Business Rules for Quality and Outcomes Framework (QOF) 2017/18 Stroke and Transient Ischaemic Attack (STIA)

Business Rules for Quality and Outcomes Framework (QOF) 2017/18 Stroke and Transient Ischaemic Attack (STIA) Author: Primary Care Domain Specification Development Service (SDS), NHS Digital Version Date: 01/04/2017 Version: 36.0

Contents 1. Amendment History... 4 2. Background... 8 2.1. Document Purpose...8 2.2. Business Rules Supporting Information...8 2.3. Clinical Codes...9 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... 19 4. Outputs... 22 4.1. Indicator(s)... 22 STIA001... 22 STIA008... 23 STIA003... 25 STIA007... 27 STIA009... 30 4.2. Payment Count(s)... 32 4.3. Management Information Count(s)... 32 4.4. Patient-level Extract(s)... 32 The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 2 of 32

5. Appendix - Supporting data for NHS Digital SDS... 32 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 32

1. Amendment History Version Date Amendment history Draft 0.3 21 June 2003 From Peter Horsfield 1.0 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. 2.0 12 November 2003 Amended following 4 Country review 3.0 20 January 2004 Amended following January READ Code Release 4.0 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 5.0 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 6.0 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 7.0 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 28 February 2006 Amended following internal & 4 Countries review The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 4 of 32

8.0 15 March 2006 Signed off following 4 Country review 8.1 18 May 2006 Responding to queries raised, Amend wording for Note 3 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 9.0 30 November 2006 Approved by NHSE 9.1 11 April 2007 April 2007 Read Code Release 10.0 18 June 2007 Signed off following 4 Country review 10.1 10 September 2007 April 2007 Release 10.2 23 September 2007 October 2007 Read Code Release. October 2007 SNOMED CT Release 10.3 27 November 2007 Following 4-Country Review: % added to 319357003 in SAL_COD 11.0 28 November 2007 Signed off following 4 Country review 11.1 30 June 2008 11.2 30 June 2008 April 2008 Read Code Release. April 2008 SNOMED CT Release. QOF Review 2007 (Replace STROKE11 with STROKE13) Following 4-Country Review: Remove ETIA_COD/DAT cluster and merge with STR_COD/DAT cluster Remove DIAG_DAT cluster Denominator Rule 2 and Numerator Rule 1 (for Stroke 13) corrected Denominator Rule 6 (for Stroke 13) amended to a 1 month window Denominator Rule 6 (for Stroke 13) amended to use STRT_DAT 12.0 24 July 2008 Signed off following 4 Country review 12.1 06 October 2008 October 2008 Read Code Release. October 2008 SNOMED CT Release. Application of v12.0 Addendum 2 corrections to SCAN_COD & SCEXC_COD. STRTIA_COD 13.0 05 December 2008 Signed off following 4 Country review 13.2 09 March 2009 QOF Review 2008 14.0 01 May 2009 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 32

14.1 25 June 2009 April 2009 Read Code Release 15.0 17 August 2009 Signed off following 4 Country review 15.1 12 October 2009 October 2009 Clinical Codes Release 15.2 28 October 2009 October 2009 Clinical Codes Release review 16.0 02 December 2009 Sign off following 4 Country review 17.0 07 May 2010 April 2010 Read Code Release following NHS IC review. 18.0 29 October 2010 October 2010 Read Code Release following NHS IC review. 19.0 13 December 2010 Signed off following 4 country review. 20.0 13 May 2011 April 2011 Read Code Release following NHS IC review. 21.0 10 November 2011 October 2011 Read Code Release following NHS IC review. 22.0 12 December 2011 Signed off following 4 Country review 23.0 31 May 2012 April 2012 Read Code Release following HSCIC review 24.0 31 October 2012 October 2012 Read Code Release following HSCIC review 25.0 28 March 2013 Signed off following consultation. Document name changed from Stroke and Transient Ischaemic Attacks (TIA) to Stroke and Transient Ischaemic Attack (STIA). 26.0 01 June 2013 April 2013 Read Code Release following HSCIC review 27.0 25 October 2013 October 2013 Read Code Release following HSCIC review 27.1 02 December 2013 Update to SCAN_COD, 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 28.0 28 March 2014 Signed off following review and negotiations. Changes made to incorporate new date terminology 29.0 27 June 2014 April 2014 Read Code Release following HSCIC review The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 6 of 32

