Subsegment / Condition Index
Long Term Conditions
Disability
Incurable Cancer
Organ Failure
Frailty and Dementia
Maternal Health
Additional Characteristics
Overview
Summary
These pages provide further details on the business rules that have been applied to create each of the subsegments (conditions) used in the Segmentation Dataset. The conditions are organised into the following segments which can be selected at the top of the page. For further information on how the segments and subsegments relate to each other see the next page, “Segment Configuration”.
- Long Term Conditions
- Disability
- Incurable Cancer
- Organ Failure
- Frailty and Dementia
- Maternal Health
Detailed Overview
The Bridges to Health National Segmentation Dataset has been produced, maintained and updated regularly since 2019 to support operational functions, care planning and improvement and service evaluation within NHS England. The dataset includes all individuals registered with a GP in England, and assigns individuals into a number of conditions (‘subsegments’), each derived using a combination of business rules and code clusters. The subsegments are categorised as cohorts of the population with similar needs and characteristics. These are either specific long-term conditions (eg. Atrial Fibrillation), aggregated conditions group (eg. Coronary Heart Disease includes individuals with myocardial infarction or angina), or ‘nested’ conditions (eg. all COPD and Severe COPD, as a subset). In addition, the dataset includes associated socio-demographic data (age, sex, ethnicity and socioeconomic deprivation), and geographical data (registered GP practice, mapped to administrative NHS organisations and aggregated geographies).
The Segmentation Dataset is derived from a number of national operational and care planning pseudonymised patient-level data sources available in the National Commissioning Data Repository in NHS England. This includes more than 15 years of longitudinally accrued data from Secondary Uses Services (SUS – a collection of data from all hospitals in England, including admitted patient care data, outpatient data, and emergency care data), Mental Health Data, Community Data, IAPT, amongst others, as well as Master Patient Index data which holds non-clinical data on the GP registered population in England including those who have died and GP registration history since 2014, and the National Diabetes Audit extracted from participating GP practices. Otherwise no additional clinical data from GP practices is included at source.
These data sources are run through a series of analytical data pipelines which link the data by pseudonymised NHS number, and apply business rules for combinations of code clusters (ICD-10, OPCS, SNOMED), relevant ‘flags’, and logic to define each subsegment between and within the source datasets. The earliest recording of the specified business rules in at least one of the source operational datasets creates a flag for that individual. These data definitions have been developed through extensive clinical review and evaluation.
Data Governance
Data is collected and used in line with NHS England’s purposes as required under the statutory duties outlined in the NHS Act 2006 and Health and Social Care Act 2012. Data is processed using best practice methodology underpinned by a Data Processing Agreement between NHS England and Outcomes Based Healthcare Ltd (OBH), who produce the Segmentation Dataset on behalf of NHS England. This ensures controlled access by appropriate approved individuals, to anonymised/pseudonymised data held on secure data environments entirely within the NHS England infrastructure. Data is processed for specific purposes only, including operational functions, service evaluation and service improvement. Where OBH has processed data, this has been agreed and is detailed in a Data Processing Agreement. The data used to produce this analysis has been disseminated to NHS England under Directions issued under Section 254 of the Health and Social Care Act 2012.
Segment Definitions
1
Healthy / Generally well
People who are ‘healthy or generally well’, though may have acute, but self-limiting problems. The principal care processes involved relate to primary prevention, with the aim of slowing people developing a first long term condition or disability.
2
Maternal Health
Women who are pregnant and receiving antenatal care, through to the immediate postpartum period.
3
Acute
People with an acute illness, and who are likely to return to their former level of health. Acute illness is defined as an illness that develops quickly, often severe, and lasts a relatively short period of time (often less than 1 month). Occurrences of acute episodes are often outcomes themselves for people in other segments.
4
Long Term Conditions (LTCs)
People with one or more LTCs have chronic illnesses that are rarely resolved, but which can be treated to maintain stability, and often slow progression.
5
Disability
People with one or more serious disability, including both physical and learning disabilities.
6
Incurable cancer
People with cancer who have a trajectory described as having a reasonably predictable decline in physical health over a period of weeks, months, or, in some cases, years. Almost all people in this segment are expected to die over a period of 12 months, and therefore often receiving care from palliative care services.
7
Organ Failure
People with one or more organ system failure, or have frequent serious exacerbations of chronic illness expected to die within 5 years. This includes people with heart failure, respiratory failure, end-stage renal failure, liver failure, or neurological organ failure.
8
Frailty and Dementia
People with moderate or severe frailty who are 65 years and over, or have dementia, who are typically on a gradual course of decline.
Data Sources
The Segmentation Dataset is derived from a number of national operational and care planning pseudonymised patient-level data sources available in the National Commissioning Data Repository in NHS England. The following table summarises the data sources used and the number of years of data that has been longitudinally accrued.
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