What do the business rules mean?

What makes a patient eligible?

1. Be on the Obesity register OBES2_REG, meaning:
   
1. Be 18 years old or over
   
2. in the contract year (these are to be referred to as "raised BMI" from herein):
   
1. Have a BMI of more than or equal to 32.5 kg/m2 with a South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background
   
2. Have a BMI of more than or equal to 35 kg/m2 otherwise
   
3. Have at least four of the following diagnoses:
   
1. atherosclerotic cardiovascular disease (ASCVD),
   
2. unresolved hypertension (hypertension code not superseded by hypertension resolved code),
   
3. dyslipidaemia, as defined by:
   
1. being on a statin
   
2. LDL >= 4.1
   
3. Triglycerides >= 1.7
   
4. HDL < 1 and male
   
5. HDL < 1.3 and female
4. obstructive sleep apnoea,
   
5. unresolved type 2 diabetes (diabetes code not superseded by diabetes resolved code).
   

1. The patient didn't have all 3 care management criteria in the contract year
   
2. The patient met all 3 care management criteria in the last 6 months of the previous contract year and the first 6 months of the current contract year
   
3. The patient did not achieve the indicator in the previous year (didn't have a high BMI or didn't meet all 3 care management criteria)

What will remove patients from eligibility?

1. If they have ever had bariatric surgery
   
2. Were prescribed tirzepatide (drug) and didn't have prescribed pharmacotherapy for obesity management code in the contract year
3. Where a weight management behavioural support service was unavailable in the contract year
   
4. Patients for whom pharmacotherapy for weight management was unsuitable in the contract year
   
5. Patients who had a persisting tirzepatide contraindication
   
6. Patients for whom shared decision making was unsuitable in the contract year.
   
7. Patients for whom a weight managment behavioural support service was unsuitable in the contract year
   
8. Patients for whom obesity quality indicator care was unsuitable in the contract year
   
9. Patients who chose not to have pharmacotherapy in the contract year
   
10. Patients who chose not to have a shared decision making discussion in the contract year
    
11. Patients who chose not to be referred to a weight management behavioural support programme in the contract year
12. Patients who have chosen not to receive any obesity quality indicator care in the contract year
    
13. Patients who have been invited twice at least 7 days apart
14. Patients who had their raised BMI within 90 days of the end of the contract year, didn't achieve the indicator and didn't have a PCA for it in the previous contract year
15. Patients who were newly registered with the practice in the last 3 months of the contract year

SNOMED codes used in this indicator

The codes referenced in this article are taken from the NHS Technology Reference Update Distribution (TRUD).  Not all of these may be present or selectable in all clinical systems.

Atherosclerotic Cardiovascular Disease codes (ASCVD_COD)

664 codes so not all listed here:

Code	Display
195167002	External capsule haemorrhage
195114002	Acute left ventricular failure
10971000087107	Myocardial ischaemia during surgery
57981008	Progressing stroke
734965006	Embolus of right middle cerebral artery
195205001	Impending cerebral ischaemia
703252002	Acute myocardial infarction of anterior wall involving right ventricle
233839009	Old anterior myocardial infarction
1269248000	Cerebrovascular accident due to occlusion of anterior choroidal artery
95454007	Brain stem haemorrhage
10663991000119105	Ischaemic ulcer of left lower leg due to atherosclerotic disease
16371781000119100	Cerebellar stroke

Hypertension codes (HYP_COD)

117 codes so not all listed here:

Code	Display
23717007	Benign essential hypertension complicating AND/OR reason for care during pregnancy
140111000119107	Hypertension in chronic kidney disease stage 4 due to type 2 diabetes mellitus
128001000119105	Hypertension concurrent and due to end stage renal disease on dialysis due to type 1 diabetes mellitus
199003007	Pre-eclampsia or eclampsia with pre-existing hypertension with postnatal complication
199002002	Pre-eclampsia or eclampsia with pre-existing hypertension - not delivered
123800009	Goldblatt hypertension
443482000	Hypertensive urgency
908651000000101	Stage 1 hypertension (NICE 2011) with evidence of end organ damage
843841000000109	Severe hypertension (NICE - National Institute for Health and Clinical Excellence 2011)

Hypertension resolved codes (HYPRES_COD)

Code	Display
162659009	Hypertension resolved

Obstructive Sleep Apnoea codes (OBSLPAPNOEA_COD)

Code	Display
73430006	Sleep apnea
78275009	Obstructive sleep apnea syndrome
16275741000119100	Severe paediatric obstructive sleep apnoea
1101000119103	Obstructive sleep apnea of adult
230494007	Alveolar sleep apnea
442164004	Organic sleep apnea
230493001	Mixed sleep apnea
1091000119108	Obstructive sleep apnea of child
765751002	Autoimmune encephalopathy with parasomnia and obstructive sleep apnea
774068004	AHDC1-related intellectual disability, obstructive sleep apnea, mild dysmorphism syndrome
719976001	Glaucoma and sleep apnea syndrome

Type 2 diabetes codes (DMTYPE2_COD)

Code	Display
703136005	Diabetes mellitus in remission
140531000119105	Neuropathic ulcer of foot due to type 2 diabetes mellitus
421750000	Ketoacidosis due to type 2 diabetes mellitus
420715001	Persistent microalbuminuria due to type 2 diabetes mellitus
314903002	Arthropathy due to type 2 diabetes mellitus
237599002	Insulin treated type 2 diabetes mellitus
443694000	Uncontrolled type 2 diabetes mellitus
395204000	Hyperosmolar non-ketotic state due to type 2 diabetes mellitus
422014003	Disorder due to type 2 diabetes mellitus
190390000	Type 2 diabetes mellitus with gangrene
789569005	Neuropathic ulcer of heel due to type 2 diabetes mellitus
314904008	Type 2 diabetes mellitus with neuropathic arthropathy
190389009	Type 2 diabetes mellitus with ulcer
313436004	Type 2 diabetes mellitus without complication
421847006	Ketoacidotic coma due to type 2 diabetes mellitus
44054006	Type 2 diabetes mellitus
445353002	Brittle type 2 diabetes mellitus
1481000119100	Diabetes mellitus type 2 without retinopathy
1196922005	Neovascular glaucoma due to diabetes mellitus type 2
314902007	Type 2 diabetes mellitus with peripheral angiopathy
140381000119104	Neuropathic ulcer of toe due to type 2 diabetes mellitus
190388001	Multiple complications due to type 2 diabetes mellitus
703138006	Type II diabetes mellitus in remission

Diabetes resolved codes (DMRES_COD)

Code	Display
315051004	Diabetes resolved

Pharmacotherapy for obesity management codes (WTMGPHARM_COD)

Code	Display
2386231000000101	NHS obesity medication pathway started

Referral into a weight management behavioural support programme codes (WTMGBSPREF_COD)

Code	Display
2386201000000107	Referral to NHS obesity medication wraparound support pathway

Shared decision making conversation codes (SHARDECMAK_COD)

Bariatric Surgery codes (BARISURG_COD)

Obesity Quality Indicator Unsuitable codes (OBPCAPU_COD)

Chose not to receive pharmacotherapy codes (WTMGPHARMDEC_COD)

Chose not to have a shared decision making discussion codes (SHARDECMAKDEC_COD)

Chose not to be referred to a weight management behavioural support programme codes (WTMGBSPREFDEC_COD)

Chose not to receive Obesity quality indicator care codes (OBPCADEC_COD)