Dataset and Business Rules - Learning Disabilities Indicator Set

Data and Business Rules – Childhood Seasonal Influenza ES Author HSCIC - SDS Version No 1.6 Version Date 30/01/2014 team

New GMS Contract QOF Implementation

Dataset and Business Rules - Learning disabilities Indicator Set 04e5fbc74f785af951509340bf9ddd40.doc Version Date:30/01/2014

Amendment History: Version Date Amendment History 0.1 24th July 2013 First draft by HSCIC 0.2 30th July 2013 Second draft by HSCIC 0.3 31st July 2013 Third draft by HSCIC 0.4 1st August 2013 Fourth draft by HSCIC – four week check added 0.5 1st August 2013 Fifth draft by HSCIC – dual payment count added 0.6 2nd August 2013 Sixth draft by HSCIC – retrospective fix added 0.7 6th August 2013 Seventh draft by HSCIC – further logic added 0.8 7th August 2013 Eighth draft by HSCIC – logic change made to payment count 0.9 9th August 2013 Ninth draft by HSCIC 1.0 19th August 2013 Tenth draft by HSCIC – amendment to payment count selection 1.1 9th September 2013 Eleventh draft by HSCIC – amendment to TIV1_COD and TIV2_COD CTV3 codes 1.2 18th September 2013 New codes checked and count CFLUMI007 updated 1.3 26th September 2013 ‘=’ removed from the Qualifying Criteria of INTRANAS2_COD and TIV2_COD 1.4 11th November 2013 INTRANAS1_COD and INTRANAS2_COD updated 1.5 14th November 2013 INTRANAS1_COD and INTRANAS2_COD updated to include 65EE. / Xaa9G 1.6 30th January 2014 Updated following October 2013 code release and review

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Dataset and business rules – Childhood Seasonal Influenza ES

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 01.09.2013 The QUALITY_SERVICE_END_DAT (QSED) for this ES is 01.04.2014

2) Clinical codes quoted are (where known) from the October 2013 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) > (greater than) e) AND b) < (less than) f) OR c) = (equal to) g) NOT d) ≠ (not equal to)

5) Where date criteria are specified with intervals of multiples of months or years these should be interpreted as calendar months or calendar years.

Dataset Specification

1) Patient selection criteria:

a) Registration status

Current registration Qualifying criteria status Currently registered Most recent registration date < (ACHIEVEMENT_DAT) for GMS Any sequential pairing of registration date and deregistration date where both of the following conditions are Previously registered met: for GMS registration date < (ACHIEVEMENT_DAT); and deregistration date >= (ACHIEVEMENT_DAT)

b) Diagnostic code status

2) Clinical data extraction criteria

Field Field name Data item Qualifying criteria Number 1 PAT_ID Patient ID number Unconditional Latest < 2 REG_DAT Date of patient registration ACHIEVEMENT_DAT 3 PAT_AGE Patients age (years) at QSSD Unconditional Read codes v2 CTV3 65ED1 Xaac3 65EE0 XaaED Earliest >= QSSD 4 INTRANAS1_COD 65EE. Xaa9G AND n47D. n47D. < (ACHIEVEMENT_DAT) n47E. n47E. (Seasonal influenza intranasal vaccination first dose codes)

7 INTRNAS1_DAT Date of INTRANAS1_COD Chosen record

Read codes v2 CTV3 65ED3 Xaac4 Earliest 65EE1 XaaEF > (INTRANAS1_DAT) 8 INTRANAS2_COD 65EE. Xaa9G AND n47D. n47D. < (ACHIEVEMENT_DAT) n47E. n47E. (Seasonal influenza intranasal vaccination second dose codes)

11 INTRANAS2_DAT Date of INTRANAS2_COD Chosen record

Read codes v2 CTV3

65ED. XaZ0d n471. n471. n472. n472. n473. n473. n474. n474. n475. n475. n47d. Earliest >= QSSD n47d. 12 TIV1_COD n47f. AND n47f. n47k. < (ACHIEVEMENT_DAT) n47k. n47m. n47m. n47n. n47n. n47o. n47o. n47y. n47y. n47z. n47z.

(TIV first dose codes)

15 TIV1_DAT Date of TIV1_COD Chosen record

16 TIV2_COD Read codes v2 CTV3 Earliest > (TIV1_DAT) AND 65ED. XaZ0d < (ACHIEVEMENT_DAT) n471. n471. n472. n472. n473. n473. n474. n474. n475. n475. n47d. n47d. n47f. n47f.

n47k. n47k. n47m. n47m. n47n. n47n. n47o. n47o. n47y. n47y. n47z. n47z.