30.0 10 October 2014 October 2014 Read Code Release following HSCIC review 31.0 12 December 2014 Signed off following review and negotiations 32.0 06 May 2015 April 2015 Read Code Release following HSCIC review 33.0 27 October 2015 October 2015 Read Code Release following HSCIC review 34.0 31 March 2016 Signed off following review and negotiations 35.0 29 July 2016 April 2016 Read Code Release following NHS Digital review 36.0 03 April 2017 Signed off following review and negotiations. Further amendments made following testing. The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 7 of 32

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 1.2 of the supporting information document which can be accessed here: http://www.digital.nhs.uk/qofesextractspecs. http://content.digital.nhs.uk/qofesextractspecs 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 8 of 32

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/qofbrv36 http://content.digital.nhs.uk/qofbrv36 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 2016 release of Read codes version 2 and clinical terms version 3 (CTV3) for this ruleset. There was no Read code release in October 2016. 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 The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 9 of 32

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 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 10 of 32

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. 01/08/2017 31/03/2018 * 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 11 of 32

3.2 Patient selection criteria All Populations and Outputs in this Ruleset are to be returned at Practice-level. 3.2.1 GMS registration status Qualifying criteria Action if true Action if false Non-technical Description (If REG_DAT Null If DEREG_DAT = Null) OR (If REG_DAT Null 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 12 of 32

3.2.2 Populations 3.2.2.1 Case registers Each patient can only be included once per register. Register Name Description Applied to patients defined in: STIA_REG Stroke/TIA register: Register of patients with a Stroke or TIA diagnosis GMS registration status SDS use only: Version 101 Rule number 1 End of rules If ESTRK_DAT Null OR If TIA_DAT Null Rule Action if true Action if false Rule description or comments Select Reject Select patients from the specified population who had a stroke or TIA diagnosis anywhere in the patient record up to and including 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 13 of 32

3.2.2.2 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 32

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 STREXC_COD Stroke exception reporting codes 9h2..% XaJ4O% 100 TIA_COD TIA codes G65..-G654., G656.-G65zz, ZV12D, Fyu55 XE0VK% (excluding F4236, G660., G661., G662.), XaX16, G65z0, G65z1 100 OSTR_COD Non-haemorrhagic stroke codes G63y0-G63y1, G64..%, G665., G666., G6760, G6W.., G6X.., Gyu63-Gyu66, Gyu6G Xa0kZ% (excluding XE1Xs%), G640.% (excluding G663., G664.), X00D3, G641., Gyu65, Gyu66 100 SCAN_COD MRI / CT scan codes 567..-5673., 569..-5693., 5675., 567C., 5694., 569F., 5C00., 5C12., 8HQ3., 8HQ4., 8HBJ., 8HTQ., 8HQF., 569K0 5671., 5672., 5673., 5691., 5692., 5693., XaJEi, XaJEh, X70oK%, 5675., XaKao, XaJIF, XaO4U, 8HQ3., 8HQ4., XaJkS, XaJYc, XaXOh, 567.., X70oI, XacM4 101 SCEXC_COD Codes for MRI / CT declined) 5695., 56F0. XaJHY, XaJIE 100 The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 15 of 32

