English

Baseline - Clinical Form

1 forms  
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Patient ID
Description

Supporting Definition: This number will not be shared with ICHOM. In the case patient-­‐level data is submitted to ICHOM for benchmarking or research purposes, a separate ICHOM Patient Identifier will be created and cross-­‐linking between the ICHOM Patient Identifier and the medical record number will only be known at the treating institution Inclusion Criteria: All patients Timing: On all forms Reporting Source: Administratively-­‐reported or clinician-­‐reported Type: Numerical Response Options: According to institution

Data type

integer

Alias
UMLS CUI [1]
C2348585
Demographic factors
Description

Demographic factors

Indicate the patient's date of birth
Description

Inclusion Criteria: All patients Timing: Baseline Reporting Source: Administratively‐reported or clinician-­reported Type: Date by DD/MM/YYYY Response Options: DD/MM/YYYY

Data type

date

Measurement units
  • DD/MM/YYYY
Alias
UMLS CUI [1]
C0001779
UMLS CUI [2]
C0421451
DD/MM/YYYY
Indicate the patient's sex at birth
Description

Inclusion Criteria: All patients Timing: Baseline Reporting Source: Administratively-­reported or clinician-­reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0079399
Clinical Factors
Description

Clinical Factors

Indicate if the patient has a documented history of diabetes mellitus (regardless of duration of disease or need for anti-diabetic agents). If newly diagnosed, the diagnosis should meet the following criteria: Fasting plasma glucose >= 7.0mmol/L (126 mg/dL) or 2-hour plasma glucose >= 11.1 mmol/L (200mg/dL) [2 hours post 75g glucose load]
Description

Inclusion Criteria: All patients Timing: Baseline and annually until positive diagnosis of diabetes Reporting Source: Clinician-­reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0011849
UMLS CUI [2,1]
C0011849
UMLS CUI [2,2]
C1518321
For newly diagnosed diabetics indicate fasting plasma glucose if available
Description

Supporting Definition: Fasting plasma glucose value in mg/dL or mmol/L Inclusion Criteria: Optional Timing: Baseline and annually Reporting Source: Clinician­‐reported Type: Numerical Response Options: N/A

Data type

float

Alias
UMLS CUI [1]
C0583513
Units of fasting plasma glucose
Description

Inclusion Criteria: If fasting plasma glucose value is provided Timing: Baseline and annually Reporting Source: Clinician-­reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0583513
UMLS CUI [1,2]
C1519795
Indicate the patient's height in centimeters or inches
Description

Supporting Definition: Height and weight are used to calculate BMI Inclusion Criteria: All patients Timing: Baseline Reporting Source: Clinician­‐reported Type: Numerical Response Options: Numerical value

Data type

float

Alias
UMLS CUI [1]
C0005890
Indicate units of height
Description

Inclusion Criteria: All patients Timing: Baseline Reporting Source: Clinician­‐reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0005890
UMLS CUI [1,2]
C1519795
Indicate the patient's weight in kilograms or pounds
Description

Supporting Definition: Height and weight are used to calculate BMI Inclusion Criteria: All patients Timing: Baseline and annually Reporting Source: Clinician-­reported Type: Numerical Response Options: Numerical value

Data type

float

Alias
UMLS CUI [1]
C0005910
Indicate units of weight
Description

Inclusion Criteria: All patients Timing: Baseline and annually Reporting Source: Clinician-­reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0005910
UMLS CUI [1,2]
C1519795
Indicate if the patient is on lipid lowering therapy
Description

Inclusion Criteria: All patients Timing: Baseline and annually Reporting Source: Clinician-­reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0585943
Specify lipid lowering therapy
Description

Inclusion Criteria: If answered 1 to LIPIDLOW Timing: Baseline and annually Reporting Source: Clinician-­reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0585943
UMLS CUI [1,2]
C2348235
Has the patient had a creatinine test?
Description

Inclusion Criteria: Optional Timing: Baseline and annually Reporting Source: Clinician-­reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1]
C0201976
Provide the patient's serum creatinine reading
Description

Supporting Definition: Please provide the most recent value Inclusion Criteria: If responded "yes" to CREADONE Timing: Baseline and annually Reporting Source: Clinician­‐reported Type: Numerical, enter "000" if unknown Response Options: Numerical value

