Wales Primary Care COPD Audit

Transcription

1 Wales Primary Care COPD Audit Next steps for improvement National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme 2016

2 The audit programme partnership Working in strategic partnership: Supported by: Commissioned by:

3 Who was in the audit? n=47992 (removal of ages >110) Average age 71.3 Min age 36 Max age 110 Median age 71 Male Female Unknown sex (U) 3 Average male age 71.7 Average female age 70.9

4 Recruitment by LHB LHB Name Patients registered with COPD who participated Number of participating practices per LHB Percentage of practices that participated Abertawe Bro Morgannwg University Local Health Board 11, Aneurin Bevan Local Health Board 11, Betsi Cadwaladr University Local Health Board 3, Cardiff and Vale University Local Health Board 5, Cwm Taf Local Health Board 7, Hywel Dda Local Health Board 7, Powys Teaching Local Health Board Wales 48,

5 What did the audit recommend?

6 Key results: Diagnosis Approximately 4 out of 5 (80.3%) patients did not have the right test (post-bronchodilator FEV1/FVC) performed/recorded Where the right test was recorded, it was not consistent with COPD (ratio of ) in around 1 in 4 cases (26.9%)

7 High value interventions in COPD What are they? The pyramid of value for COPD interventions, developed by the London Respiratory Network with The London School of Economics and Political Science (modified from the IMPRESS guide to the relative value of COPD interventions view&gid=51&itemid=82).

8 High value interventions in COPD Are we delivering them? National COPD Audit Programme: Clinical audit of COPD in primary care in Wales Fig 3. The pyramid of value for COPD interventions The pyramid of value for COPD interventions, developed by the London Respiratory Network with The London School of Economics and Political Science (modified from the IMPRESS guide to the relative value of COPD interventions view&gid=51&itemid=82), gives estimates of cost per QALY gained. 18 Questions 21 and 22: Inhaler technique Rationale: NICE CG101 3 states: Number Quality statement In most cases, bronchodilator therapy is best administered using a hand-held inhaler device (including a spacer device if appropriate) If the patient is unable to use a particular device satisfactorily, it is not suitable for him or her, and an alternative should be found Inhalers should be prescribed only after patients have received training in the use of the device and have demonstrated satisfactory technique Patients should have their ability to use an inhaler device regularly assessed by a competent healthcare professional and, if necessary, should be re-taught the correct technique. Healthcare Quality Improvement Partnership The value pyramid providing a representation of the proportion of people who were receiving value-based interventions for COPD in Wales in

9 Key results: High value interventions 19.2% of people were exception reported for the flu vaccine

10 Key results: High value interventions One third (33.5%) of people with COPD were listed as current tobacco smokers Approximately 10% of people with COPD who smoke received tobacco dependency treatment in the last year

11 Key results: High value interventions 2 in 3 people with COPD who are eligible for PR have yet to be referred (65.5%)

12 Key results: Optimal therapy Identify those closer to death or admission to help them live well at home: The DOSE score Wales Question 10a: Breathlessness (dyspnoea) the percentage of people with an MRC scale of 1 5 within the last year 58.2% Question 10b: Obstruction the percentage of people with COPD with any spirometry test code within the last year 50.1% Question 10c: Smoking the percentage of people with COPD with a smoking status recorded within the last year 71.7% Question 10d: Exacerbations the percentage of people with COPD with at least one exacerbation recorded within the last year 10.8%

13 Percentage Key results: Optimal therapy Know your population - Breathlessness 50% Distribution of breathlessness within the COPD population using the MRC breathlessness scale 40% 30% 20% 10% 0% 36.2% 24.3% 14.7% 10.5% 11.1% 3.2% Unknown MRC value

14 Key results: Optimal therapy Know your population - GOLD GOLD classifies people with COPD by: i) degree of breathlessness, ii) number of exacerbations in the last year, and iii) airflow limitation. Extracted data suggest only 21% of people have data recorded that would allow a prescriber to follow this guideline. Annual recording of all three metrics is key to providing individualised therapeutic plans. Global Initiative for Chronic Obstructive Lung Disease. Pocket guide to COPD diagnosis, management and prevention: A guide for healthcare professionals. GOLD,

15 Coding and data recording Differences were found between QOF figures and the findings from the audit QOF The % of patients with COPD in whom the diagnosis has been confirmed by postbronchodilator spirometry was 90.4%. Audit findings The % of people with COPD who have a postbronchodilator FEV1/FVC ever recorded, where the code was consistent with COPD was 14.4%.

16 Better measures : codes & templates Diagnosis Could low number of FEV1/FVC (339m) recorded be due to coding issues? Analysis of 10 additional Read codes suggested this may be the case (results went from 14.4% to 58%). Suggestion: Use 339m: FEV1/FVC ratio after bronchodilator as your diagnostic code. Use a value <1.0 ( 0.68 not 68%). Remember if its not <0.7 its probably not COPD.

17 Better measures : codes & templates Exacerbations Use H3122: Acute exacerbation of chronic obstructive airways disease to record each acute event Use 66Yf: Number of COPD exacerbations in past year once a year when counting up the events

18 Quality Improvement Start small, keep it short, share and reflect Choose one of the four recommendations to focus on.

19 Quality Improvement Example: Diagnosis Plan: Investigate the % of patients at your practice who have had a postbronchodilator FEV1/FVC result recorded Act: Identify gaps in your improvement & speak to those who can help Do: Make changes based on your findings: *Implement a template *Ensure Read Code 339m is used Study: Plot the change over time

20 Quality Improvement Example: High value interventions Plan: Investigate the % of patients at your practice who have had all elements of the DOSE score recorded in the last year Act: Which element is recorded less? What needs to happen next? Do: Agree codes and alerts within a template to ensure this is recorded Study: Has the rate improved?

21 Quality improvement Through education and networking

22 Involve your patients Ask your population with COPD if they are getting the right care

23 What next? Another extraction of data in April Please remember to sign up if you have not already done so! Development of an Audit+ module for COPD Reporting dashboards Mail-merge facilities Access to aggregated reports via the NWIS Primary Care Information Portal Comparison and benchmarking at LHB and Wales level

24 National COPD Audit Programme