Cluster Name Description Read V2 CTV3 Cluster Version BP_COD BP recording codes 246..% (excluding 2460., 2468., 246H., 246I., 246K., 246L., 246M., 246h., 246i., 246j., 246k., 246n.%, 246o.%) X773t%, 246..% THEN EXCLUDE XaI9f, XaI9g, XaZvo, XaZxj, X779b, X779R, X779T, X779W, XaYai, XaYg8, XaYg9, Xabhx, Xac5K, Xac5L, Xaedn%, 2460., 2468., XaCFN, XaCFO, X779g, X779Q, X779S, X779V, X779X, Xa0Ca 103 BPEX_COD BP recording exception codes 8I3Y. XaJkR 100 HTMAX_COD Code for maximal BP therapy 8BL0. XaJ5h 100 XSAL_COD Salicylate contra-indications: persistent 14LK., ZV148, U6051, TJ53. XaIpk, Xa5FM%, XE22E%, Xa5dp%, XaDzd, U6051 100 TXSAL_COD Salicylate contra-indications: expiring 8I24., 8I38., 8I66., 8I70., 8IHJ. XaDvH, XaFsE, XaIIi, XaJ5a, XadAO 101 XORANTICOAG_COD Oral anticoagulant contraindications: persistent 14LP., TJ42.% (excluding TJ420), U6042, ZV14A, 1Z34., 1Z43., 1Z340, 1Z431, 1Z341, 1Z430 XaJ60, TJ42.% (excluding TJ420), U6042, XaJ8B, Xa5yP%, Xad9m, Xad9p, Xad9n, Xad9o, Xa5Zn, Xa5yG 101 TXORANTICOAG_COD Oral anticoagulant contraindications: expiring 8I25., 8I3E., 8I65., 8I71., 8I2R., 8I3d., 8I6N., 8I7A., 8I2o., 8IES., 8I611, 8I7R., 8I2u., 8IH1., 8I6s., 8I7V., 8IJ0., 8IHG., 8I7Z., 8IJ1., 8IHH., 8I7a. XaFsz, XaIIn, XaIIh, XaJ5b, XaKAB, XaKAD, XaKA7, XaKA0, XaZbj, XaZZl, XaZbl, XaZbr, XabEn, XabEe, XabEp, XabEo, XadAI, Xad9q, Xad9s, XadAK, Xad9r, Xad9t 101 XCLO_COD Clopidogrel contraindications: persistent 14LQ., U6048, ZV14B XaJ8V, XaJ3e, XaJ5v 100 The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 16 of 32

Cluster Name Description Read V2 CTV3 Cluster Version TXCLO_COD XDIPY_COD TXDIPY_COD Clopidogrel contraindications: expiring Dipyridamole contraindications: persistent Dipyridamole contraindications: expiring 8I2K., 8I3R., 8I6B., 8I72. XaJ6Y, XaJ6Z, XaJ5l, XaJ5c 100 14LX., TJC44, U60C3 Xa61Z, Xa5d6, TJC44 100 8I2b., 8I3n., 8I6a., 8I7J. XaLFv, XaLFw, XaLFx, XaLFy 100 OSAL_COD OTC salicylate codes 67I8., 8B63., 8B3T. XaFsi, XaF7N, XE0hr% 100 SAL_COD Salicylate prescription codes bu2..%, di1..%, j11..%, blm..%, bu4..% bu2..%, x04tl%, blm..%, bu4..% 100 CLO_COD Clopidogrel prescription codes bu5..%, 8B6P. bu5..%, XaJd8 100 ORANTICOAG_COD Oral anticoagulant drugs bs...%, 8B2K. x01o3%, x01o5%, XaKAk, bs...% 103 DIPY_COD Dipyridamole prescription codes bu1..% (excluding bu13., bu1z.), bu4..% bu1..% (excluding bu1z.%), bu4..% 102 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 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 The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 17 of 32

Cluster Name Description Read V2 CTV3 Cluster Version 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, Gyu66 101 End of clusters The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 18 of 32

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 STREXC_DAT STREXC_COD Latest <= ACHV_DAT 5 STRT_DAT n/a Earliest of (TIA_DAT, ESTRK_DAT) 6 TIA_DAT TIA_COD Earliest <= ACHV_DAT 7 OSTR_DAT OSTR_COD Earliest <= ACHV_DAT 8 SCAN_DAT SCAN_COD 9 SCEXC_DAT SCEXC_COD Earliest <= ACHV_DAT >= (DIAG_DAT 93 days) Earliest <= ACHV_DAT >= DIAG_DAT 10 BP_DAT BP_COD Latest <= ACHV_DAT 11 BPSYS_VAL BP_COD Recorded on BP_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 stroke exception reporting code in the patients record up to and including the achievement date. Date of the patient s first Stroke or TIA diagnosis up to and including the achievement date Date of the patient s first TIA diagnosis up to and including the achievement date Date of the patient s first Non-haemorrhagic stroke diagnosis up to and including the achievement date Date of the first MRI or CT scan within the period from 3 months (93 days) prior to the patient s latest Stroke or TIA diagnosis up to and including the achievement date. Date of the first declined MRI or CT scan within the period from the date of the latest Stroke or TIA diagnosis up to and including the achievement date. Date of the most recent blood pressure recording up to and including the achievement date. The systolic blood pressure value associated with the most recent blood pressure recording The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 19 of 32

