014 Review of proposed date changes for QOF 2014/15 Jan14_Review 23 January 2014 Internal review of changes for 2014/15 28 28 March 2014 Signed off following review and negotiations. Changes made to incorporate new date terminology. 29 27 June 2014 April 2014 Read Code Release following HSCIC review 30 10 October 2014 October 2014 Read Code Release following HSCIC review NHS Digital is the trading name of the Health and Social Care Information Centre. Page 6 of 31

31 12 December 2014 Signed off following review and negotiations 32 06 May 2015 April 2015 Read Code Release following HSCIC review 33 27 October 2015 October 2015 Read Code Release following HSCIC review 34 31 March 2016 Signed off following review and negotiations 35 29 July 2016 April 2016 Read Code Release following NHS Digital review NHS Digital is the trading name of the Health and Social Care Information Centre. Page 7 of 31

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. 2.2. Business Rules Supporting Information Further information regarding the setup of the business rules, terminology used and the calculation methods can be found in version 1.1 of the supporting information document which can be accessed here: http://www.digital.nhs.uk/qofesextractspecs. 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: http://www.digital.nhs.uk/qofbrv35. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 8 of 31

Clinical code clusters are applied to the April 2016 release of Read codes version 2 and clinical terms version 3 (CTV3) for this ruleset. 2.4. Guidance Guidance for all Quality Services can be found on the NHS Employers website through the following links: http://www.nhsemployers.org/your-workforce/primary-care-contacts/general-medical-services/quality-and-outcomes-framework http://www.nhsemployers.org/your-workforce/primary-care-contacts/general-medical-services NHS Digital is the trading name of the Health and Social Care Information Centre. Page 9 of 31

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 01/04/2016 The last day of the period during which a GP Practice provides the Quality Service 31/03/2017 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 Monthly Annual Date not used in this ruleset 31/03/2017 The last day of each month NHS Digital is the trading name of the Health and Social Care Information Centre. Page 10 of 31

Term Definition Timeframe for this Service Reporting Period Reporting Period Start Date (RPSD) Reporting Period End Date (RPED) FLUCOM_DAT FLUEND_DAT 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 new GMS contract requires that influenza vaccinations should be given between 1 st August and 31 st March of any given contract year in order to qualify for the relevant indicators. FLUCOM_DAT is the 1 st August which falls within the current service year. The new GMS contract requires that influenza vaccinations should be given between 1 st August and 31 st March of any given contract year in order to qualify for the relevant indicators. FLUEND_DAT is the 31 st March which falls within the current service year. The time period between the RPSD and the ACHV_DAT Date not used in this ruleset. Date not used in this ruleset. 01/08/2016 31/03/2017 * 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. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 11 of 31

3.2 Patient selection criteria 3.2.1 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. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 12 of 31

3.2.2 Populations All Populations and Outputs in this Ruleset are to be returned at Practice-level. 3.2.2.1 Case registers Each patient can only be included once per register. Register Name Description Applied to patients defined in: COPD_REG COPD register: Register of patients with a COPD diagnosis GMS registration status SDS use only: Version 101 Rule number 1 End of rules If COPD_DAT Null AND If COPDRES_DAT = Null Rule Action if true Action if false Rule description or comments Select Reject Select patients from the specified population who have an unresolved COPD diagnosis. Reject the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 13 of 31

3.2.2.2 Cohorts N/A - there are no cohorts for this service. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 14 of 31

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 COPDEXC_COD COPD exception reporting codes 9h5..% XaJ4R% 100 COPD_COD COPD codes H3..., H31..% (excluding H3101, H31y0, H3122), H32..%, H36..-H3z.. (excluding H3y0., H3y1.), H5832, H4640, H4641, Hyu30, Hyu31 H31..%, H32..% (excluding XaIQg, H582.), H3...% (excluding H3122%), Xaa7C, Xac33, H3120 102 SPEX_COD Spirometry exception codes 8I3b., 8I6L., 8I2j., 33720 XaK27, XaK2A, XaWPN, XaXlR 100 COPDSPIR_COD Spirometry codes for COPD 8HRC., 745D4 XaK02, XaXeg, XaaXF 100 FEV1_COD Codes for FEV1 33971, 3398.-3399., 339M., 339O., 339O0, 339R.-339U., 339a.-339b., 339e.-339f., 339j.-339m., 339O1, 33972 3397.% (excluding X77Qv, XaCJK, 33970), 3398., 3399.%, XaJ9B, XaJ9C, XaJ9D, XaJ9E, X77RZ, X77Rb, X77Ra, XaEFy, XaEFz, XaZyl, Xaafd 100 XFLU_COD Flu vaccine contraindications: persisting 14LJ., U60K4, ZV14F XaIAA, XaJ7u, XaJ8X, Xa5um%, Xa5WJ% 100 TXFLU_COD Flu vaccine contraindications: expiring 9OX51, 8I2F0, 8I6D0, 68NE0, 9OX54, 9OX56 XaZ0i, XaZ0j, XaZ0k, Xaa9f, XaadS, XaadU 101 NHS Digital is the trading name of the Health and Social Care Information Centre. Page 15 of 31