(TIV second dose codes)

19 TIV2_DAT Date of TIV2_COD Chosen record

Read codes v2 CTV3 Earliest >= QSSD 20 INTRANAS1OHP_COD 65E21 Xaac7 AND (Seasonal influenza intranasal vaccination first dose given by other < (ACHIEVEMENT_DAT) healthcare provider codes) 23 INTRANAS1OHP_DAT Date of INTRANAS1OHP_COD Chosen record

Read codes v2 CTV3 Earliest >= QSSD 24 INTRANAS2OHP_COD 65E22 Xaac8 AND (Seasonal influenza intranasal vaccination second dose given by other < (ACHIEVEMENT_DAT) healthcare provider codes) 27 INTRANAS2OHP_DAT Date of INTRANAS2OHP_COD Chosen record

Read codes v2 CTV3 Earliest >= QSSD 28 TIVOHP_COD 65E20 XaZ0e AND 65ED2 XaaZp < (ACHIEVEMENT_DAT) (TIV dose given by other healthcare provider codes)

31 TIVOHP_DAT Date of TIVOHP_COD Chosen record

Read codes v2 CTV3 Earliest >= QSSD 32 TIVPHARM_COD 65ED0 XaZfY AND < (ACHIEVEMENT_DAT) (TIV dose given by pharmacist codes)

35 TIVPHARM_DAT Date of TIVPHARM_COD Chosen record

ES Count rulesets

The following section shows how the Cohorts and Counts used within this ES are defined. In some instances the Cohorts are used to derive multiple Counts. In this instance Cohort 1 forms the cohort for the payment count CFLU001 and the additional counts CFLUMI007 and CFLUMI008.

Where a Count is to be used for payment it is listed as a PaymentCount i.e. PaymentCount_CFLU001 and where a Count is used to support additional reporting it will be listed as an AdditionalCount i.e. AdditionalCount_CFLUMI001.

For an explanation of the dates in this section used please refer to Point 1 of the Notes section above.

Cohort 1

Count 0.1: The number of patients aged two or three but not yet four on 1 September 2013

Rule Rule Action if true Action if false number If PAT_AGE >= 2 AND 1 Select Reject If PAT_AGE < 4

Rule 1: The aim of this rule is to identify patients who are aged two or three but not yet four on QUALITY_SERVICE_START_DAT. If a patient meets this age criteria they are added to the Cohort count, otherwise they are rejected and not added to the Cohort count.

Cohort 2

Count 0.2: The number of patients aged two on 1 September 2013

Rule Rule Action if true Action if false number

1 If PAT_AGE = 2 Select Reject

Rule 1: The aim of this rule is to identify patients who are aged two but not yet three on QUALITY_SERVICE_START_DAT. If a patient meets this age criteria they are added to the Cohort count, otherwise they are rejected and not added to the Cohort count.

Cohort 3

Count 0.3: The number of patients aged three on 1 September 2013

Rule Rule Action if true Action if false number

1 If PAT_AGE = 3 Select Reject

Rule 1: The aim of this rule is to identify patients who are aged three but not yet four on QUALITY_SERVICE_START_DAT. If a patient meets this age criteria they are added to the Cohort count, otherwise they are rejected and not added to the Cohort count.

PaymentCount_CFLU001: Monthly count of doses of seasonal influenza vaccination given to patients aged two and three but not four on 1 September 2013

PaymentCount_CFLU001: To be applied to the Cohort 1 population

Rule Rule Action if true Action if false number [If INTRANAS1_DAT < (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS2_DAT < (PAYMENTPERIODEND_DAT – 1 month)]

[If INTRANAS1_DAT < (PAYMENTPERIODEND_DAT – 1 month) AND 1 Reject Next rule If TIV1_DAT < (PAYMENTPERIODEND_DAT – 1 month)]

[If TIV1_DAT < (PAYMENTPERIODEND_DAT – 1 month) AND If TIV2_DAT < (PAYMENTPERIODEND_DAT – 1 month)]

2 [If INTRANAS1_DAT < (PAYMENTPERIODEND_DAT Reject Next rule – 1 month) AND ((If INTRANAS2_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS2_DAT < PAYMENTPERIODEND_DAT) AND If INTRANAS2_DAT < (INTRANAS1_DAT + 4 weeks)]

[If INTRANAS1_DAT < (PAYMENTPERIODEND_DAT – 1 month) AND ((If TIV1_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If TIV1_DAT < PAYMENTPERIODEND_DAT) AND If TIV1_DAT < (INTRANAS1_DAT + 4 weeks))]

[If TIV1_DAT < (PAYMENTPERIODEND_DAT – 1 month) AND ((If TIV2_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If TIV2_DAT < PAYMENTPERIODEND_DAT) AND If TIV2_DAT < (TIV1_DAT + 4 weeks))]

