Data and Business Rules – Learning Disabilities ES
Author
HSCIC - SDS team
Version No
4.0
Version Date
New GMS Contract Implementation
Dataset and Business Rules
Learning Disabilities ES
Published by HSCIC on behalf of NHS England
07/05/2014
Learning disabilities ES_v4.0
Version Date: 07/05/2014
Amendment History:
Version
0.1
0.2
Date
th
17 January 2013
th
25 January 2013
0.3
18 February 2013
0.4
19 February 2013
1.0
2
1.1
3 April 2013
1.2
8 April 2013
1.3
19 April 2013
1.4
23 April 2013
1.5
3 May 2013
1.6
8 May 2013
2.0
8 May 2013
2.1
22
2.2
17 September 2013
2.3
30 January 2014
3.0
30 April 2014
4.0
7 May 2014
th
th
nd
April 2013
rd
th
th
rd
Amendment History
First draft by HSCIC
Second draft by HSCIC following more detailed
requirements
Third draft by HSCIC using start dates and
BASELINE DATE. Focuses only on payment and
not additional counts
Fourth draft by HSCIC adding
reporting/additional counts specification to the
payment criterion. Provides options of count or
numerator/denominator
Final version by HSCIC clarifying
reporting/additional counts specification to the
payment criterion
Specification updated following further
discussion around counts required
Specification updated following discussion
around use of date criteria
Updated following further discussions around
counts
Specification updated following meeting
rd
Specification updated following teleconference
th
Specification updated following discussions
th
Tracked changes accepted
nd
May 2013
Updated for publication
th
Count IDs/wording updates
th
Updated following October 2013 code release
and review
Signed off following review and negotiations.
Changes made to incorporate new enhanced
services terminology and align date syntax with
QOF.
Updated following April 2014 code release.
th
th
This document is produced by HSCIC 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, HSCIC and NHS England.
Published by HSCIC on behalf of NHS England
Page 2 of 14
Learning disabilities ES_v4.0
Version Date: 07/05/2014
Dataset and business rules – Learning Disabilities ES
Notes
1) Dates used:
a. ACHIEVEMENT_DAT: The date up to which patient information is considered
when determining the output for each extraction.
b. PAYMENTPERIODEND_DAT: The end date of the period for which payments
are made for a given Quality Service. For any given Quality Service there will
be one or more payment periods.
c. QUALITY_SERVICE_START_DAT (QSSD): The start of the period during
which a GP Practice provides the Quality Service
d. QUALITY_SERVICE_END_DAT (QSED): The end of the period during which a
GP Practice provides the Quality Service
The QUALITY_SERVICE_START_DAT (QSSD) for this ES is 01.04.2014
The QUALITY_SERVICE_END_DAT (QSED) for this ES is 31.03.2015
2) Clinical codes quoted are (where known) from the April 2014 release of Read codes
version 2 and clinical terms version 3 (CTV3). The codes are shown within the document
as a 5 character value to show that the Read Code is for a 5-Byte system.
i)
Where a ‘%’ wildcard is displayed, the Read Code is filled to 5 characters with
full-stops. When implementing a search for the Read Code, only the non full-stop
values should be used in the search, For example, a displayed Read Code of
c1...% should be implemented as a search for c1%, i.e. should find c1 and any of
it’s children.
ii) Where a range of read codes are displayed, the Read Code is filled to 5
characters with full-stops. When implementing the search, only the non full-stop
values should be used in the search, For example, a displayed Read Code range
of G342. – G3z.. should find all codes between G342 and G3z (including any
children where applicable).
3) Where Rulesets are specified as multiple rules they are to be processed sequentially.
Processing of rules should terminate as soon as a ‘Reject’ or ‘Select’ condition is
encountered. A count should be returned for each Select statement. Unless explicitly
stated there is no need to return a count for the Reject statements.
4) Rules are expressed as logical statements that evaluate as either ‘true’ or ‘false’. The
following operators are required to be supported:
a)
b)
c)
d)
>
<
=
≠
(greater than)
(less than)
(equal to)
(not equal to)
e) AND
f) OR
g) NOT
5) Where date criteria are specified with intervals of multiples of months or years these
should be interpreted as calendar months or calendar years.
