The input model consists of a list of requested engines and a set of variables with values as described in the below table. The table describes the various parameters and their derivation and relevance to each algorithm
For application providers that wish to calculate the defaults, a set of value sets are available either via the REST API or via the Endeavour Predict Information manager application, both of which use the EP ontology server.
For example for QRISK3 the sets can be viewed at https://im.endeavourhealth.net/#/directory/folder/http:%2F%2Fapiqcodes.org%2Fqcodes%23QPredict_331
Each concept set is universally identified with an RDF IRI (which is in the format of a URL) and the base iri namespace for Q concept sets is
"http://apiqcodes.org/qcodes#QCodeGroup_" thus in the below table the numbers following this base IRI are used for brevity
When querying records it is assumed that a reference date is used and that entry dates are relative to the reference date and that any entry after the reference date is ignored.
Input parameters needed to calculate a QRISK3® score and their handling are as follows:
| Parameter | Type | Values | Algorithms | Description and query definition |
|---|---|---|---|---|
| Row id | integer | All | Used by the client as a reference when a batch API is used. i.e. returned by the result.
It has no scope beyond the API request/response | |
| Age | integer | All | Age of the person in years at the reference date | |
| Gender | Character | Male - M
Female - F |
All | The Gender of the patient. Note that the risk following gender
transition is unknown, and thus a clinical judgement as to whether to use the category of male or category of female. |
| Cardiovascular disease | boolean | true
false |
QRISK3 | Cardiovascular disease prior to the reference date
This is an inclusion criteria and should therefore be false. A valid RISK score requires absence of cardiovascular disease. Query defined as Condition with concept of code group 411 |
| Atrial fibrillation | boolean | true
false |
QRISK3 | Atrial fibrillation at any time prior to reference date.
QRisk does not differentiate a single one off AF event from chronic or intermittent AF. Clinical interpretation may be required for those with a single event many years ago. Query defined as Observation with concept of code group 24 |
| Erectile impotence | boolean | true
false |
QRISK3 | A diagnosis of Erectile dysfunction or at least 2 prescriptions for drugs for dysfunction, one of which is within 28 days
Note that this factor is associated with a diagnosis as recorded in GP health records, and may or may not be valid as a response to a question. Query defined as Condition with code group 59, or (Drugs such as Alprostadil, Tadalafil, Sildenafil, Vardenafil, Avanafil, Yohimbine, Aviptadil), the latest of which is within the last 28 days |
| Atypical anti psychotics | boolean | true or false | QRISK3 | Second generation ‘atypical’ antipsychotic - prescribed two or more issues in the previous 6 months (includes amisulpride, aripiprazole, clozapine, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, sertindole, or zotepine). Query defined as
2 or more Prescriptions for code group 1169 within the last 6 months |
| Systemic corticosteriods | boolean | true or false | QRISK3 | Patient taking systemic corticosteroids. Query definition
2 or more prescriptions for oral corticosteroids such as Hydrocortisone, Betamethasone, Deflazacort, Dexamethasone, Methylprednisolone, Prednisolone |
| Migraine | boolean | true or false | QRISK3 | Diagnosis of migraine i.e. a diagnosis of migraine recorded in health records. Self reported migraines not resulting in a health record entered diagnosis is not evaluated. Query definition
Condition with concept group 39 |
| Rheumatoid arthritis | boolean | true or false | QRISK3 | Diagnosis of Rheumatoid arthritis. Query definition is
Condition with concept group 58 |
| Chronic renal disease | boolean | true or false | QRISK3 | Diagnosis of chronic renal disease. Query definition is:
Condition with concept group of 322 |
| Severe mental Illness | boolean | true or false | QRISK3 | Diagnosis of severe mental illness (psychosis, severe depression, manic depression, schizophrenia). Query definition is
Condition with concept group 3187 |
| Systemic lupus erythematosus | boolean | true or false | QRISK3 | Diagnosis of Systemic Lupus erythematosus. Query definition is :
Condition with code group 70 |