Data type

float

Alias
UMLS CUI [1,1]
C0201976
UMLS CUI [1,2]
C1274040
What are the units of creatinine?
Description

Inclusion Criteria: If value for creatinine is provided Timing: Baseline and annually Reporting Source: Clinician‐reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0201976
UMLS CUI [1,2]
C1519795
Was the creatinine reader calibrated to IDMS (isotope dilution mass spectrometry)
Description

Inclusion Criteria: If value for creatinine is provided Timing: Baseline and annually Reporting Source: Clinician-­reported/administratively­‐reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0201976
UMLS CUI [1,2]
C0006751
UMLS CUI [1,3]
C3274766
Treatment variables
Description

Treatment variables

Alias
UMLS CUI-1
C0087111
What is the management approach?
Description

Supporting Definition: Non‐pharmacological management includes lifestyle interventions, exercise, diet and other non-­pharmacological approaches. Inclusion Criteria: All patients Timing: Baseline and annually Reporting Source: Clinician-­reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0449445
Is patient on any of the following drug classes? 1 = ACEi/ARB
Description

Supporting Definition: Please select all options that apply Inclusion Criteria: If answered '1' to treatment approach (TX) Timing: Baseline and annually Reporting Source: Clinician­‐reported Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0003364
UMLS CUI [1,2]
C0596463
UMLS CUI [2]
C0003015
UMLS CUI [3]
C0521942
Is patient on any of the following drug classes? 2 = Alpha‐blocker
Description

Supporting Definition: Please select all options that apply Inclusion Criteria: If answered '1' to treatment approach (TX) Timing: Baseline and annually Reporting Source: Clinician­‐reported Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0003364
UMLS CUI [1,2]
C0596463
UMLS CUI [2]
C0001641
Is patient on any of the following drug classes? 3 = Beta-blocker
Description

Supporting Definition: Please select all options that apply Inclusion Criteria: If answered '1' to treatment approach (TX) Timing: Baseline and annually Reporting Source: Clinician­‐reported Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0003364
UMLS CUI [1,2]
C0596463
UMLS CUI [2]
C0001645
Is patient on any of the following drug classes? 4 = Loop Diuretics
Description

Supporting Definition: Please select all options that apply Inclusion Criteria: If answered '1' to treatment approach (TX) Timing: Baseline and annually Reporting Source: Clinician­‐reported Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0003364
UMLS CUI [1,2]
C0596463
UMLS CUI [2]
C0354100
Is patient on any of the following drug classes? 5 = Thiazides
Description

Supporting Definition: Please select all options that apply Inclusion Criteria: If answered '1' to treatment approach (TX) Timing: Baseline and annually Reporting Source: Clinician­‐reported Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0003364
UMLS CUI [1,2]
C0596463
UMLS CUI [2]
C0012802
Is patient on any of the following drug classes? 6 = Calcium channel blocker
Description

Supporting Definition: Please select all options that apply Inclusion Criteria: If answered '1' to treatment approach (TX) Timing: Baseline and annually Reporting Source: Clinician­‐reported Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0003364
UMLS CUI [1,2]
C0596463
UMLS CUI [2]
C0006684
Is patient on any of the following drug classes? 7 = Other
Description

Supporting Definition: Please select all options that apply Inclusion Criteria: If answered '1' to treatment approach (TX) Timing: Baseline and annually Reporting Source: Clinician­‐reported Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0003364
UMLS CUI [1,2]
C0596463
UMLS CUI [2]
C0205394
Is patient on any of the following drug classes? 999 = Unknown
Description

Supporting Definition: Please select all options that apply Inclusion Criteria: If answered '1' to treatment approach (TX) Timing: Baseline and annually Reporting Source: Clinician­‐reported Type: Multiple answer

Data type

boolean

Alias
UMLS CUI [1,1]
C0003364
UMLS CUI [1,2]
C0596463
UMLS CUI [2]
C0439673
Survival, disease control and cardiovascular complications
Description

Survival, disease control and cardiovascular complications

Alias
UMLS CUI-1
C1148433
UMLS CUI-2
C0012634
UMLS CUI-3
C0243148
UMLS CUI-4
C0007226
UMLS CUI-5
C0009566
Patient systolic blood pressure reading in mmHg
Description

