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| | 99 | - X40J4 Type I diabetes mellitus |
| | 100 | - Xa4g7 Unstable type I diabetes mellitus |
| | 101 | - X40JY Insulin-dependent diabetes mellitus secretory diarrhoea synd |
| | 102 | - C1080 Type I diabetes mellitus with renal complications |
| | 103 | - C1081 Type I diabetes mellitus with ophthalmic complications |
| | 104 | - C1082 Type I diabetes mellitus with neurological complications |
| | 105 | - C1083 Type I diabetes mellitus with multiple complications |
| | 106 | - C1085 Type I diabetes mellitus with ulcer |
| | 107 | - C1086 Type I diabetes mellitus with gangrene |
| | 108 | - C1088 Type I diabetes mellitus - poor control |
| | 109 | - C1089 Type I diabetes mellitus maturity onset |
| | 110 | - XaELP Type I diabetes mellitus without complication |
| | 111 | - XaFWG Type I diabetes mellitus with hypoglycaemic coma |
| | 112 | - XaFmK Type I diabetes mellitus with peripheral angiopathy |
| | 113 | - XaFmL Type I diabetes mellitus with arthropathy |
| | 114 | - XaFmM Type I diabetes mellitus with neuropathic arthropathy |
| | 115 | - XaEnn Type I diabetes mellitus with mononeuropathy |
| | 116 | - XaEno Type I diabetes mellitus with polyneuropathy |
| | 117 | - XaKyW Type 1 diabetes mellitus with gastroparesis |
| | 118 | - C1087 Type I diabetes mellitus with retinopathy |
| | 119 | - XaF04 Type I diabetes mellitus with nephropathy |
| | 120 | - XaFm8 Type I diabetes mellitus with diabetic cataract |
| | 121 | - XaIzM Type 1 diabetes mellitus with persistent proteinuria |
| | 122 | - XaIzN Type 1 diabetes mellitus with persistent microalbuminuria |
| | 123 | - XaJSr Type 1 diabetes mellitus with exudative maculopathy |
| | 124 | - C1010 Type 1 diabetes mellitus with ketoacidosis |
| | 125 | - C1030 Type 1 diabetes mellitus with ketoacidotic coma |
| | 126 | - XM1Xk Xa4g7 Xa4g7 Unstable type I diabetes mellitus |
| | 127 | - XM1Xk C1088 C1088 Type I diabetes mellitus - poor control |
| 142 | | |
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| | 131 | - C10.. Diabetes mellitus |
| | 132 | - XaOPu Latent autoimmune diabetes mellitus in adult |
| | 133 | - X40JA Secondary diabetes mellitus |
| | 134 | - XaMzI Cystic fibrosis related diabetes mellitus |
| | 135 | - X40JB Secondary pancreatic diabetes mellitus |
| | 136 | - X40JC Secondary endocrine diabetes mellitus |
| | 137 | - XSETK Drug-induced diabetes mellitus |
| | 138 | - XaJlR Secondary diabetes mellitus without complication |
| | 139 | - XaJUI Diabetes mellitus induced by non-steroid drugs |
| | 140 | - XaJlM DM induced by non-steroid drugs without complication |
| | 141 | - XaJlL Secondary pancreatic diabetes mellitus without complication |
| | 142 | - X40JG Genetic syndromes of diabetes mellitus |
| | 143 | - X40JI Diabetes mellitus autosomal dominant |
| | 144 | - X40JO Congenital lipoatrophic diabetes |
| | 145 | - X40JS Hyperproinsulinemia |
| | 146 | - XSETH Maturity onset diabetes mellitus in young |
| | 147 | - X40JZ Diabetes-deafness syndrome maternally transmitted |
| | 148 | - XSETp Diabetes mellitus due to insulin receptor antibodies |
| | 149 | - XM1Xk Unstable diabetes |
| | 150 | - X008t Diab insipidus,diab mell,optic atrophy and deafness |
| 177 | | Below are some questions with responses by Sarah-Jane Gray (in italics) about the Read Codes used to generate a QRisk Score: |
| 178 | | |
| 179 | | - What (Read code or otherwise) do the CCG use to identify that a health check has occurred for payment purposes? |
| 180 | | ''XaPkZ - Cardiovascular disease risk assessment done'' |
| 181 | | |
| 182 | | - For questions where the answer is a tick box (yes/no) is there a way to differentiate for all cases between an answer of ‘no’ / unticked and the question not being answered? |