6) If a Data item has a NULL value and is used in the Qualifying Criteria (in section 2 –
Clinical Data Extraction Criteria) of another Data item then the dependant data item fields
will also be NULL as dates cannot be checked against a NULL value. For example, if the
Qualifying Criteria is looking for an intervention to have taken place after a test and the
patient has an intervention date but no test date it is not possible to check the
intervention has taken place after the test (as there is no test date to check against).
This means the data items for the intervention will also be NULL.
Published by HSCIC on behalf of NHS England
Page 3 of 14
Learning disabilities ES_v4.0
Version Date: 07/05/2014
Dataset Specification
1) Patient selection criteria:
For this ES there is a manually collected field that is available to CQRS. The field is the ‘local’ practice register for Learning Disabilities. This field is
not defined in this specification, but it is used for reporting and payment.
a) Registration status
Current registration
status
Qualifying criteria
Currently registered
for GMS
Most recent registration date <= (ACHIEVEMENT_DAT)
Previously registered
for GMS
Any sequential pairing of registration date and deregistration date where both of the following conditions are
met:
registration date <= (ACHIEVEMENT_DAT); and
deregistration date > (ACHIEVEMENT_DAT)
Published by HSCIC on behalf of NHS England
Page 4 of 14
Learning disabilities ES_v4.0
Version Date: 07/05/2014
b) Diagnostic code status
Not applicable for this ES
Published by HSCIC on behalf of NHS England
Page 5 of 14
Learning disabilities ES_v4.0
Version Date: 07/05/2014
2) Clinical data extraction criteria
Field
Number
Field name
Data item
Qualifying criteria
1
PAT_ID
Patient ID number
Unconditional
2
REG_DAT
Date of patient registration
Latest <=
ACHIEVEMENT_DAT
3
PAT_AGE
Patients age (years) at QSED
Unconditional
4
LD_COD
Read codes v2
CTV3
E3...%
Eu7..%
Eu814
Eu815
Eu816
Eu817
Eu81z
918e.
Eu818
E3...%
XaQZ4
XaQZ3
XaKYb
XaREt
XaREu
Eu81z
XaaiS
Earliest <=
ACHIEVEMENT_DAT
(Learning Disability codes)
5
6
LD_DAT
HLTHCHK_COD
Date of LD_COD
Chosen record
Read codes v2
CTV3
69DB.
XaPx2
(Learning Disability health check codes)
7
HLTHCHK_DAT
Published by HSCIC on behalf of NHS England
Date of HLTHCHK_COD
Earliest >= QSSD
AND
<= ACHIEVEMENT_DAT
Chosen record
Page 6 of 14
Learning disabilities ES_v4.0
8
HLTHAP_COD
Version Date: 07/05/2014
Read codes v2
CTV3
9HB4.
9HB2.
XaJsd
XaJWA
(Health action plan provided codes)
9
10
11
HLTHAP_DAT
HLTHAPDEC_COD
HLTHAPDEC_DAT
Published by HSCIC on behalf of NHS England
Date of HLTHAP_COD
Earliest (>= QSSD)
AND
(>= HLTHCHK_DAT)
AND
<=
(ACHIEVEMENT_DAT)
Chosen record
Read codes v2
CTV3
9HB0.
XaJW9
(Health action plan declined codes)
Earliest (>= QSSD)
AND
(>= HLTHCHK_DAT)
AND
<=
(ACHIEVEMENT_DAT)
Date of HLTHAPDEC_COD
Chosen record
Page 7 of 14
Learning disabilities ES_v4.0
Version Date: 07/05/2014
ES Count rulesets
For this ES there is a manually collected field that is available to CQRS. The field is the ‘local’
practice register for Learning Disabilities. This field is not defined in this specification, but it is
used for reporting and payment.
The following section shows how the various counts used within this ES are defined.
In some instances the cohort counts (list of eligible patients) are used to derive multiple
counts. In this instance Cohort_Count_LDCC001 forms the cohort for the derived count
ManagementInformationCounts_LDMI001 to LDMI005.
Where a Count is to be used for payment it is listed as a PaymentCount i.e.