Cluster Name Description Read V2 CTV3 Cluster Version FLU_COD Flu vaccination codes n47..% (excluding n47a., n47b., n47d., n47f., n47g., n47r., n47s., n47t., n47u.), 65ED., 65E20, 65ED0, 65ED2, 65ED1, 65ED3, 65E21, 65E22, 65E23, 65E24, 65ED4, 65ED5, 65ED6, 65ED7, 65ED8, 65ED9 n47..% (Excluding n47a., n47b., n47d., n47f., n47g., n47r., n47s., n47t., n47u.), XaZ0d, XaZ0e, XaZfY, XaaZp, Xaac3, Xaac4, Xaac7, Xaac8, XabvT, Xac5J, Xad9j, Xad9k, Xaeet, Xaeeu, Xaeev, Xaeew 103 MRC_COD Codes for MRC Breathlessness Scale Score 173H., 173I., 173J., 173K., 173L. XaIUi, XaIUl, XaIUm, XaIUn, XaIUo 100 COPDRVW_COD Codes for COPD review 66YM., 66YB0, 66YB1 XaIet, XaXCa, XaXCb 100 MRC1_COD Codes for MRC Breathlessness Scale Score 3 173J., 173K., 173L. XaIUm, XaIUn, XaIUo 100 OXYSAT_COD Codes for oxygen saturation value 44YA0, 44YA1, 44YA3, 44YA5 X770D, Xaa6j, Xaa6l, Xabhv 100 COPDRES_COD COPD resolved codes 2126F Xabwy 100 End of clusters NHS Digital is the trading name of the Health and Social Care Information Centre. Page 16 of 31

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 COPDEXC_DAT COPDEXC_COD Latest <= ACHV_DAT 5 COPD_DAT COPD_COD Latest <= ACHV_DAT 6 SPEX_DAT SPEX_COD Latest <= ACHV_DAT 7 COPDSPIR_DAT COPDSPIR_COD Earliest >= (COPD_DAT 93 days) AND <= ACHV_DAT 8 FEV1_DAT FEV1_COD Latest <= ACHV_DAT 9 XFLU_DAT XFLU_COD Latest <= ACHV_DAT 10 TXFLU_DAT TXFLU_COD Latest <= ACHV_DAT 11 FLU_DAT FLU_COD Latest <= ACHV_DAT 12 MRC_DAT MRC_COD Latest <= ACHV_DAT 13 COPDRVW_DAT COPDRVW_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 most recent COPD exception reporting code in the patient record up to the achievement date Date of the most recent COPD diagnosis up to the achievement date Date of the most recent spirometry exception reporting code in the patient record up to the achievement date Date of the first spirometry for COPD from 3 months (93 days) prior to diagnosis up to the achievement date Date of the most recent code for FEV 1 up to the achievement date Date of the most recent persisting flu vaccine contraindication up to the achievement date Date of the most recent expiring flu vaccine contraindication up to the achievement date Date of the most recent flu vaccination up to the achievement date Date of the most recent MRC Breathlessness Scale Score up to the achievement date Date of the most recent COPD review up to the achievement date NHS Digital is the trading name of the Health and Social Care Information Centre. Page 17 of 31

Field number Field name Code cluster (if applicable) 14 MRC1_DAT MRC1_COD Qualifying criteria Earliest > (ACHV_DAT 12 months) AND <= ACHV_DAT 15 OXYSAT_DAT OXYSAT_COD Latest <= ACHV_DAT 16 OXYSAT_VAL OXYSAT_COD Latest <= ACHV_DAT 17 COPDRES_DAT COPDRES_COD End of fields Latest > COPD_DAT AND <= ACHV_DAT Non-technical Description Date of the first MRC Breathlessness Scale Score of 3 or more in the 12 month period leading up to the achievement date Date of the most recent oxygen saturation recorded up to the achievement date Value of the most recent oxygen saturation recorded up to the achievement date Date of the most recent COPD resolved code after the most recent COPD diagnosis and up to the achievement date NHS Digital is the trading name of the Health and Social Care Information Centre. Page 18 of 31

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: COPD001 The contractor establishes and maintains a register of patients with COPD. COPD_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. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 19 of 31