Field number Field name Code cluster (if applicable) Qualifying criteria 12 BPDIA_VAL BP_COD Recorded on BP_DAT 13 BPEX_DAT BPEX_COD Latest <= ACHV_DAT 14 HTMAX_DAT HTMAX_COD Latest <= ACHV_DAT 15 XSAL_DAT XSAL_COD Latest <= ACHV_DAT 16 TXSAL_DAT TXSAL_COD Latest <= ACHV_DAT 17 XORANTICOAG_DAT XORANTICOAG_COD Latest <= ACHV_DAT 18 TXORANTICOAG_DAT TXORANTICOAG_COD Latest <= ACHV_DAT 19 XCLO_DAT XCLO_COD Latest <= ACHV_DAT 20 TXCLO_DAT TXCLO_COD Latest <= ACHV_DAT 21 XDIPY_DAT XDIPY_COD Latest <= ACHV_DAT 22 TXDIPY_DAT TXDIPY_COD Latest <= ACHV_DAT Non-technical Description The diastolic blood pressure value associated with the most recent blood pressure recording Date of the most recent blood pressure recording exception code in the patient s record up to and including the achievement date. Date of the most recent maximal BP therapy code in the patient s record up to and including the achievement date. Date of the most recent persisting salicylate contraindication up to and including the achievement date. Date of the most recent expiring salicylate contraindication up to and including the achievement date. Date of the most recent persisting oral anticoagulant contraindication up to and including the achievement date. Date of the most recent expiring oral anticoagulant contraindication up to and including the achievement date. Date of the most recent persisting clopidogrel contraindication up to and including the achievement date. Date of the most recent expiring clopidogrel contraindication up to and including the achievement date. Date of the most recent persisting dipyridamole contraindication up to and including the achievement date. Date of the most recent expiring dipyridamole 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 20 of 32

Field number Field name Code cluster (if applicable) Qualifying criteria 23 OSAL_DAT OSAL_COD Latest <= ACHV_DAT 24 SAL_DAT SAL_COD Latest <= ACHV_DAT 25 CLO_DAT CLO_COD Latest <= ACHV_DAT 26 ORANTICOAG_DAT ORANTICOAG_COD Latest <= ACHV_DAT 27 DIPY_DAT DIPY_COD Latest <= ACHV_DAT 28 XFLU_DAT XFLU_COD Latest <= ACHV_DAT 29 TXFLU_DAT TXFLU_COD Latest <= ACHV_DAT 30 FLU_DAT FLU_COD Latest <= ACHV_DAT 31 STRK_DAT STRK_COD Latest First or New episode <= ACHV_DAT 32 ESTRK_DAT STRK_COD Earliest <= ACHV_DAT 33 DIAG_DAT n/a End of fields Latest of (TIA_DAT,STRK_DAT) Non-technical Description Date of the most recent OTC salicylate up to and including the achievement date. Date of the most recent salicylate prescription up to and including the achievement date. Date of the most recent clopidogrel prescription up to and including the achievement date. Date of the most recent oral anticoagulant prescription up to and including the achievement date. Date of the most recent dipyridamole prescription up to and including the achievement date. Date of the most recent persisting flu vaccine contraindication up to and including the achievement date. Date of the most recent expiring flu vaccine contraindication up to and including the achievement date. Date of the most recent flu vaccination up to and including the achievement date. Date of the most recent first or new episode of Stroke up to and including the achievement date. Date of the patient s first Stroke diagnosis up to and including the achievement date. Date of the most recent first or new episode of Stroke or TIA 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 21 of 32