[If TIV1_DAT < (PAYMENTPERIODEND_DAT – 1 month) AND ((If INTRANAS1_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS1_DAT < PAYMENTPERIODEND_DAT) AND If INTRANAS1_DAT < (TIV1_DAT + 4 weeks))]

(If INTRANAS1_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS1_DAT < PAYMENTPERIODEND_DAT)

(If INTRANAS2_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS2_DAT < PAYMENTPERIODEND_DAT)

OR 3 Select Reject (If TIV1_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If TIV1_DAT < PAYMENTPERIODEND_DAT)

(If TIV2_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If TIV2_DAT < PAYMENTPERIODEND_DAT)

These rules will be used to determine payment

Rule 1: The aim of this rule is to identify if a patient has received two doses of seasonal influenza vaccination after the QUALITY_SERVICE_START_DAT but before the start of the payment period. If a patient has already received two doses within this period, regardless of

of 20 04e5fbc74f785af951509340bf9ddd40.doc Version Date:30/01/2014 length of time time between these two doses they will be rejected from the count, otherwise they are passed to the next rule.

Rule 2: The aim of this rule is to identify if a patient has received their first dose of seasonal influenza vaccine in the previous payment period then received a second dose of the vaccine in the current payment period but where there were less than four weeks between the first and the second dose being administered. If the patient meets this criteria they are rejected from the count, otherwise they are passed to the next rule.

Rule 3: The aim of this rule is to identify the number of first and second doses of seasonal influenza vaccination (intranasal or TIV) that have been administered within the period. If a patient has received either their first or second dose within the period and they are added to the payment count, otherwise they are rejected.

NOTE: The below count (PaymentCount_CFLU001a) is an additional payment count to be added to the figure given by the ‘Select’ statement of PaymentCount_CFLU001 if required. This count below will be the number of patients who have received a second dose of the vaccination within the same month as they received their first dose and where there is at least a four week gap between doses. The patient will already be counted for the first dose in PaymentCount_CFLU001 so this counts their second dose within that same month (providing this was at least four weeks from their first dose)

PaymentCount_ CFLU001a: Count of second doses given to patients within the same month but at least four weeks after the first dose

PaymentCount_CFLU001a: To be applied to the population selected by PaymentCount_CFLU001

Rule Rule Action if true Action if false number 1 [If INTRANAS1_DAT >= Select (PAYMENTPERIODEND_DAT – 1 month) Reject AND If INTRANAS1_DAT < PAYMENTPERIODEND_DAT) AND If INTRANAS2_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS2_DAT < PAYMENTPERIODEND_DAT) AND If INTRANAS2_DAT >= (INTRANAS1_DAT + 4 weeks)]

[If INTRANAS1_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS1_DAT < PAYMENTPERIODEND_DAT) AND If TIV1_DAT >= (PAYMENTPERIODEND_DAT

– 1 month) AND If TIV1_DAT < PAYMENTPERIODEND_DAT) AND If TIV1_DAT >= (INTRANAS1_DAT + 4 weeks)]

[(If TIV1_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If TIV1_DAT < PAYMENTPERIODEND_DAT) AND (If TIV2_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If TIV2_DAT < PAYMENTPERIODEND_DAT) AND If TIV2_DAT >= (TIV1_DAT + 4 weeks)]

[(If TIV1_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If TIV1_DAT < PAYMENTPERIODEND_DAT) AND If INTRANAS1_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS1_DAT < PAYMENTPERIODEND_DAT) AND If INTRANAS1_DAT >= (TIV1_DAT + 4 weeks)]

This rule will be used to determine payment

Rule 1: The aim of this rule is to identify where a patient has received a second dose of the vaccination within the same month the patient received their first dose, where there are at least four weeks between the two doses. If this criteria is met the patient will be added to the payment count, otherwise they are rejected.

Counts CFLU001 and CFLU001a are to be added together before sending as a single figure for doses administered for that month.

AdditionalCount_CFLUMI001: The number of patients aged two on 1 September 2013 who received a Fluenz vaccination within the reporting period

AdditionalCount_CFLUMI001: To be applied to the Cohort 2 population

Rule Rule Action if true Action if false number (If INTRANAS1_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS1_DAT < PAYMENTPERIODEND_DAT)

1 OR Select Reject

If INTRANAS2_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS2_DAT < PAYMENTPERIODEND_DAT)

Rule 1: The aim of this rule is to identify if the patient has received a dose of intranasal seasonal influenza vaccination (first or second) within the period (this window is defined by PAYMENTPERIODEND_DAT). If the patient did receive an intranasal seasonal influenza dose within the period they will be added to the count, otherwise they are rejected.