| 183 | | ''No – one of the drawbacks of the system in terms of data gathering is that the read codes are for a positive response and rarely a negative. Tickbox indicates a ‘yes’ response to that question but absence of a tick could be either ‘no’ or ‘not applicable / not asked’'' |
| 184 | | |
| 185 | | - Similarly, for questions where the answer is a number, is there a way to differentiate for all cases between an answer of zero and the question not being answered? |
| 186 | | ''Generally with numeric, because a negative (0) can be recorded, question not being answered is not the same as a negative response.'' |
| 187 | | |
| 188 | | - What audit data is available for the data completeness for health checks? |
| 189 | | ''Might need more explanation on what you mean for this one J'' |
| 190 | | |
| 191 | | - For calculations such as QRisk or BMI, is it possible for the health check form to be filled in such a way that they are not calculated? |
| 192 | | ''Yes. These should be recorded as part of a health check but there is the possibility (particularly with QRISK being a tool external to the template which ‘pops up’) but it is possible to complete the template without calculating these.'' |
| 193 | | |
| 194 | | - For calculations such as QRisk or BMI, is it possible for the calculation to be based on historic data? Is there a limit to how old that data can be? |
| 195 | | ''Yes. This is generally the most recent reading in the last 5yrs except ‘treated for hypertension’ in QRISK which needs to be hypertension diagnosis (any time) but hyp meds prescribed within last 6 months of the calculation. For BMI/BP, if nothing is recorded then a default value considering the patient’s age, sex and ethnicity is calculated.'' |
| 196 | | |
| 197 | | - Is there a way to correctly identify all the values associated with a health check or QRisk calculation? |
| 198 | | ''Not easily. We can produce a template specification for the NHS Health Check template which lists all the codes used (this is what you attached to the original email) but not for the QRISK calculation.'' |
| 199 | | |
| 200 | | |
| 201 | | - In addition, we want to make sure that we have all the information that was used to calculate the QRisk score. From what I can gather, the following fields are required for this calculation: |
| 202 | | - Ethnicity |
| 203 | | - Age > ''directly taken from patient demographic information'' |
| 204 | | - Sex > ''directly taken from patient demographic information'' |
| 205 | | - Smoking Status |
| 206 | | - Systolic blood pressure |
| 207 | | - Total cholesterol:HDL ratio |
| 208 | | - BMI |
| 209 | | - Family History of CHD in 1st degree relative under 60 > ''both codes used in the template will mark this as positive. On S1 is just ‘Family history of CVD’ ?'' |
| 210 | | - Townsend deprivation score > ''directly taken from patient demographic information (if postcode recognised)'' |
| 211 | | - Treated hypertension > ''Any codes in the HYP cluster (I can provide these) with hypertension medication in <6m'' |
| 212 | | - Rhematoid arthritis > ''Any codes in the RARTH cluster'' |
| 213 | | - Chronic renal disease > ''Any codes in the CKD cluster'' |
| 214 | | - Type 2 diabetes > ''Codes and children of X40J5 (“Type II diabetes mellitus’)'' |
| 215 | | - Atrial fibrillation > ''Any codes in the AFIB cluster'' |
| 216 | | - ''+ also ‘personal history of CVD’'' |
| 217 | | |
| 218 | | - Do you know what algorithm for calculating QRisk is used in SystemOne, as this may resolve the ambiguities? |
| 219 | | ''Afraid not, and I can’t see any way of obtaining this from S1 – will see if it’s available elsewhere.'' |
| 220 | | |
| 221 | | |