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: STIA001 The contractor establishes and maintains a register of patients with stroke or TIA. STIA_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 22 of 32

Indicator ID Description Applied to population: STIA008 The percentage of patients with a stroke or TIA (diagnosed on or after 1 April 2014) who have a record of a referral for further investigation between 3 months before or 1 month after the date of the latest recorded stroke or the first TIA. STIA_REG SDS use only: Version 101 The numerator is applied to the patients selected into the denominator for this indicator. Denominator Rule number 1 If STRK_DAT >= 01/04/2014 OR If TIA_DAT >= 01/04/2014 Rule Action if true Action if false Rule description or comments Next rule Reject 2 If SCAN_DAT <= (DIAG_DAT + 31 days) Select Next rule 3 If REG_DAT > (PPED 3 months) Reject Next rule 4 If STREXC_DAT > (PPED 12 months) Reject Next rule 5 If SCEXC_DAT <= (DIAG_DAT + 31 days) Reject Next rule 6 If STRT_DAT > (PPED 3 months) Reject Select Pass to the next rule all patients from the specified population who meet either of the criteria below: Latest first/new stroke diagnosis was on or after 1 April 2014. Earliest TIA diagnosis was on or after 1 April 2014. Reject the remaining patients. Select patients passed to this rule who had an MRI/CT scan up to and including 31 days following their 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 stroke 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 declined an MRI/CT scan up to and including 31 days following their diagnosis. Pass all remaining patients to the next rule. Reject patients passed to this rule whose earliest stroke or TIA 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 23 of 32

End of denominator rules Numerator Rule number Rule Action if true Action if false Rule description or comments 1 If SCAN_DAT <= (DIAG_DAT + 31 days) Select Reject End of numerator rules Select patients from the denominator who had an MRI/CT scan up to and including 31 days following their 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 24 of 32

Indicator ID Description Applied to population: STIA003 The percentage of patients with a history of stroke or TIA in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmhg or less. STIA_REG SDS use only: Version 101 The numerator is applied to the patients selected into the denominator for this indicator. Denominator Rule number 1 If BPSYS_VAL <= 150 If BPDIA_VAL <= 90 If BP_DAT > (PPED 12 months) Rule Action if true Action if false Rule description or comments Select Next rule 2 If BPEX_DAT > (PPED 12 months) Reject Next rule 3 If REG_DAT > (PPED 9 months) Reject Next rule 4 If STREXC_DAT > (PPED 12 months) Reject Next rule 5 If STRT_DAT > (PPED 9 months) Reject Next rule 6 If HTMAX_DAT > (PPED 12 months) Reject Select Select patients from the specified population who meet all of the criteria below: Had a BP systolic value of 150 or lower Had a BP diastolic value of 90 or lower Had these values recorded 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 blood pressure exception reporting code in their record 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 registered with the Practice in the 9 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 stroke 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 earliest stoke or TIA diagnosis was in the 9 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 maximal BP therapy in the 12 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 25 of 32

End of denominator rules Numerator Rule number 1 If BPSYS_VAL <= 150 If BPDIA_VAL <= 90 If BP_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 meet all of the criteria below: Had a BP systolic value of 150 or lower Had a BP diastolic value of 90 or lower Had these values recorded in the 12 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 26 of 32

Indicator ID Description Applied to population: STIA007 The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken. STIA_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 OSTR_DAT = Null If TIA_DAT = Null Rule Action if true Action if false Rule description or comments Reject Next rule Reject patients from the specified population who do not have a Non-haemorrhagic stroke or a TIA diagnosis up to and including the achievement date. Pass all remaining patients to the next rule. 2 If SAL_DAT > (PPED 12 months) OR If ORANTICOAG_DAT > (PPED 12 months) OR If CLO_DAT > (PPED 12 months) OR If OSAL_DAT > (PPED 12 months) OR If DIPY_DAT > (PPED 12 months) Select Next rule Select patients passed to this rule who had a prescription for any of the following in the 12 months leading up to and including the payment period end date: Salicylates Oral anticoagulants Clopidogrel OTC salicylates Dipyridamole. Pass all remaining patients to the next rule. 3 If REG_DAT > (PPED 3 months) Reject Next rule 4 If STREXC_DAT > (PPED 12 months) Reject Next rule 5 If OSTR_DAT <= (PPED 3 months) OR If TIA_DAT <= (PPED 3 months) Next rule Reject 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 stroke 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. Pass to the next rule all patients passed to this rule who have a Non-haemorrhagic stroke or a TIA diagnosis in the 3 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 27 of 32

