Author / HSCIC–SDS team / Version No / 2.3 / Version Date / 30/01/2014
New GMS Contract Implementation
Dataset and Business Rules
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Rotavirus DES
Rotavirus DES_v2.3_monthly / Version Date: 30/01/2014Amendment History:
Version / Date / Amendment History0.1 / 21st January 2013 / First draft by HSCIC
0.2 / 7th February 2013 / Second draft by HSCIC following additional information
0.3 / 18th February 2013 / Third draft by HSCIC using start dates and BASELINE DATE. Focuses only on payment and not on additional counts
0.4 / 28th February 2013 / Fourth draft by HSCIC to add in the additional counts
0.5 / 25th March 2013 / Fifth draft by HSCIC to add in the read codes released in march 2013 release
1.0 / 2nd April 2013 / Final version by HSCIC to clarify details
1.1 / 3rd April 2013 / Specification updated following further discussions around counts required
1.2 / 5th April 2013 / Specification amended to update ROTAVACEXC_COD
1.3 / 8th April 2013 / Specification updated following discussion around use of date criteria
1.4 / 19th April 2013 / Specification updated following further discussions around counts
1.5 / 23rd April 2013 / Specification updated following meeting
1.6 / 2nd May 2013 / Specification updated following teleconference
1.7 / 8th May 2013 / Specification updated following discussions
2.0 / 8th May 2013 / Tracked changes accepted
2.1 / 22nd May 2013 / Updated for publication
2.2 / 13th September 2013 / Count IDs/wording update
2.3 / 30th January 2014 / Updated following October 2013 code release and review
Dataset and business rules – Rotavirus DES
Notes
1)Dates used:
- ACHIEVEMENT_DAT: The date up to which patient information is considered when determining the output for each extraction.
- 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.
- QUALITY_SERVICE_START_DAT (QSSD): The start of the period during which a GP Practice provides the Quality Service
- 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 DES is 01.07.2013
The QUALITY_SERVICE_END_DAT (QSED) for this DES is 01.04.2014
2)Clinical codes quoted are (where known) from the October2013 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:
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Rotavirus DES_v2.3_monthly / Version Date: 30/01/2014a)> (greater than)
b)< (less than)
c)= (equal to)
d)≠ (not equal to)
e)AND
f)OR
g)NOT
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Rotavirus DES_v2.3_monthly / Version Date: 30/01/20145)Where date criteria are specified with intervals of multiples of months or years these should be interpreted as calendar months or calendar years.
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Rotavirus DES_v2.3_monthly / Version Date: 30/01/2014Dataset Specification
1)Patient selection criteria:
a)Registration status
Current registration status / Qualifying criteriaCurrently 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)
b)Diagnostic code status
2)Clinical data extraction criteria
Field Number / Field name / Data item / Qualifying criteria1 / pat_id / Patient ID number / Unconditional
2 / reg_dat / Date of patient registration / Latest < ACHIEVEMENT_DAT
3 / PAT_AGE / Patient age (months) at ACHIEVEMENT_DAT / Unconditional
4 / PAT_DOB / Patients date of birth / Unconditional
5 / ROTAVAC1_COD / Read codes v2 / CTV3 / Earliest ACHIEVEMENT_DAT
65d0. / Xaa9n
(Rotavirus vaccination 1st dose given codes)
6 / ROTAVAC1_DAT / Date of ROTAVAC1_COD / Chosen record
7 / ROTAVAC2_COD / Read codes v2 / CTV3 / Earliest < ACHIEVEMENT_DAT
65d1. / Xaa9o
(Rotavirus vaccination 2nd dose given codes)
8 / ROTAVAC2_DAT / Date of ROTAVAC2_COD / Chosen record
9 / ROTAVACEXC_COD / Read codes v2 / CTV3 / Earliest < ACHIEVEMENT_DAT
68Nw.
8I2s.
8IEm.
9Nih.
9Nii.
8IEm0
8IEm1
14L50
U60K5 / Xaa9s
XaaBo
XaaBn
Xaa9q
Xaa9r
XaaWN
XaaWO
Xaait
XaadN
(Rotavirus vaccination exception reporting codes)
10 / ROTAVACEXC_DAT / Date of ROTAVACEXC_COD / Chosen record
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Rotavirus DES_v2.3_monthly / Version Date: 30/01/2014DES countrulesets
The following section shows how the Cohorts and Counts used within this DES are defined. In some instances the Cohorts are used to derive multiple Counts. For example, Cohort2 forms the cohort for the derived counts AdditionalCounts RotaMI001, RotaMI002, RotaMI003 and RotaMI004. Where a Count is to be used for payment it is listed as a PaymentCount i.e. PaymentCount_Rota001 and where a Count is used to support additional reporting it will be listed as an AdditionalCount i.e. AdditionalCount_RotaMI001.
