i2b2 - GEM data load for GENVASC

Patient Request

UHLDWH.DWBRICCS.dbo.UVW_GENVASC_PATIENTS_GEM => UHLDBSQLCORP02.LLR_CSS.dbo.BRICCS_GENVASC_PATIENTS

Data Response

UHLDBSQLCORP02.LLR_CSS.dbo.Genvasc_Clinical_ReadCode => UHLDWH.DWBRICCS.dbo.Genvasc_Clinical_ReadCode

UHLDBSQLCORP02.LLR_CSS.dbo.Genvasc_Ethnic_ReadCode => UHLDWH.DWBRICCS.dbo.Genvasc_Ethnic_ReadCode

Health Check Read Codes

Field Name	Read Code v3	Concept Code
Cardiovascular disease risk assessment declined	XaN8t	HCK:0000486
Cardiovascular disease risk assessment offered	XaPl0	HCK:0000490
Informed consent given	XaLQR	HCK:0000485
Patient informed about research study	9Q...	HCK:0000466
Cigarette consumption	Ub1tI	HCK:0000470
Smoking cessation advice	Ua1Nz	HCK:0000468
Health education - smoking	6791.	HCK:0000463
Referral to smoking cessation advisor	XaItC	HCK:0000482
Not interested in stopping smoking	XaIkY	HCK:0000480
Cigar consumption	Ub1tJ	HCK:0000471
Loose tobacco consumption	Y01e6	HCK:0000999
Smoker	137R.	HCK:0000449
Ex-smoker	Ub1na	HCK:0000469
Never smoked tobacco	XE0oh	HCK:0000492
Current non-smoker	137L.	HCK:0000448
Ethnic groups (census)	9S...	HCK:0000467
- White - ethnic group	9S1..	HCK:0000088
- Other ethnic non-mixed (NMO)	9SA..	HCK:0000104
- Ethnic groups (census) NOS	9SZ..	HCK:0000123
- Mixed ethnic census group	XaFwG	HCK:0000262
- Black - ethnic group	XaFwH	HCK:0000263
- Asian - ethnic group	XaFwz	HCK:0000265
- Other ethnic group	XaFx1	HCK:0000267
Ethnic category - 2001 census	XaJQu	HCK:0000483
- British or mixed British - ethnic category 2001 census	XaJQv	HCK:0000278
- Irish - ethnic category 2001 census	XaJQw	HCK:0000279
- Other White background - ethnic category 2001 census	XaJQx	HCK:0000280
- White and Black Caribbean - ethnic category 2001 census	XaJQy	HCK:0000281
- White and Black African - ethnic category 2001 census	XaJQz	HCK:0000282
- White and Asian - ethnic category 2001 census	XaJR0	HCK:0000283
- Other Mixed background - ethnic category 2001 census	XaJR1	HCK:0000284
- Indian or British Indian - ethnic category 2001 census	XaJR2	HCK:0000285
- Pakistani or British Pakistani - ethnic category 2001 census	XaJR3	HCK:0000286
- Bangladeshi or British Bangladeshi - ethn categ 2001 census	XaJR4	HCK:0000287
- Other Asian background - ethnic category 2001 census	XaJR5	HCK:0000288
- Caribbean - ethnic category 2001 census	XaJR6	HCK:0000289
- African - ethnic category 2001 census	XaJR7	HCK:0000290
- Other Black background - ethnic category 2001 census	XaJR8	HCK:0000291
- Chinese - ethnic category 2001 census	XaJR9	HCK:0000292
- Other - ethnic category 2001 census	XaJRA	HCK:0000293
- Ethnic category not stated - 2001 census	XaJRB	HCK:0000295
FH: Cardiovascular disease 1st degree female reltve < 65 yrs	XaP9M	HCK:0000488
FH: Cardiovascular disease 1st degree male relative < 55 yrs	XaP9K	HCK:0000487
Alcohol intake	136..	HCK:0000447
Advice on alcohol consumption	Xa1dA	HCK:0000476
Enjoys light exercise	1383.	HCK:0000450
Enjoys moderate exercise	1384.	HCK:0000451
Enjoys heavy exercise	1385.	HCK:0000452
Body mass index - observation	22K..	HCK:0000455
O/E - height	229..	HCK:0000453
O/E - weight	22A..	HCK:0000454
Waist circumference	Xa041	HCK:0000475
Ideal body weight	66CB.	HCK:0000462
Advice about weight	XaADJ	HCK:0000477
Dietary advice	8CA4.	HCK:0000464
Refer to weight management programme	XaJSu	HCK:0000484
Referral to dietitian	XaBSz	HCK:0000478
Pulse rate	X773s	HCK:0000473
Pulse regular	XM02J	HCK:0000495
Pulse irregular	X76JE	HCK:0000472
O/E - Systolic BP reading	2469.	HCK:0000456
O/E - Diastolic BP reading	246A.	HCK:0000457
Fasting	X78x9	HCK:0000474
Serum cholesterol level	XE2eD	HCK:0000493
Serum HDL cholesterol level	44P5.	HCK:0000459
Serum triglyceride levels	XE2q9	HCK:0000494
Serum LDL cholesterol level	44P6.	HCK:0000460
Serum glucose level	44f..	HCK:0000458
Total cholesterol:HDL ratio	44PF.	HCK:0000461
HbA1c level (DCCT aligned)	XaERp	HCK:0000479
Cardiovascular event risk	XaIpv	HCK:0000481
Cardiovascular disease risk assessment done	XaPkZ	HCK:0000489
Follow-up arranged	8H8..	HCK:0000465
High risk of diabetes mellitus	XaZLG	HCK:0000491

Recreating the Health Check Discussion

Below are some questions with responses by Sarah-Jane Gray (in italics) about the Read Codes used to generate a QRisk Score:

• What (Read code or otherwise) do the CCG use to identify that a health check has occurred for payment purposes?

XaPkZ - Cardiovascular disease risk assessment done

• 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?

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’

• 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?

Generally with numeric, because a negative (0) can be recorded, question not being answered is not the same as a negative response.

• What audit data is available for the data completeness for health checks?

Might need more explanation on what you mean for this one J

• 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?

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.

• 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?

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.

• Is there a way to correctly identify all the values associated with a health check or QRisk calculation?

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.

• 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:
  • Ethnicity
  • Age > directly taken from patient demographic information
  • Sex > directly taken from patient demographic information
  • Smoking Status
  • Systolic blood pressure
  • Total cholesterol:HDL ratio
  • BMI
  • 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’ ?
  • Townsend deprivation score > directly taken from patient demographic information (if postcode recognised)
  • Treated hypertension > Any codes in the HYP cluster (I can provide these) with hypertension medication in <6m
  • Rhematoid arthritis > Any codes in the RARTH cluster
  • Chronic renal disease > Any codes in the CKD cluster
  • Type 2 diabetes > Codes and children of X40J5 (“Type II diabetes mellitus’)
  • Atrial fibrillation > Any codes in the AFIB cluster
  • + also ‘personal history of CVD’

• Do you know what algorithm for calculating QRisk is used in SystemOne, as this may resolve the ambiguities?

Afraid not, and I can’t see any way of obtaining this from S1 – will see if it’s available elsewhere.

Health Check Information

Information about the Health Check can be found on the ​HSCIC Health Check page. This includes a ​list of mappings for the