PaymentCount_LD001 and where a Count is used to support management information
reporting it will be listed as a ManagementInformationCount i.e.
ManagementInformationCount_LDMI001.
For an explanation of the dates in this section used please refer to Point 1 of the Notes
section above.
1. Cohort Count
Cohort_Count_LDCC001: Number (and list of eligible patients) of registered patients aged 14
and over at QUALITY_SERVICE_END_DAT (QSED)
Rule
number
1
Rule
If PAT_AGE >= 14
Action if true
Action if false
Select
Reject
Rule 1: The aim of this rule is to identify patients who reach the age of 14 or over by the
QUALITY_SERVICE_END_DAT (QSED). If the patient is aged 14 or over at QSED they are
selected into this Cohort count. If the patient is aged under 14 at QSED they are rejected
and not included in this Cohort count.
Published by HSCIC on behalf of NHS England
Page 8 of 14
Learning disabilities ES_v4.0
Version Date: 07/05/2014
2. Payment Count
PaymentCount_LD001: Quarterly count of registered patients aged 14 and over, as at 31
March 2015, on the practice’s Learning Disability register who have received a learning
disability health check and have not received a health check in a previous quarter in this
financial year.
PaymentCount ruleset:
To be applied to registered patients
This is a quarterly count of the number of health checks for patients aged 14 and over, as at
31 March 2015. It is not possible to check whether these patients are on the
practices’s local Learning Disability register. An assumption has been made that where
a patient has a health check that they are on the local learning disability register.
Rule
number
Rule
1
If PAT_AGE >= 14
2
If HLTHCHK_DAT >
(PAYMENTPERIODEND_DAT – 3 months)
Action if true
Action if false
Next rule
Reject
Select
Reject
This count will be used to determine payment.
Rule 1: The aim of this rule is to identify those patients aged 14 or over at the QSED. If the
patient is aged 14 or over at QSED they are passed on to the next rule. If the patient is aged
under 14 at QSED they are rejected and not included in this count.
Rule 2: The aim of this rule is to identify the number of patients who have received a health
check within the quarter. If the earliest health check on or after QSSD is within the quarter
(this window is defined by the PAYMENTPERIODEND_DAT) then the patient is added to the
count. Otherwise the patient is rejected and not included in the count.
Published by HSCIC on behalf of NHS England
Page 9 of 14
Learning disabilities ES_v4.0
Version Date: 07/05/2014
3. Management Information Counts
ManagementInformationCount_LDMI001: Quarterly count of registered patients aged 14 and
over, as at 31 March 2015 , identified as having a QOF diagnostic learning disability who
received a learning disability health check in the reporting period.
ManagementInformationCount ruleset:
To be applied to the above Cohort as
defined in Cohort_Count_LDCC001 population
Rule
number
Rule
1
If LD_DAT ≠ Null
2
If HLTHCHK_DAT >
(PAYMENTPERIODEND_DAT – 3 months)
Action if true
Action if false
Next rule
Reject
Select
Reject
Rule 1: The aim of this rule is to identify patients included in Cohort_Count_LDCC001
who have a record of a learning disabilities diagnosis code (as defined in QOF) anywhere
within their record prior to the ACHIEVEMENT_DAT. If a patient meets this criteria they are
passed to the next rule, otherwise they are rejected and not included in this count.
Rule 2: The aim of this rule is to identify patients who have received a learning disabilities
health check within the quarter. If a patient has received a learning disabilities health check
in the quarter they are selected into the count, otherwise they are rejected and not included
in the count.
NOTE: This count will be used to support management information reporting and will not be
used for payment.
Published by HSCIC on behalf of NHS England
Page 10 of 14
Learning disabilities ES_v4.0
Version Date: 07/05/2014
ManagementInformationCount_LDMI002: Quarterly (cumulative) count of registered patients
aged 14 and over, as at 31 March 2015, identified as having a QOF diagnostic learning
disability, as at reporting period end date.