For an explanation of the dates in this section used please refer to Point 1 of the Notes section above.
Cohort 1
Count_ROTADES0.1: The number of the contractors registered patients under 7 months old (at ACHIEVEMENT_DAT) whose clinical notes include a record of the 1st dose of rotavirus immunisation being given from 6 weeks old.
Rule number / Rule / Action if true / Action if false1 / If PAT_AGE < 7 months
AND
If ROTAVAC1_DAT >= (PAT_DOB + 6 weeks) / Next rule / Reject
2 / If ROTAVAC2_DATQSSD / Reject / Select
Rule 1: The aim of this rule is to identify patients under 7 months old (at ACHIEVEMENT_DAT) who have received their 1st dose of Rotavirus vaccination from 6 weeks old. If the patient is under 7 months old and have received the 1st dose of Rotavirus vaccination from 6 weeks old they are passed on to the next rule. Otherwise the patient is rejected and not included in the Cohort count.
Rule 2: The aim of this rule is to identify patients who have received the 2nd dose of their Rotavirus vaccination before the QUALITY_SERVICE_START_DAT (QSSD). If the patient has received the 2nd dose of their Rotavirus vaccination prior to this date then they are rejected and not included in the Cohort count. Otherwise, they are added to the Cohort count.
Please note: At present this will produce a count which is not directly useful but allows thePaymentCount_Rota001 (see below) to operate:
The reason is that this cohort will be patients who, within that month, are aged less than 7 months old and who had their 1st rotavirus vaccination 6 weeks or more after their birth. Patients will drop out once they reach 7 months and new births will be added each time it runs (monthly) so the patient cohort could be different each month. A patient will stay in this cohort even if they have received their 2nd dose in a previous month until they reach 7 months of age. Rule 2 is used to exclude patients who have received their 2nd dose of rotavirus before the QUALITY_SERVICE_START_DATE (QSSD) of 1st July 2013
PaymentCount_Rota001 will then use this cohort to identify the subset of patients who successfully have their 2nd dose in the correct period and are therefore eligible for payment purposes.
Cohort 2
Count_ROTADES0.2: The number of the contractors registered patients who attain 6 months old within the month
Rule number / Rule / Action if true / Action if false1 / If PAT_AGE = 6 months / Select / Reject
Rule 1: The aim of this rule is to identify patients who attain the age of 6 months within the month. If a patient attains 6 months old within this month they are added to the Cohort count, otherwise the patient is rejected and not included in the Cohort count.
Note: This cohort is fluid. A patient will only appear in this cohort count for one month which will be the month they turn 6 months old.
PaymentCount_Rota001:The number of the contractors registered patients whose clinical notes include a record of completed rotavirus immunisation being given before 6 months of age in the financial year
PaymentCount ruleset: To be applied to the above Cohort 1 population
Rule number / Rule / Action if true / Action if false1 / If ROTAVAC2_DAT= (ROTAVAC1_DAT + 4 weeks) / Next rule / Reject
2 / If ROTAVAC2_DAT >= (PAT_DOB + 6 months) / Reject / Next rule
3 / If ROTAVAC2_DAT >= (PAYMENTPERIODEND_DAT – 1 month) / Select / Reject
These rules will be used to determine payment
Rule 1: The aim of this rule is to identify patients included in Cohort 1who have received the 2nd dose of their Rotavirus vaccination at least 4 weeks after their 1st dose of Rotavirus vaccination. If the patient meets this criteria they are passed on to the next rule otherwise the patient is rejected from this count.
Rule 2: The aim of this rule is to identify if the patient received their 2nd dose of the Rotavirus vaccination on or after when they attained the age of 6 months old. If the patient did receive the 2nd dose of the Rotavirus after they attained the age of 6 months old they are rejected from this count, otherwise the patient is passed on to the next rule
Rule 3: The aim of this rule is identify if the patient received the 2nd dose of the Rotavirus vaccination within the period (this window is defined by the PAYMENTPERIODEND_DAT). If the patient did receive the 2nd dose of Rotavirus vaccination within this period they are added to the count, otherwise they are not included in the payment count.
