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.
Cardiovascular disease
Optional Boolean 1 or 0 .
Cardiovascular disease prior to the reference date
This is an inclusion criteria and should therefore be 0. The request will be rejected if this is set t
Atrial fibrillation
Mandatory Boolean 1 or 0.
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.
Rule
Observation concept qr:24, effective date < reference date
| Code group | Maps to |
|---|---|
| qr:24 | 1 |
Atypical anti psychotics
Mandatory Boolean 1 or 0.
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)
Rule
Medication request medication in qr:1169, effective date >=- 6 months relative to reference date Count(entries)>=2
| Code Group | Map |
|---|---|
| qr:1169 | 1 |
Systemic corticosteriods
Mandatory Boolean 0 or 1
Systemic corticosteroids –prescribed two or more issues in the previous 6 months
Rule
Medication requests, medication in qr: 1194, effective date >=- 6 months relative to reference date
Count(entries) >=2
| Code Group | Map |
|---|---|
| qr:1194 | 1 |
Migraine
Mandatory boolean 0 or 1
Diagnosis of migraine prior to the reference date
Rule
Observation concept in qr:39, effective date <= reference date
| Code Group | Map |
|---|---|
| qr:39 | 1 |
Rheumatoid arthritis
Mandatory boolean 1 or 0
Diagnosis of Rheumatoid arthritis prior to the reference date
Rule
Observation concept in qr:58, effective date <=reference date
| Code Group | Map |
|---|---|
| qr:58 | 1 |
Chronic renal disease
Mandatory boolean 1 or 0
Chronic renal disease at any time prior to the reference date
Rule
Observation concept in qr:322, effective date <= reference date
| Code Group | Map |
|---|---|
| qr:322 | 1 |
Severe mental Illness
Mandatory boolean 1 or 0
Diagnosis of severe mental illness (psychosis, severe depression, manic depression, schizophrenia) at any time prior to the reference date
Rule
Observation concept in qr:3187 ,effective date <=reference date
| Code Group | Map |
|---|---|
| qr:3187 | 1 |
Systemic lupius erythematosis
Diagnosis of systemic lupus erythematosis at any time prior to the reference date
Rule
Observation concept in qr:70, effective date <= reference date
| Code Group | Map |
|---|---|
| qr:3187 | 1 |
Treated hypertension
Mandatory boolean 1 or 0
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.
Rule
Observation concept in qr:21, effective date <= reference date)
AND
Medication requests medication in (medication qr:740 qr:751 qr:759 qr:760 qr:765 to be revised), effective date >= - 6months relative to reference date
| Code Group | Name | Map |
|---|---|---|
| qr:21 | Hypertension | 1 |
| qr:740 | Thaizides | 1 |
| qr:751 | Beta blockers | 1 |
| qr:759 | ACE inhibitors | 1 |
| qr: 760 | Angiotensin ii receptor agonists | 1 |
| qr:765 | Calcium channel blockers | 1 |
Body mass index
Optional double
The most recently recorded body mass index for the patient recorded prior to the reference date recorded in the last 5 years.
Rule
Observation concept in, qr:200, effective date >= -5 years relative to reference date.
Most recent entry
Handling of out of range values
<18 is set to 18
>47 is set to 47
| Code Group | Name | Map |
|---|---|---|
| qr:200 | Body mass index | 1 |
Diabetes Category
Mandatory integer 0 or 1 or 2
Categorical variable to denote no diabetes, type 1 diabetes or type 2 diabetes diagnosed at any time prior to the reference ate
Rule
Observation concept in qr:1913,qr:2411 effective date <=reference date
Most recent entry
| Code Group | Name | Map |
|---|---|---|
| qr:1913 | Type 1 diabetes | 1 |
| qr:2411 | Type II diabetes | 2 |
==== Ethnicity ===-
Mandatory integer between 0 and 17
Ethnic category
Rule
Patient Ethnicity in (qr:17071, qr:17072, qr:17073, qr:17074, qr:17075, qr:17076, qr:17077, qr:17089, qr:17079, qr:17080, qr:17081, qr:17090, qr:17985, qr:17086, qr: 17087)
| Code Group | Name | Map |
|---|---|---|
| null | 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 stated and not classified | 17 |
nteger (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/