NOTE: This count will be used to support additional reporting and will not be used for payment

AdditionalCount_CFLUMI002: The number of patients aged two on 1 September 2013 who received a 1st dose of TIV within the reporting period

Rule Rule Action if true Action if false number If TIV1_DAT >= (PAYMENTPERIODEND_DAT – 1 month) 1 Select Reject AND If TIV1_DAT < PAYMENTPERIODEND_DAT

Rule 1: The aim of this rule is to identify if the patient has received a first dose of TIV within the period (this window is defined by PAYMENTPERIODEND_DAT). If the patient did receive a first dose of TIV within the period they will be added to the count, otherwise they are rejected.

AdditionalCount_CFLUMI003: The number of patients aged two on 1 September 2013 who received a 2nd dose of TIV within the reporting period

Rule 1: The aim of this rule is to identify if the patient has received a second dose of TIV within the period (this window is defined by PAYMENTPERIODEND_DAT). If the patient did receive a second dose of TIV within the period they will be added to the count, otherwise they are rejected.

AdditionalCount_CFLUMI004: The number of patients aged three on 1 September 2013 who received a Fluenz vaccination within the reporting period

Rule Rule Action if true Action if false number (If INTRANAS1_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS1_DAT < PAYMENTPERIODEND_DAT)

1 OR Select Reject

If INTRANAS2_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS2_DAT < PAYMENTPERIODEND_DAT)

Rule 1: The aim of this rule is to identify if the patient has received a dose of intranasal seasonal influenza vaccination (first or second) within the period (this window is defined by PAYMENTPERIODEND_DAT). If the patient did receive an intranasal seasonal influenza dose within the period they will be added to the count, otherwise they are rejected.

AdditionalCount_CFLUMI005: The number of patients aged three on 1 September 2013 who received a 1st dose of TIV within the reporting period

Rule 1: The aim of this rule is to identify if the patient has received a first dose of TIV within the period (this window is defined by PAYMENTPERIODEND_DAT). If the patient did receive a first dose of TIV within the period they will be added to the count, otherwise they are rejected.

AdditionalCount_CFLUMI006: The number of patients aged three on 1 September 2013 who received a 2nd dose of TIV within the reporting period

Rule 1: The aim of this rule is to identify if the patient has received a second dose of TIV within the period (this window is defined by PAYMENTPERIODEND_DAT). If the patient did receive a second dose of TIV within the period they will be added to the count, otherwise they are rejected.

AdditionalCount_CFLUMI007: The number of patients aged two and three but not yet four on 1 September 2013 who have not received a seasonal influenza vaccination

Rule Rule Action if true Action if false number If INTRANAS1_DAT < PAYMENTPERIODEND_DAT OR If INTRANAS2_DAT < PAYMENTPERIODEND_DAT OR If TIV1_DAT < PAYMENTPERIODEND_DAT OR If TIV2_DAT < PAYMENTPERIODEND_DAT OR 1 Reject Select If INTRANAS1OHP_DAT < PAYMENTPERIODEND_DAT OR If INTRANAS2OHP_DAT < PAYMENTPERIODEND_DAT OR If TIVOHP_DAT < PAYMENTPERIODEND_DAT OR If TIVPHARM_DAT < PAYMENTPERIODEND_DAT

Rule 1: The aim of this rule is to identify if a patient has not received a seasonal influenza vaccination (intranasal or TIV) at any point from the QUALITY_SERVICE_START_DAT up to the PAYMENTPERIODEND_DAT. If a patient has received a seasonal influenza vaccination they are rejected, otherwise they are added to the count

AdditionalCount_CFLUMI008: The number of patients aged two and three but not yet four on 1 September 2013 who have received a seasonal influenza vaccination given by another healthcare provider within the reporting period

Rule Rule Action if true Action if false number (If INTRANAS1OHP_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS1OHP_DAT < PAYMENTPERIODEND_DAT)

(If INTRANAS2OHP_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If INTRANAS2OHP_DAT < PAYMENTPERIODEND_DAT) 1 Select Reject OR

(If TIVOHP_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If TIVOHP_DAT < PAYMENTPERIODEND_DAT)

(If TIVPHARM_DAT >= (PAYMENTPERIODEND_DAT – 1 month) AND If TIVPHARM_DAT < PAYMENTPERIODEND_DAT)

Rule 1: The aim of this rule is to identify if the patient received a seasonal influenza vaccination from another healthcare provider (including pharmacists) within the period (this window is defined by PAYMENTPERIODEND_DAT). If the did receive a dose of TIV from another healthcare provider (including pharmacists) within the period they are added to the count, otherwise they are rejected.