Skip to main content
COVID-19 – high risk shielded patient list identification methodology

Amendments from previous version

Summary

This is a summary of the changes made from Version 1 of the algorithm.

Rule Disease group Amendment from previous version
1 Solid organ transplant recipients who remain on long term immune suppression therapy Amendment improves specificity of selection by ensuring that there is evidence of condition and medication.
2a

Cancer undergoing active chemo/ radiotherapy

or radical radiotherapy for lung cancer.
No amendment to algorithm rules. The time window for the algorithm means a later set of data is used.
  People having immunotherapy or other continuing antibody treatments for cancer * No amendment
  People having other targeted cancer treatments which affect the immune system, such as protein kinase or PARP inhibitors. * No amendment
2b People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma at any stage of treatment

No amendment to algorithm rules. The time window for the algorithm means a later set of data is used.

  People who have had bone marrow or stem cell transplants in the last 6 months, or still taking immunosuppression drugs.

No amendment to algorithm rules. The time window for the algorithm means a later set of data is used.

3 People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD Amendment improves specificity of selection by ensuring that there is evidence of condition and medication.
  Cystic Fibrosis, idiopathic pulmonary Fibrosis, etc. Need to go straight through. Regardless of treatment. Idiopathic pulmonary fibrosis and related interstitial fibrosis conditions were added to SNOMED-CT extract only. ICD coding was not added as it appears a number of bronchopneumonia have been coded into these categories.
4 People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell) From analysis of this group during the production, unusual numbers of patients were found coded with D70 – Agranulocytosis, therefore this code was removed from this subset and account for this reduction. Note D70 is still within the cancer category and is captured in GP extracts.  Minor numbers were lost due to clinical review of some genetic conditions, which do not carry increased infection risks. In addition, sickle cell disease was broken down in ICD10 into sub-categories to remove sickle cell trait.
  People on immunosuppression therapies sufficient to significantly increase risk of infection From analysis of this group during the production, unusual numbers of patients were found coded with D70 – Agranulocytosis, therefore this code was removed from this subset and account for this reduction. Note D70 is still within the cancer category and is captured in GP extracts.  Minor numbers were lost due to clinical review of some genetic conditions, which do not carry increased infection risks. In addition, sickle cell disease was broken down in ICD10 into sub-categories to remove sickle cell trait.
5 People who are pregnant with significant congenital heart disease No amendment.

 

Version 2 to version 3 amendments

Amendments as follows: 

  • switch from one-off GPFLU to weekly GPSPL extract
  • update of 6 month date range for PCPM data

Version 3 to version 4 amendments

Amendments as follows:

  • SNOMED-CT: 716872004 anti-neoplastic chemotherapy regimen moved from category 4 (People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections) to category 2b (People with cancers of the blood or bone marrow)
  • additions (general practice and NHS Trust) and subtractions (general practice only) logic applied

Version 4 to version 5 amendments

Amendments as follows:

  • update of 6 month date range for PCPM data

Version 5 to version 6 amendments

No amendments made.

Version 6 to version 7 amendments

Amendments as follows:

  • subtractions (NHS Trust) logic applied

Version 7 to version 8 amendments

No amendments made.

Version 17 amendments

  • Introduction of the Detained Person’s SPL.
  • Removal of the following codes due to clinical assessment that these should be classed as speciality guidance. Note that all of the below codes have been included in the SPL since the introduction of GPFLU data in version 2 and subsequent use of GP SPL data.
SNOMED concept ID Code description Rule Disease group  Group 
175901007 Live donor renal transplant 1 Transplant Speciality guidance 
175902000 Cadaveric renal transplant 1 Transplant Speciality guidance 
236138007 Xenograft renal transplant 1 Transplant Speciality guidance 
236436003 End stage renal failure with renal transplant 1 Transplant Speciality guidance 
240047005 X-linked muscular dystrophy with limb girdle distribution 4 Rare genetic, metabolic and autoimmune diseases Speciality guidance 
240048000 X-linked muscular dystrophy with abnormal dystrophin 4 Rare genetic, metabolic and autoimmune diseases Speciality guidance
240049008 Intermediate X-linked muscular dystrophy 4 Rare genetic, metabolic and autoimmune diseases Speciality guidance
240050008 Manifesting female carrier of X-linked muscular dystrophy 4 Rare genetic, metabolic and autoimmune diseases Speciality guidance
240051007 X-linked limb girdle muscular dystrophy with normal dystrophin 4 Rare genetic, metabolic and autoimmune diseases Speciality guidance
240071003 X-linked muscular dystrophy not predominantly limb girdle 4 Rare genetic, metabolic and autoimmune diseases Speciality guidance
6471000179103 Transplantation of kidney and pancreas 1 Transplant Speciality guidance
697923008 Pulmonary hypertension in lymphangioleiomyomatosis 3 Respiratory Speciality guidance
70536003 Transplant of kidney 1 Transplant Speciality guidance
711411006 Allotransplantation of kidney from beating heart cadaver 1 Transplant Speciality guidance
711413009 Allotransplantation of kidney from non-beating heart cadaver 1 Transplant Speciality guidance