AdditionalCount_RotaMI001: The number of contractors registered patients who attain the age of 6 months old within the period whose clinical notes suggest the patient has received the 1st dose of rotavirus vaccination (anytime from 6 weeks after their birth) but have not received a 2nd completing dose of rotavirus immunisation.
AdditionalCount ruleset: To be applied to the above Cohort 2 population
Rule number / Rule / Action if true / Action if false1 / If ROTAVACEXC_DAT ≠ Null / Reject / Next rule
2 / If ROTAVAC1_DAT >= (PAT_DOB + 6 weeks)
AND
If ROTAVAC2_DAT = Null / Select / Reject
Rule 1: The aim of this rule is to identify patients included in Cohort 2 who have a valid Rotavirus exception code recorded. If the patient does have an exception code recorded they are rejected and not included in the count, otherwise they are passed on to the next rule.
Rule 2: The aim of this rule to identify patients who received their 1st dose of the Rotavirus vaccination from 6 weeks old and who have not received a 2nd dose of Rotavirus vaccination. If the patient meets this criteria they are added to the count, otherwise they are rejected and not included in this count.
NOTE: This count will be used to support additional reporting and will not be used for payment
AdditionalCount_RotaMI002: The number of patients who attain the age of 6 months old within the period whose clinical notes suggest the patient has received the 1st dose of rotavirus vaccination (anytime from 6 weeks after their birth) and have received a 2nd dose but this 2nd dose has been given within 4 weeks of the 1st dose.
AdditionalCount ruleset: To be applied to the above Cohort 2 population
Rule number / Rule / Action if true / Action if false1 / If ROTAVACEXC_DAT ≠ Null / Reject / Next rule
2 / If ROTAVAC1_DAT >= (PAT_DOB + 6 weeks)
AND
If ROTAVAC2_DAT < (ROTAVAC1_DAT + 4 weeks)) / Select / Reject
Rule 1: The aim of this rule is to identify patients included in Cohort 2 who have a valid Rotavirus exception code recorded. If the patient does have an exception code recorded they are rejected and not included in the count, otherwise they are passed on to the next rule.
Rule 2: The aim of this rule is to identify patients who received their 1st dose of Rotavirus vaccination from 6 weeks old and received their 2nd dose of Rotavirus vaccination within 4 weeks of their 1st dose. If the patient meets this criteria they are added to the count, otherwise they are rejected and not included in this count.
NOTE: This count will be used to support additional reporting and will not be used for payment
AdditionalCount_RotaMI003:The number of contractors registered patients who attain the age of 6 months old within the period whose clinical notes suggest the patient has received the 2nd dose of rotavirus vaccination but has not received the 1st dose
AdditionalCount ruleset: To be applied to the above Cohort 2 population
Rule number / Rule / Action if true / Action if false1 / If ROTAVACEXC_DAT ≠ Null / Reject / Next rule
2 / If ROTAVAC2_DAT ≠ Null
AND
If ROTAVAC1_DAT = Null / Select / Reject
Rule 1: The aim of this rule is to identify patients included in Cohort 2 who have a valid Rotavirus exception code recorded. If the patient does have an exception code recorded they are rejected and not included in the count, otherwise they are passed on to the next rule.
Rule 2: The aim of this rule is to identify patients who have received a 2nd dose of the Rotavirus vaccination but who who have not received a 1st dose. If the 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 additional reporting and will not be used for payment
AdditionalCount_RotaMI004: The number of contractors registered patients who attain the age of 6 months old within the period with no rotavirus immunisation (either a record that indicates the vaccination was declined/contraindicated or that there is neither a 1st nor 2nd dose of the vaccination)
AdditionalCount ruleset: To be applied to the above Cohort 2 population
Rule number / Rule / Action if true / Action if false1 / If ROTAVACEXC_DAT ≠ Null
OR
(If ROTAVAC2_DAT = Null
AND
If ROTAVAC1_DAT = Null) / Select / Reject
Rule 1: The aim of this rule is to identify patients included in Cohort 2 who either have a valid Rotavirus exception code recorded OR who have no record of a 1st and 2nd dose of the Rotavirus vaccinations. If the patient meets either of the two above criteria they are added to the count, otherwise they are rejected and not included in this count.
NOTE: This count will be used to support additional reporting and will not be used for payment
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