Indicator ID Description Applied to population: COPD002 The percentage of patients with COPD (diagnosed on or after 1 April 2011) in whom the diagnosis has been confirmed by post bronchodilator spirometry between 3 months before and 12 months after entering on to the register. COPD_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 COPD_DAT >= 01.04.2011 Next rule Reject 2 If COPDSPIR_DAT >= (COPD_DAT 93 days) AND If COPDSPIR_DAT <= (COPD_DAT + 1 year) Select Next rule 3 If REG_DAT > (PPED 3 months) Reject Next rule 4 If COPDEXC_DAT > (PPED 12 months) Reject Next rule 5 If SPEX_DAT > (PPED 12 months) Reject Next rule 6 If COPD_DAT > (PPED 3 months) Reject Select End of denominator rules Pass to the next rule all patients from the specified population whose latest COPD diagnosis was on or after 1 st April 2011. Reject the remaining patients. Select patients passed to this rule who had spirometry for COPD any time from 3 months (93 days) before their COPD diagnosis up to 1 year following 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 the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who had a COPD exception reporting code in their record in the 12 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who had a spirometry exception reporting code in their record in the 12 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule whose COPD diagnosis was in the 3 months leading up to the payment period end date. Select the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 20 of 31

Numerator Rule number 1 If COPDSPIR_DAT >= (COPD_DAT 93 days) AND If COPDSPIR_DAT <= (COPD_DAT + 1 year) End of numerator rules Rule Action if true Action if false Rule description or comments Select Reject Select patients passed to this rule who had spirometry for COPD any time from 3 months (93 days) before their COPD diagnosis up to 1 year following diagnosis. Reject the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 21 of 31

Indicator ID Description Applied to population: COPD003 The percentage of patients with COPD who have had a review, undertaken by a healthcare professional, including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months. COPD_REG SDS use only: Version 100 The numerator is applied to the patients selected into the denominator for this indicator. Denominator Rule number 1 If COPDRVW_DAT > (PPED 12 months) AND If MRC_DAT > (PPED 12 months) Rule Action if true Action if false Rule description or comments Select Next rule 2 If REG_DAT > (PPED 3 months) Reject Next rule 3 If COPDEXC_DAT > (PPED 12 months) Reject Next rule 4 If COPD_DAT > (PPED 3 months) Reject Select End of denominator rules Select patients from the specified population who had both of the following in the 12 months leading up to the payment period end date: COPD review MRC Breathlessness Scale Score. 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 the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who had a COPD exception reporting code in their record in the 12 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule whose COPD diagnosis was in the 3 months leading up to the payment period end date. Select the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 22 of 31

Numerator Rule number 1 If COPDRVW_DAT > (PPED 12 months) AND If MRC_DAT > (PPED 12 months) End of numerator rules Rule Action if true Action if false Rule description or comments Select Reject Select patients from the denominator who had both of the following in the 12 months leading up to the payment period end date: COPD review MRC Breathlessness Scale Score. Reject the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 23 of 31

Indicator ID Description Applied to population: COPD004 The percentage of patients with COPD with a record of FEV 1 in the preceding 12 months COPD_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 FEV1_DAT > (PPED 12 months) Select Next rule 2 If REG_DAT > (PPED 3 months) Reject Next rule 3 If COPDEXC_DAT > (PPED 12 months) Reject Next rule 4 If SPEX_DAT > (PPED 12 months) Reject Next rule 5 If COPD_DAT > (PPED 3 months) Reject Select End of denominator rules Select patients from the specified population who have a record of FEV 1 record in the 12 months leading up to the payment period end 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 the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who had a COPD exception reporting code in their record in the 12 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who had a spirometry exception reporting code in their record in the 12 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule whose COPD diagnosis was in the 3 months leading up to the payment period end date. Select the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 24 of 31

Numerator Rule number Rule Action if true Action if false Rule description or comments 1 If FEV1_DAT > (PPED 12 months) Select Reject End of numerator rules Select patients from the denominator population who have a record of FEV 1 record in the12 months leading up to the payment period end date. Reject the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 25 of 31

Indicator ID Description Applied to population: COPD005 The percentage of patients with COPD and Medical Research Council dyspnoea grade 3 at any time in the preceding 12 months, with a record of oxygen saturation value within the preceding 12 months. COPD_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 MRC1_DAT > (PPED 12 months) Next rule Reject 2 If OXYSAT_DAT > (PPED 12 months) AND If OXYSAT_VAL Null Select Next rule 3 If REG_DAT > (PPED 3 months) Reject Next rule 4 If COPDEXC_DAT > (PPED 12 months) Reject Next rule 5 If COPD_DAT > (PPED 3 months) Reject Select End of denominator rules Pass to the next rule all patients from the specified population who have a MRC Breathlessness Scale Score of 3 or more in the 12 month period leading up to the achievement date. Reject the remaining patients. Select patients passed to this rule who had an oxygen saturation value recorded in the 12 month period leading up to 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 the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who had a COPD exception reporting code in their record in the 12 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule whose COPD diagnosis was in the 3 months leading up to the payment period end date. Select the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 26 of 31