6 If XSAL_DAT = Null If TXSAL_DAT = Null Select Next rule Select patients passed to this rule who do not have any persisting or expiring salicylate contraindications. Pass all remaining patients to the next rule. 7 If XSAL_DAT = Null If TXSAL_DAT <= (PPED 12 months) Select Next rule Select patients passed to this rule who do not have any persisting salicylate contraindications and the latest expiring salicylate contraindication was recorded at least 12 months prior to the payment period end date. Pass all remaining patients to the next rule. 8 If XORANTICOAG_DAT = Null If TXORANTICOAG_DAT = Null Select Next rule Select patients passed to this rule who do not have any persisting or expiring oral anticoagulant contraindications. Pass all remaining patients to the next rule. 9 If XORANTICOAG_DAT = Null If TXORANTICOAG_DAT <= (PPED 12 months) Select Next rule Select patients passed to this rule who do not have any persisting oral anticoagulant contraindications and the latest expiring oral anticoagulant contraindication was recorded at least 12 months prior to the payment period end date. Pass all remaining patients to the next rule. 10 If XCLO_DAT = Null If TXCLO_DAT = Null Select Next rule Select patients passed to this rule who do not have any persisting or expiring clopidogrel contraindications. Pass all remaining patients to the next rule. 11 If XCLO_DAT = Null If TXCLO_DAT <= (PPED 12 months) Select Next rule Select patients passed to this rule who do not have any persisting clopidogrel contraindications and the latest expiring clopidogrel contraindication was recorded at least 12 months prior to the payment period end date. Pass all remaining patients to the next rule. 12 If XDIPY_DAT = Null If TXDIPY_DAT = Null Select Next rule Select patients passed to this rule who do not have any persisting or expiring dipyridamole contraindications. Pass all remaining patients to the next rule. 13 If XDIPY_DAT = Null If TXDIPY_DAT <= (PPED 12 months) Select Reject Select patients passed to this rule who do not have any persisting dipyridamole contraindications and the latest expiring dipyridamole contraindication was recorded at least 12 months prior to the payment period end date. Reject the remaining patients. End of denominator rules The Health and Social Care Information Centre is a non-departmental body created by statute, also known as NHS Digital. Page 28 of 32

Numerator Rule number 1 If SAL_DAT > (PPED 12 months) OR If ORANTICOAG_DAT > (PPED 12 months) OR If CLO_DAT > (PPED 12 months) OR If OSAL_DAT > (PPED 12 months) OR If DIPY_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 a prescription for any of the following in the 12 months leading up to and including the payment period end date: Salicylates Oral anticoagulants Clopidogrel OTC salicylates Dipyridamole. 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 29 of 32

Indicator ID Description Applied to population: STIA009 The percentage of patients with stroke or TIA who have had influenza immunisation in the preceding 1 August to 31 March. STIA_REG SDS use only: Version 101 The numerator is applied to the patients selected into the denominator for this indicator. Denominator Rule number 1 If FLU_DAT >= FLUCOM_DAT 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 STREXC_DAT > (PPED 12 months) Reject Next rule 4 If STRT_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 August and 31 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 and including the payment period end date. Pass all remaining patients to the next rule. Reject patients passed to this rule who had a stroke 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 earliest stoke or TIA diagnosis was 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 persisting flu vaccine contraindication. Pass all remaining patients to the next rule. Reject patients passed to this rule who had an expiring flu vaccine contraindication in the 12 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 30 of 32

Numerator Rule number 1 If FLU_DAT >= FLUCOM_DAT 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 August and 31 March. 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 31 of 32

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 36.0 Ruleset Database ID Stroke 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 32 of 32