| 222 | | == Health Check Information |
| 223 | | |
| 224 | | Information about the Health Check can be found on the [[http://www.hscic.gov.uk/nhshealthcheck|HSCIC Health Check]] page. This includes a [[http://www.hscic.gov.uk/media/9445/NHS-Health-Check---Read-Code-Mapping-Guidance-XLS-396kb/xls/NHS_Health_Check_-_Read_Code_Mapping_Guidance.xls|list of mappings]] for the codes between Read v2 and v3. |
| 225 | | |
| 226 | | == Primary Care Medication Coding |
| 227 | | |
| 228 | | After speaking to Stephanie Webb, I have gleaned the following information about primary care medication data: |
| 229 | | |
| 230 | | - It is extracted from System One and EMIS into the GEM data warehouse |
| 231 | | - System One data is ''probably'' in Read Code format. |
| 232 | | - EMIS is ''probably'' not, but don't know what format it is in. |
| 233 | | |
| 234 | | == Patient Post Codes |
| 235 | | |
| 236 | | After speaking to Stephanie Webb, I have gleaned the following information about patient post codes data. |
| 237 | | |
| 238 | | - Post code data is not historic, only current post code data is recorded. |
| 239 | | - GEM do not get post code data from the primary care IT systems, but get the information from the Exeter database. |
| 240 | | - It may be possible to get the data from System One and EMIS, but this would involve an additional charge. |
| 241 | | |
| 242 | | == Issues |
| 243 | | |
| 244 | | 1. Missing Hypertension codes |
| 245 | | |
| 246 | | I (RB) am still unclear which coding system is being used. Therefore I am going to submit the codes from DM+D, Read CTV3, ATC code and BNF code and see what comes back. |
| 247 | | |
| 248 | | 2. Missing Diabetes Type 1 codes |
| 249 | | |
| 250 | | The paper in the BMJ says that the QRisk2 algorithm uses a diagnosis of diabetes type 1, but not type 2. However, the QRisk2 batch processor accepts a parameter for diabetes type 1 and this affects the result. Therefore, I (RB) have got to submit the Type 1 codes above, but keep them separated. |
| 251 | | |
| 252 | | I have sought clarification from Stephen Hippisley-Cox at ClinRisk about why this requirement has changed. |
| 253 | | |
| 254 | | 3. Missing Similar Codes |
| 255 | | |
| 256 | | It has become clear that we need to expand the codes used to define certain values (eg, blood pressure) to include other codes that we have yet been requesting. This will have to be done by manually searching the Read Code hierarchy. |
| 257 | | |
| 258 | | I have asked Sarah-Jane to post a question on the SystemOne User Forum to see if we can get a definitive list of codes that are used. |
| 259 | | |
| 260 | | I have been sent a link to the codes that ClinRisk suggest by Stephen Hippisley-Cox. http://qrisk.org/QRISK2-2013-Code-Lists.pdf |
| 261 | | |
| 262 | | 4. Historic diagnosis |
| 263 | | |
| 264 | | I think that we need to ignore the ''window'' when it comes to diagnoses. This needs to be confirmed by Prof. |
| 265 | | |
| 266 | | 5. Differing versions of the QRisk2 algorithm |
| 267 | | |
| 268 | | Sarah-Jane has posted a question on the SystemOne user forum asking which version they use. |
| 269 | | |
| 270 | | 6. Discrepancies between SystemOne and ClinRisk QRisk2 calculation tools |
| 271 | | |
| 272 | | The SystemOne QRisk2 calculation tool has some differences to the ClinRisk tool. Instead of separating diabetes into types 1 and 2, it just has a tick box for diabetes. Also, it has a tick box for 'personal history of CVD' that is not present on the ClinRisk QRisk2 calculations tools. |
| 273 | | |
| 274 | | I have asked Sarah-Jane to post a question on the SystemOne user forum asking what differences this will make to the result. |
| | 164 | ''XaPkZ - Cardiovascular disease risk assessment done' |