Numerator Rule number 1 If OXYSAT_DAT > (PPED 12 months) AND If OXYSAT_VAL Null End of numerator rules Rule Action if true Action if false Rule description or comments Select Reject Select patients from the denominator who who had an oxygen saturation value recorded in the 12 month period leading up to the achievement date. Reject the remaining patients. Indicator-specific Supporting Information Overview This indicator has been developed to measure the effectiveness of the provision of a clinical care component for patients on the COPD register. The aspect that is being measured is relating to a record of oxygen saturation value in those patients with an MRC Dyspnoea Scale 3. Disease register The disease register is made up of patients who are eligible to receive the required care component. In this case: Patients who have a diagnosis of a COPD (i.e. there is evidence in the patient s electronic health record of a COPD diagnosis code) Numerator and Denominator The success criteria for this indicator (numerator) are achieved for those patients in the denominator who have a record of oxygen saturation value within the preceding 12 months. The patients that make up the denominator for this indicator are those patients where it is appropriate for the care component to be carried out. This is the relevant disease register adjusted for exclusions and exceptions. For this indicator there is one exclusion. The indicator is looking for patients with an MRC Dyspnoea Scale 3 within the preceding 12 months therefore anyone whose score is outside this time period is excluded. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 27 of 31

Exceptions Patients that don t achieve the success criteria of the indicator are also checked for valid exceptions. For this indicator the exceptions are: any patient who has been registered within the last 3 months of the qualifying year (new patient). New patients may be regarded as exceptions if they fulfil the criteria of the indicator but do not yet have a record of an oxygen saturation value maybe because there hasn t been an opportunity in the qualifying year to arrange this. any patient that has a relevant COPD exception code recorded within the preceding 12 months. any patient that has been diagnosed with COPD within the last 3 months of the year (new COPD patient). Newly diagnosed patients may be regarded as exceptions if they fulfil the criteria of the indicator but do not yet a record of an oxygen saturation value maybe because there hasn t been an opportunity in the qualifying year to arrange this. Note: For the new COPD patient exception, this is only applicable for the first ever diagnosis of COPD for the patient. For a subsequent diagnosis, this exception rule is not considered. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 28 of 31

Indicator ID Description Applied to population: COPD007 The percentage of patients with COPD who have had influenza immunisation in the preceding 1 August to 31 March. COPD_REG SDS use only: Version 100 The numerator is applied to the patients selected into the denominator for this indicator. Denominator Rule number 1 If FLU_DAT >= FLUCOM_DAT AND If FLU_DAT <= FLUEND_DAT Rule Action if true Action if false Rule description or comments Select Next rule 2 If REG_DAT > (PPED 3 months) Reject Next rule 3 If COPDEXC_DAT > (PPED 12 months) Reject Next rule 4 If COPD_DAT > (PPED 3 months) Reject Next rule 5 If XFLU_DAT Null Reject Next rule 6 If TXFLU_DAT > (PPED 12 months) Reject Select End of denominator rules Select patients from the specified population who had a flu vaccination between 1 st August and 31 st March. 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 the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who had a COPD exception reporting code in their record in the 12 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule whose COPD diagnosis was in the 3 months leading up to the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who have a persisting flu vaccine contraindication. Pass all remaining patients to the next rule. Reject patients passed to this rule who have an expiring flu vaccine contraindication record in the 12 months leading up to the payment period end date. Select the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 29 of 31

Numerator Rule number 1 If FLU_DAT >= FLUCOM_DAT AND If FLU_DAT <= FLUEND_DAT End of numerator rules Rule Action if true Action if false Rule description or comments Select Reject Select patients from the denominator who had a flu vaccination between 1 st August and 31 st March. Reject the remaining patients. NHS Digital is the trading name of the Health and Social Care Information Centre. Page 30 of 31

4.2. Payment Count(s) N/A - there are no payment counts for this service. 4.3. Management Information Count(s) N/A - there are no management information counts for this service. 4.4. Patient-level Extract(s) N/A - Not applicable for this service. 5. Appendix - Supporting data for NHS Digital SDS Category Database value TRUD version V21_0_0 Document version 35.0 Ruleset Database ID COPD Database Service ID QOF QSR Reference if applicable n/a NHS Digital is the trading name of the Health and Social Care Information Centre. Page 31 of 31