COVID-19 – high risk shielded patient list identification methodology

Amendments from previous version

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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

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