Inclusion Criteria: All patients Timing: Minimum annually (included here as it is a factor of disease control (due to the timeline information in the reference guide obtainable from ICHOM.org)) Reporting Source: Clinician‐reported Type: Numerical Response Options: Numerical value

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
Patient diastolic blood pressure reading in mmHg
Description

Inclusion Criteria: All patients Timing: Minimum annually (included here as it is a factor of disease control (due to the timeline information in the reference guide obtainable from ICHOM.org)) Reporting Source: Clinician‐reported Type: Numerical Response Options: Numerical value

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Does the patient have chronic kidney disease as evidenced by proteinuria?
Description

Supporting Definition: Renal disease (ICD10: I12 Hypertensive renal disease incl. any condition in N00-­‐ N07, N18.-­‐, N19 or N26 due to hypertension) (Please ensure that other causes of proteinuria, such as urinary tract infection, have been ruled out) Inclusion Criteria: All patients Timing: Baseline and annually Reporting Source: Clinician‐reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1]
C1561643
UMLS CUI [2]
C0033687
How was proteinuria detected?
Description

Inclusion Criteria: If "yes" to CKD Timing: Baseline and annually Reporting Source: Clinician‐reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0033687
UMLS CUI [1,2]
C3887511
Proteinuria as provided by electronically read urine dipstick
Description

Inclusion Criteria: If responded "1" or "2" to PROTEINEVID Timing: Baseline and annually Reporting Source: Clinician‐reported Type: Single response

Data type

integer

Alias
UMLS CUI [1,1]
C1274040
UMLS CUI [1,2]
C1160927
Evidence of proteinuria as evidenced by urinary ACR
Description

Inclusion Criteria: If responded "3" to PROTEINEVID Timing: Baseline and annually Reporting Source: Clinician-­reported Type: Numerical Response Options: Numerical value

Data type

float

Alias
UMLS CUI [1,1]
C0455271
UMLS CUI [1,2]
C2826772
Units of urinary ACR
Description

Inclusion Criteria: If ACR value provided Timing: Baseline and annually Reporting Source: Clinician‐reported Type: Single answer

Data type

integer

Alias
UMLS CUI [1,1]
C0455271
UMLS CUI [1,2]
C1519795
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Similar models