ManagementInformationCount ruleset:
To be applied to the above Cohort as
defined in Cohort_Count_LDCC001 population
Rule
number
1
Rule
If LD_DAT <= PAYMENTPERIODEND_DAT
Action if true
Action if false
Select
Reject
Rule 1: The aim of this rule is to identify those patients included in
Cohort_Count_LDCC001 with a record of a learning disability as identified in QOF up to
the PAYMENTPERIODEND_DAT. If a patient does have a record of a QOF diagnostic learning
disability they will be added to this count. Otherwise the patient will be rejected and not
included in this count.
NOTE: This count will be used to support management information reporting and will not be
used for payment.
Published by HSCIC on behalf of NHS England
Page 11 of 14
Learning disabilities ES_v4.0
Version Date: 07/05/2014
ManagementInformationCount_LDMI003: Quarterly (Cumulative) count of registered patients
age 14 and over, as at 31 March 2015, who have received a learning disability health check
and have been provided a health action plan, up to the end of the reporting period.
ManagementInformationCount ruleset:
To be applied to the Cohort as defined
in Cohort_Count_LDCC001 population
Rule
number
1
Rule
If HLTHAP_DAT <= PAYMENTPERIODEND_DAT
Action if true
Action if false
Select
Reject
Rule 1: The aim of this rule is to identify patients included in Cohort_Count_LDCC001
who have received a health action plan on or after the day they received a learning disability
health check, up to the PAYMENTPERIODEND_DAT. If a patient meets this criteria they are
added to the count, otherwise they are rejected and not included in the count.
NOTE: This count will be used to support management information reporting and will not be
used for payment.
Published by HSCIC on behalf of NHS England
Page 12 of 14
Learning disabilities ES_v4.0
Version Date: 07/05/2014
ManagementInformationCount_LDMI004: Quarterly (Cumulative) count of registered patients
age 14 and over, as at 31 March 2015, who have received a learning disability health check
and declined a health action plan, up to the end of the reporting period.
ManagementInformationCount ruleset:
To be applied to the above Cohort as
defined in Cohort_Count_LDCC001 population
Rule
number
Rule
Action if true
Action if false
1
If HLTHAP_DAT <= PAYMENTPERIODEND_DAT
Reject
Next rule
2
If HLTHAPDEC_DAT <=
PAYMENTPERIODEND_DAT
Select
Reject
Rule 1: The aim of this rule is to identify patients included in Cohort_Count_LDCC001
who have received a health action plan up to the PAYMENTPERIODEND_DAT. If a patient
has received a health action plan they are rejected from this count, otherwise they are
passed to the next rule.
Rule 2: The aim of this rule is to identify patients who have declined a health action plan on
or after the day they received a learning disability health check, up to the
PAYMENTPERIODEND_DAT. If a patient meets this criteria they are added to the count,
otherwise they are rejected and not included in the count.
NOTE: This count will be used to support management information reporting and will not be
used for payment.
Published by HSCIC on behalf of NHS England
Page 13 of 14
Learning disabilities ES_v4.0
Version Date: 07/05/2014
ManagementInformationCount_LDMI005: Quarterly (Cumulative) count of registered patients
age 14 and over, as at 31 March 2015, who have received a learning disability health check
that have neither received nor declined a health action plan, up to the end of the reporting
period.
ManagementInformationCount ruleset:
To be applied to the above Cohort as
defined in Cohort_Count_LDCC001 population
Rule
number
Rule
Action if true
Action if false
1
If HLTHCHK_DAT <= PAYMENTPERIODEND_DAT
Next rule
Reject
2
If HLTHAP_DAT <= PAYMENTPERIODEND_DAT
OR
If HLTHAPDEC_DAT <=
PAYMENTPERIODEND_DAT
Reject
Select
Rule 1: The aim of this rule is to identify patients included in Cohort_Count_LDCC001
who have received a learning disability health check up to the PAYMENTPERIODEND_DAT. If
a patient has received a learning disability health check they are passed to the next rule,
otherwise they are rejected and not included in the count.
Rule 2: The aim of this rule is to identify if patients have either received or declined a health
action plan on or after the day they received a learning disability health check, up to the
PAYMENTPERIODEND_DAT. If a patient has either received or declined a health action plan
they are rejected and not included in the count, otherwise the patient is added to the count.
NOTE: This count will be used to support management information reporting and will not be
used for payment.
Published by HSCIC on behalf of NHS England
Page 14 of 14