Version 23 amendments

Amendments as follows:

  • Implementation of RCPCH guidance

Version 36

Amendments as follows:

  • Introduction of Down Syndrome in category 4: People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (see Table 1 above), treated under a new CMO Rule 'Learning Disabilities'

For Down Syndrome the following clinical codes are included:

GPES SNOMED Codes
205615000     Trisomy 21- meiotic nondisjunction (disorder)
254264002     Partial trisomy 21 in Down syndrome (disorder)
205616004     Trisomy 21- mitotic nondisjunction mosaicism (disorder)
41040004     Complete trisomy 21 syndrome (disorder)
709469005     Periodontitis co-occurrent with Down syndrome (disorder)
724643004     Transient abnormal myelopoiesis co-occurrent with Down syndrome (disorder)
724644005   Myeloid leukemia co-occurrent with Down syndrome (disorder)
733194007     Dementia co-occurrent and due to Down syndrome (disorder)

Any of the above codes recorded with no time parameters applied

HES ICD10 Code

Q90 Down syndrome (all 4 character codes under this) and all sub-types, counting people with a hospital episode since 2006

  • Introduction of Chronic Kidney Disease Stage 5 in category 4: People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (see Table 1 above), treated under a new CMO Rule ‘Chronic Kidney Disease’

For Chronic Kidney Disease Stage 5 the following codes are included:

GPES SNOMED Codes
433146000     Chronic kidney disease stage 5 (disorder)
324501000000107     Chronic kidney disease stage 5 with proteinuria (disorder)
950251000000106     Chronic kidney disease with glomerular filtration rate category G5 and albuminuria category A1 (disorder)
950291000000103     Chronic kidney disease with glomerular filtration rate category G5 and albuminuria category A2 (disorder)
950311000000102     Chronic kidney disease with glomerular filtration rate category G5 and albuminuria category A3 (disorder)
324541000000105     Chronic kidney disease stage 5 without proteinuria (disorder)
129161000119100     Chronic kidney disease stage 5 due to hypertension (disorder)
285011000119108    Chronic kidney disease stage 5 due to benign hypertension (disorder)
96711000119105     Hypertensive heart AND chronic kidney disease stage 5 (disorder)
153851000119106    Malignant hypertensive chronic kidney disease stage 5 (disorder)
90761000119106     Chronic kidney disease stage 5 due to type 1 diabetes mellitus (disorder)
140101000119109     Hypertension in chronic kidney disease stage 5 due to type 2 diabetes mellitus (disorder)
691411000119101     Anemia co-occurrent and due to chronic kidney disease stage 5 (disorder)
711000119100     Chronic kidney disease stage 5 due to type 2 diabetes mellitus (disorder)

HES ICD10 Code

N18.5 Chronic kidney disease, stage 5, without a newer CKD1-4 episode (N18.1-4) with a hospital episode since 01 April 2012

Business logic has been applied to manage conflict between GPES/ HES. If either dataset identifies a CKD5 patient, but the other dataset has the patient coded with CKD1-4, the patient should be treated as Clinically Extremely Vulnerable and added to the Shielded Patient List (an inclusive approach).
    
Transplant and dialysis were excluded from CKD5 at the request of the CMO for England, noting that transplant and dialysis are risk groups in their own right.

Version 39

Amendments as follows:

  • Processing of new additions for Down Syndrome was suspended from version 37.0. NHS Digital undertook a review of coding anomalies and this has been published as a known issue, with associated action plan

Version 44 (plus 46)

Amendments as follows:

  • Cohorts identified by the University of Oxford Q-COVID algorithm were introduced into the Shielded Patient List. The added 1.53M patients to the Shielded Patient List
  • In version 44 this represented the cohort aged 19 – 69 identified by the COVID19 Population Risk Assessment
  • In version 46 this represented the cohort aged 70 and over identified by the COVID19 Population Rick Assessment

See the link for further details about which datasets have been used by the algorithm to identify Clinically Extremely Vulnerable cohorts:  COVID-19 Population Risk Assessment

Version 52

Amendments as follows:

  • Change to rule 2a used to identify adult patients at very high risk of hospitalisation from COVID-19
Previous rule New rule
Patient coded with neoplasm of lung AND radiotherapy within same episode of care since 2006 Patient coded with neoplasm of lung AND radiotherapy within same episode of care in the last 12 months
Last edited: 18 March 2021 3:36 pm