Baseline - Clinical Form

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Patient ID
Item
Patient ID
integer
C2348585 (UMLS CUI [1])
Item Group
Demographic factors
Age
Item
Indicate the patient's date of birth
date
C0001779 (UMLS CUI [1])
C0421451 (UMLS CUI [2])
Item
Indicate the patient's sex at birth
integer
C0079399 (UMLS CUI [1])
Sex
Code List
Indicate the patient's sex at birth
CL Item
Male (1)
C1706180 (UMLS CUI-1)
(Comment:en)
CL Item
Female (2)
C0086287 (UMLS CUI-1)
(Comment:en)
CL Item
Undisclosed (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item Group
Clinical Factors
Item
Indicate if the patient has a documented history of diabetes mellitus (regardless of duration of disease or need for anti-diabetic agents). If newly diagnosed, the diagnosis should meet the following criteria: Fasting plasma glucose >= 7.0mmol/L (126 mg/dL) or 2-hour plasma glucose >= 11.1 mmol/L (200mg/dL) [2 hours post 75g glucose load]
integer
C0262926 (UMLS CUI [1,1])
C0011849 (UMLS CUI [1,2])
C0011849 (UMLS CUI [2,1])
C1518321 (UMLS CUI [2,2])
Past medical history: Diabetes
Code List
Indicate if the patient has a documented history of diabetes mellitus (regardless of duration of disease or need for anti-diabetic agents). If newly diagnosed, the diagnosis should meet the following criteria: Fasting plasma glucose >= 7.0mmol/L (126 mg/dL) or 2-hour plasma glucose >= 11.1 mmol/L (200mg/dL) [2 hours post 75g glucose load]
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Fasting plasma glucose
Item
For newly diagnosed diabetics indicate fasting plasma glucose if available
float
C0583513 (UMLS CUI [1])
Item
Units of fasting plasma glucose
integer
C0583513 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Units of fasting plasma glucose
Code List
Units of fasting plasma glucose
CL Item
mg/dL (1)
C0439269 (UMLS CUI-1)
(Comment:en)
CL Item
mmol/L (2)
C1532563 (UMLS CUI-1)
(Comment:en)
Height
Item
Indicate the patient's height in centimeters or inches
float
C0005890 (UMLS CUI [1])
Item
Indicate units of height
integer
C0005890 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Height units
Code List
Indicate units of height
CL Item
Centimeters (1)
C0475210 (UMLS CUI-1)
(Comment:en)
CL Item
Inches (2)
C0439204 (UMLS CUI-1)
(Comment:en)
Weight
Item
Indicate the patient's weight in kilograms or pounds
float
C0005910 (UMLS CUI [1])
Item
Indicate units of weight
integer
C0005910 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Weight units
Code List
Indicate units of weight
CL Item
Kilograms (1)
C0439209 (UMLS CUI-1)
(Comment:en)
CL Item
Pounds (2)
C0439219 (UMLS CUI-1)
(Comment:en)
Item
Indicate if the patient is on lipid lowering therapy
integer
C0585943 (UMLS CUI [1])
Lipid lowering therapy
Code List
Indicate if the patient is on lipid lowering therapy
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item
Specify lipid lowering therapy
integer
C0585943 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Lipid lowering medication
Code List
Specify lipid lowering therapy
CL Item
Statin (1)
C0360714 (UMLS CUI-1)
(Comment:en)
CL Item
Ezetimibe (2)
C1142985 (UMLS CUI-1)
(Comment:en)
CL Item
Fibrates (3)
C1449704 (UMLS CUI-1)
(Comment:en)
CL Item
Other (4)
C0205394 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item
Has the patient had a creatinine test?
integer
C0201976 (UMLS CUI [1])
Past medical history: Diabetes
Code List
Has the patient had a creatinine test?
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Creatinine
Item
Provide the patient's serum creatinine reading
float
C0201976 (UMLS CUI [1,1])
C1274040 (UMLS CUI [1,2])
Item
What are the units of creatinine?
integer
C0201976 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Units of fasting plasma glucose
Code List
What are the units of creatinine?
CL Item
mg/dL (1)
C0439269 (UMLS CUI-1)
(Comment:en)
CL Item
mmol/L (2)
C1532563 (UMLS CUI-1)
(Comment:en)
Item
Was the creatinine reader calibrated to IDMS (isotope dilution mass spectrometry)
integer
C0201976 (UMLS CUI [1,1])
C0006751 (UMLS CUI [1,2])
C3274766 (UMLS CUI [1,3])
Creatinine calibration
Code List
Was the creatinine reader calibrated to IDMS (isotope dilution mass spectrometry)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
No (2)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item Group
