QRISK3: Difference between revisions

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It is strongly recommended that for any individual decision, or potential entry of the risk score in the record, that each set of assumptions are confirmed. Purely automated calculations may be used for population based risk stratification in order to plan interventions.
It is strongly recommended that for any individual decision, or potential entry of the risk score in the record, that each set of assumptions are confirmed. Purely automated calculations may be used for population based risk stratification in order to plan interventions.


== Patient inclusion criteria ==
=== Reference date ===
Scores may be calculated retrospectively. The reference date (current date or past date) is used for all values i.e. what those values were on the reference date. For example when looking for dates within 6 months this means 6 months prior to a reference date
 
=== Patient inclusion criteria ===
This section documents the criteria for a person suitable for the application of QRISK3
This section documents the criteria for a person suitable for the application of QRISK3


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• Free from a diagnosis of cardiovascular disease on or before the reference date
• Free from a diagnosis of cardiovascular disease on or before the reference date


== Variables and function parameters ==
=== Variables and function parameters ===
QRISK® operates as a function whose parameters represent independent variables. The values of those variables, when used in the algorithm are derived in one of two ways
QRISK® operates as a function whose parameters represent independent variables. The values of those variables, when used in the algorithm are derived in one of two ways


Line 36: Line 39:


Input parameters needed to calculate a QRISK3® score and their handling are as follows:
Input parameters needed to calculate a QRISK3® score and their handling are as follows:
{| class="wikitable"
|+
!Parameter
!Data type
!description
!Values
!Concept Sets   
!Rules
!Missing or out of range adjustments
|-
|row number
|integer
|An id that is returned in the result in order to reconcile with the client.
Its scope relates only to the specific request response and thus only relevant for bulk calculation
|
|
|
|
|-
|age
|Integer
|Patients age in years on the refence date
|
|
|
|Reject if missing
|-
|gender
|Character
|Patient gender of male or female.
|M or F
|
|
|Reject if missing
Binary values only accepted. QRISK does not have information on transgender or indeterminate gender risks at this stage. It is the responsibility of the requester as to whether to apply the higher risk M gender e.g. For Trans Women
|-
|cvd
|boolean
|Cardiovascular disease prior to the reference date
|1 or 0
|??
|Any entry  effective Date < reference date
|Reject if true.
Whilst the patient is not suitable for a score , this parameter is supported as a second line assurance
|-
|af
|boolean
|Atrial fibrillation at any time prior to reference date.
|1 or 0
|qr:24
|
|Assumes 0 by default
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.
|-
|atypicalantipsychotics
|boolean
|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)
|1 or 0
|qr:1169
|Medication requests,  effective date within 6 months prior to reference date
Count (entry)>=2
|Assumes 0 by default.
|-
|corticosteroids
|boolean
|systemic corticosteroids –prescribed two or more issues in the previous 6 months
|1 or 0
|qr:1194
|Medication requests,  effective date within 6 months prior to reference date
Count (entry)>=2
|Assumes 0 be default
|-
|migraine
|boolean
|Diagnosis of migraine prior to the reference date
39
|1 or 0
|qr:39
|any effective  prior to reference date
|Assumes 0 by default
|-
|rheumatoidArthritis
|boolean
|Diagnosis of Rheumatoid arthritis prior to the reference date
|1 or 0
|qr:58
|any effective date prior to the reference date
|Assumes 0 by default
|-
|renal
|boolean
|Chronic renal disease at any time prior to the refernce date
|1 or 0
|qr:322
|any effective date prior to the reference date
|Assumes 0 be default
|-
|severementalIllness
|boolean
|Diagnosis of severe mental illness (psychosis, severe depression, manic depression, schizophrenia) at any time prior to the refernce date
|1 or 0
|qr:3187
|any effective date prior to the reference date
|Assumes 0 to be default
|-
|sle
|boolean
|Diagnosis of systemic lupus erythematosis at any time prior to the reference date
|1 or 0
|qr:70
|any effective date prior to the reference date
|Assumes 0 to be default
|-
|treatedHypertension
|boolean
|diagnosis of hypertension at any time in the patient’s records AND On antihypertensive treatment if 1 or more  medication requests within  6 months prior to the reference date.
|1 or 0
|(hypertension  qr:21)
(medication
qr:740
qr:751
qr:759
qr:760
qr:765
to be revised)
|(hypertension effective date prior to refence date)
and
(Medication requests,  effective date within 6 months prior to reference date
|Assumes 0 by default
|-
|bmi
|double
|The most recently recorded body mass index for the patient recorded prior to the search date recorded in the last 5 years.
|
|qr:200
|effective date within 5 years prior to reference date.
Latest entry,
numeric value
|<18 is set to 18
>47 is set to 47
if null uses estimate value
|-
|diabetesCategory
|integer
|categorical variable to denote no diabetes, type 1 diabetes or type 2 diabetes diagnosed at any time prior to the refernce ate and
|0 or 1 or 2 or
|qr:1913
rq:2411
|any effective date prior to the reference date
most recent effective date entry,
categorise as
qr:1913= 1
qr:2411 = 2
|Assumes 0 by default
|-
|ethnicity
|integer
|17 caregories
|0 to 17
|qr:17087= Not recorded
qr:17071 = White british
qr:17072 =White Irish
qr:17073 =Other White Background
qr:17074 =White & Black Caribbean
qr:17075  =White & Black African
qr:17076 =White & Asian
qr:17077 =other mixed
wr:17089=Indian
qr:17079 =Pakistani
qr:17080 Bangladeshi
qr:17081 =Other Asian
qr:17090 =Caribbean
qr: 17083=Black African
qr:17091 =Other Black
qr:17985 =Chinese
qr:17086 Other ethnic group
qr:17087 Note recorded
|latest from all groups
if none ->0
qr:17071 = White british->1
qr:17072 =White Irish ->2
qr:17073 =Other White Background->3
qr:17074 =White & Black Caribbean->4
qr:17075  =White & Black African->5
qr:17076 =White & Asian->6
qr:17077 =other mixed->7
wr:17089=Indian->8
qr:17079 =Pakistani->9
qr:17080 Bangladeshi->10
qr:17081 =Other Asian->11
qr:17090 =Caribbean->12
qr: 17083=Black African->13
qr:17091 =Other Black->14
qr:17985 =Chinese->15
qr:17086 Other ethnic group->16
qr:17087 Not recorded->17
|
|-
|fhCVD
|boolean
|Family history of coronary heart disease in a first degree relative under the age of 60 years recorded before the reference date
|1 or 0
|qr:404
|qr:404
|Assumes 0 by default
|-
|ratio
|doble
|The most recent ratio of total serum cholesterol/HDL recorded in the last 5 years. The ratio is either directly directly recorded (eg using group 405) or can be calculated using group 16 divided by group 367
|
|qr:367 = Serum HDL
qr:16 = Total cholesterol
qr:405 =  total cholesterol/hdl ratio
|From all groups most recent of each effective date...
if group 16 after group 405
and 367 after  group 405 then  16/367
else if group 16 no group 367 then use 405
else if
|
|}
rati
Double (nullable)
The most recent ratio of total serum cholesterol/HDL recorded in the last 5 years. The ratio is either directly directly recorded (eg using group 405) or can be calculated using group 16 divided by group 367
16
367
405
n/a
smoke_cat
Integer
(nullable)
The most recently recorded smoking status 5 levels i.e.
• non-smoker (group
2239
2238
0= non smoker
1 =ex-smoker
QRISK® 3 10-year Risk Search Definition
© Copyright, ClinRisk Ltd 2023
8
2239)
• Ex-smoker(group 2238)
• Light-smoker(group 2244)
• Moderate-smoker(group 2242)
• Heavy-smoker (group 2243)
2244
2242
2243