| Treated hypertension | boolean | true or false | QRISK3 | Diagnosis of hypertension at any time in the patient’s records AND On antihypertensive treatment if 1 or more prescriptions within the last 6 months. Query definition as follows
Condition with concept group 21, and 1 or more Prescriptions for anti hypertensive drugs within the last 6 months |
| Body mass index | double | QRISK3 | The most recently recorded body mass index within the last 5 years. Query definition is
Latest Observation with code group 200 within the last 5 years Out of range values handled by the engine are <18 is set to 18, >47 is set to 47 | |
| Diabetes Category | Enumerated | None, type1, type2 | QRISK3 | Diagnosis of diabetes mapped to a category. Note that resolved diabetes or well controlled diabetes) is not accounted for in the algorithm. Judgement should be used as to how the risk is applied. Query definition as follows
From latest diagnosis of code groups 1913,2411 Map code group 1913 Type1, Map code group 2411 Type2 |
| Ethnicity | Enumerated | NotRecorded, British, Irish, OtherWhiteBackground, WhiteAndBlackCaribbeanMixed, WhiteAndBlackAfricanMixed, WhiteAndAsianMixed, OtherMixed, Indian, Pakistani, Bangladeshi, OtherAsian,Caribbean, BlackAfrican,OtherBlack, Chinese,OtherEthnicGroup, NotStated | QRISK3 | Most recent ethnicity. Query definition is
latest entry for code groups 17071, 17072, 17073, 17074, 17075,17076, 17077, 17089, 17079, 17080, 17081, 17090, 17985,17086, 17087) Maps 17071 White british, 17072 White Irish, 17073 Other White Background 17074 White & Black Caribbean 17075 White & Black African 17076 White & Asian 17077 other mixed 17089 Indian 17079 Pakistani 17080 Bangladeshi 17081 Other Asian 17090 Caribbean 17083 Black African 17091 Other Black 17985 Chinese 17086 Other ethnic group qr:17087 Not stated and not classified |
| Family history of Coronary heart disease | boolean | true or false | QRISK3 | Family history of coronary heart disease in a first degree relative under the age of 60 years. Query definition is
Entry for concept group 404 |
| Total cholesterol HDL ratio | double | QRISK3 | The latest ratio of total serum cholesterol/HDL recorded in the last 5 years. The ratio is either directly directly recorded can be calculated using total cholesterol divided by hdl. Query definition is:
latest Observation with concept group 16 (TC) Latest concept group 367 (HDL)
then value= TCHDL numeric value else if TC effective date > TCHDL AND HDL effective date >TCHDL effective date
else value = null
| |
| Smoking category | Enumerated | NonSmoker, ExSmoker,
LightSmoker, ModerateSmoker, HeavySmoker, NotKnown |
QRISK3 | The most recently recorded smoking status with 5 levels
This categorisation has one group for ex-smokers rather than trying to distinguish between ex light, ex moderate and ex heavy smokers. This categorisation does not distinguish between cigarette/cigar and pipe smokers Special consideration should be given to records that contain both numeric values for the number of cigarettes smoked, and concepts that categorise into light moderate or heavy. The logic on non smoker is that from the entry of the most recent if it has a numeric value or if there other codes on the same day with numerics take the numeric value on the same day as the most recent, unless the most recent is non smoker Query definition is Observation with concept group,2239 -(NONE), 2238 (EX) 2244 (LIGHT), 2242 (MODERATE),2243 (HEAVY) as ENTRIES GET latest from ENTRIES with Numeric Value >0 (LATESTWITHVALUE) GET latest from ENTRIES (LATESTSMOKING) IF Date of LATESTWITHVALUE == Date of LATESTSMOKING use SmokingValueMap ELSE nbsp; use Smoking concept group Map
2239 None smoker 2238 Ex Smoker 2244 light smoker 2242 Moderate smoker 2243 Heavy smoker Numeric value map 0-9 Light Smoker 10-19 Moderate smoker >=20 Heavy smoker |
| Systolic blood pressure | integer | QRISK3 | The most recent systolic blood pressure within 5 years. Query definition is
Handling of values out of range <70 is set to 70, >210 is set to 210 | |
| Standard deviation of systolic blood pressures | double | QRISK3 | The SAMPLE style Standard deviation of all of the available systolic blood pressures prior to the reference date recorded in the last 5 years. Note that EP QRISK3 will calculate the spb 5 from a list of values. Query definition is
Observation with concept group 198 and numerivc value not null
| |
| Townsend score | double | QRISK3 | The Townsend score associated with the output area of a patient’s postcode based on the 2001 census data.
Available via API Default handling of unknown is 0 (the mean of the national scores) |