Treatment variables
C0087111 (UMLS CUI-1)
Item
What is the management approach?
integer
C0087111 (UMLS CUI [1,1])
C0449445 (UMLS CUI [1,2])
Treatment approach
Code List
What is the management approach?
CL Item
Non­‐pharmacological management only (0)
C1518422 (UMLS CUI-1)
C0013216 (UMLS CUI-2)
(Comment:en)
CL Item
Pharmacological management (with or without non‐pharmacological treatment) (1)
C0013216 (UMLS CUI-1)
(Comment:en)
Antihypertensive drug class: ACEi/ARB
Item
Is patient on any of the following drug classes? 1 = ACEi/ARB
boolean
C0003364 (UMLS CUI [1,1])
C0596463 (UMLS CUI [1,2])
C0003015 (UMLS CUI [2])
C0521942 (UMLS CUI [3])
Antihypertensive drug class: Alpha‐blocker
Item
Is patient on any of the following drug classes? 2 = Alpha‐blocker
boolean
C0003364 (UMLS CUI [1,1])
C0596463 (UMLS CUI [1,2])
C0001641 (UMLS CUI [2])
Antihypertensive drug class: Beta-blocker
Item
Is patient on any of the following drug classes? 3 = Beta-blocker
boolean
C0003364 (UMLS CUI [1,1])
C0596463 (UMLS CUI [1,2])
C0001645 (UMLS CUI [2])
Antihypertensive drug class: Loop Diuretics
Item
Is patient on any of the following drug classes? 4 = Loop Diuretics
boolean
C0003364 (UMLS CUI [1,1])
C0596463 (UMLS CUI [1,2])
C0354100 (UMLS CUI [2])
Antihypertensive drug class: Thiazides
Item
Is patient on any of the following drug classes? 5 = Thiazides
boolean
C0003364 (UMLS CUI [1,1])
C0596463 (UMLS CUI [1,2])
C0012802 (UMLS CUI [2])
Antihypertensive drug class: Calcium channel blocker
Item
Is patient on any of the following drug classes? 6 = Calcium channel blocker
boolean
C0003364 (UMLS CUI [1,1])
C0596463 (UMLS CUI [1,2])
C0006684 (UMLS CUI [2])
Antihypertensive drug class: Other
Item
Is patient on any of the following drug classes? 7 = Other
boolean
C0003364 (UMLS CUI [1,1])
C0596463 (UMLS CUI [1,2])
C0205394 (UMLS CUI [2])
Antihypertensive drug class: Unknown
Item
Is patient on any of the following drug classes? 999 = Unknown
boolean
C0003364 (UMLS CUI [1,1])
C0596463 (UMLS CUI [1,2])
C0439673 (UMLS CUI [2])
Item Group
Survival, disease control and cardiovascular complications
C1148433 (UMLS CUI-1)
C0012634 (UMLS CUI-2)
C0243148 (UMLS CUI-3)
C0007226 (UMLS CUI-4)
C0009566 (UMLS CUI-5)
Systolic blood pressure
Item
Patient systolic blood pressure reading in mmHg
integer
C0871470 (UMLS CUI [1])
Diastolic blood pressure
Item
Patient diastolic blood pressure reading in mmHg
integer
C0428883 (UMLS CUI [1])
Item
Does the patient have chronic kidney disease as evidenced by proteinuria?
integer
C1561643 (UMLS CUI [1])
C0033687 (UMLS CUI [2])
Chronic renal disease
Code List
Does the patient have chronic kidney disease as evidenced by proteinuria?
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Item
How was proteinuria detected?
integer
C0033687 (UMLS CUI [1,1])
C3887511 (UMLS CUI [1,2])
Evidence of proteinuria
Code List
How was proteinuria detected?
CL Item
Manually read urine dipstick (1)
C0430370 (UMLS CUI-1)
C2911685 (UMLS CUI-2)
C0175674 (UMLS CUI-3)
(Comment:en)
CL Item
Electronically read urine dipstick (2)
C0430370 (UMLS CUI-1)
C2911685 (UMLS CUI-2)
C0022885 (UMLS CUI-3)
(Comment:en)
CL Item
Urinary albumin/creatinine ratio (3)
C0455271 (UMLS CUI-1)
(Comment:en)
Item
Proteinuria as provided by electronically read urine dipstick
integer
C1274040 (UMLS CUI [1,1])
C1160927 (UMLS CUI [1,2])
Results of urine dip
Code List
Proteinuria as provided by electronically read urine dipstick
CL Item
+ (1)
C3525587 (UMLS CUI-1)
C1446409 (UMLS CUI-2)
C0205447 (UMLS CUI-3)
(Comment:en)
CL Item
++ (2)
C3525587 (UMLS CUI-1)
C1446409 (UMLS CUI-2)
C0205448 (UMLS CUI-3)
(Comment:en)
CL Item
+++ (3)
C3525587 (UMLS CUI-1)
C1446409 (UMLS CUI-2)
C0205449 (UMLS CUI-3)
(Comment:en)
CL Item
Unknown/results unavailable (4)
C0439673 (UMLS CUI-1)
C1254595 (UMLS CUI-2)
(Comment:en)
Results of urine ACR if done in place of urine dip
Item
Evidence of proteinuria as evidenced by urinary ACR
float
C0455271 (UMLS CUI [1,1])
C2826772 (UMLS CUI [1,2])
Item
Units of urinary ACR
integer
C0455271 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Units of urinary ACR
Code List
Units of urinary ACR
CL Item
mg/g (1)
C1300563 (UMLS CUI-1)
(Comment:en)
CL Item
mg/mmol (2)
C0567349 (UMLS CUI-1)
(Comment:en)
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