2 =light smoker
==== Row ID ====
Optional Integer. 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


3= moderate smoker
==== Age ====
Mandatory Integer. Age of the person in years at the reference date


4= heavy smoker
==== Gender ====
Mandatory Character 'M' or 'F'.  Male or female.


Null if missing
Binary values only accepted. QRISK does not have information on transgender or indeterminate gender risks at this stage. It is the responsibility of the requester as to whether to apply the higher risk M gender e.g. For Trans Women and to explain the rationale.


sbp
sbp

Revision as of 08:05, 18 July 2023

Please note that at this current time, these services are not available for use in a live environment and must not be used. The following information is made available in advance of go-live

Background

Information about QRISK3 and the free to use Web site can be viewed https://qrisk.org

Integration with systems

Systems may have access to longitudinal health records, in particular those held in General Practice. In that case those systems may elect to use QRISK in a way that provides likely values for the variables used in the algorithm, those values being derived from the records.

That being the case, a set of query criteria and rules are applied to the record entries and the values of the variables derived. These are then presented to a user for confirmation, or amendment before being submitted as a set of parameters to the function via an API.

It is strongly recommended that for any individual decision, or potential entry of the risk score in the record, that each set of assumptions are confirmed. Purely automated calculations may be used for population based risk stratification in order to plan interventions.

Reference date

Scores may be calculated retrospectively. The reference date (current date or past date) is used for all values i.e. what those values were on the reference date. For example when looking for dates within 6 months this means 6 months prior to a reference date

Patient inclusion criteria

This section documents the criteria for a person suitable for the application of QRISK3

All dates are relative to the time at which the algorithm is applied to the patient and is referred to as the reference date.

  • Aged between 25 and 84 inclusive at the reference date

• Free from a diagnosis of cardiovascular disease on or before the reference date

Variables and function parameters

QRISK® operates as a function whose parameters represent independent variables. The values of those variables, when used in the algorithm are derived in one of two ways

a) By direct entry by a user

b) By a query of a health record.

When passed into the algorithms as arguments to the function, the values are presented either as a double, an integer, a boolean 1 or 0, or a character. The client must convert to these formats before submitting as arguments (e.g. as case statement)

If variables are unknown (missing) or their values are out of range, the algorithm may either reject the request, provide a default value, or adjust the out of range value to an outer limit.

Each concept set has an IRI and the iri namespace is http://apiqcodes.org/qcodes#. Which uses the iri prefix qr in the following table

Input parameters needed to calculate a QRISK3® score and their handling are as follows:

Row ID

Optional Integer. 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

Mandatory Integer. Age of the person in years at the reference date

Gender

Mandatory Character 'M' or 'F'. Male or female.

Binary values only accepted. QRISK does not have information on transgender or indeterminate gender risks at this stage. It is the responsibility of the requester as to whether to apply the higher risk M gender e.g. For Trans Women and to explain the rationale.

sbp

Integer (nullable)

The most recent systolic blood pressure prior to search date recorded in the last 5 years

198

n/a

sbps5

Double (nullable)

Standard deviation of all of the available systolic blood pressures prior to the search date recorded in the last 5 years

198

n/a

town

Double (nullable)

The Townsend score associated with the output area of a patient’s postcode based on the 2001 census data.

n/a

n/a

postcode

String

Patient’s postcode. This can be missing if Townsend score is supplied.

n/a

n/