Quality indicators for CVD prevention across Europe. Michel Wensing Senior researcher
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1 Quality indicators for CVD prevention across Europe Michel Wensing Senior researcher
2 on behalf of the EPA Cardio project group Michel Wensing, Richard Grol, Joachim Szecsenyi, Stephen Campbell, Jan van Lieshout, Sabine Ludt.
3 Overview of the presentation Background and Overview EPA (European Practice Assessment) Cardio project Development of quality indicators for CVD prevention Some findings
4 EPA Cardio Sp UK Fr NL B Ger Sz A SL FI Austria Belgium England Finland France Germany Netherlands Slovenia Spain Switzerland 283 general practices from 10 countries
5 European Health Award 2009
6 Development of quality indicators for CVD prevention Aim: to develop a set of internationally validated and comparable indicators for cardiovascular risk management and prevention. Campbell SM et al. European countries. European Journal of Cardiovascular Prevention and Rehabilitation 2008; 15:
7 Development of EPA Cardio quality indicators for CVD prevention International review of indicators for CVD prevention (>600 indicators) Selection of indicators using expert panels of GPs in 2-round Delphi survey in all ten countries Indicator had to have a median score of 7 or more (out of 9) for both validity and feasibility, without disagreement.
8 Development of EPA Cardio quality indicators for CVD prevention 85% (171/202) of indicators rated valid by at least one country Range of indicators rated valid from Germany (30%) to Finland (61%) 16% (33/202) of indicators rated valid by all ten country panels Campbell SM et al. European Journal of Cardiovascular Prevention and Rehabilitation 2008; 15:
9 EPA Cardio indicators Recorded life style advice (n=8) Recorded clinical processes and outcomes (n=24) Recorded practice organisation (n=8) > Mostly in patients with established CVD or diabetes
10 EPA Cardio: Study populations Young adults (18-45 years), registered with or regular visitors to participating practices Patients at high CVD risk (10% 10 yr mortality risk, 20% 10 yr morbidity risk) excluding established CHD Patients with established coronary heart disease Protocol published as: Wensing M et al. Implementation Science 2009; 4; 3
11 EPA Cardio: Sampling procedures General practices stratified by size and urbanization to reflect the national situation (n= per country) Young adults sampled from practice register or practice visitors (15 patients sampled per practice, 42% response rate) CHD patients and high risk patients registered in general practice (n=15 per group per practice): questionnaire and chart audit (94% of targetted sample available)
12 Study 1: Medical record review of high risk patients Patients at high CVD risk (10% 10 yr mortality risk, 20% 10 yr morbidity risk, hypertension, raised cholesterol) excluding established CHD Varying procedures for sampling these patients; country samples are not entirely comparable Medical record audit in general practices, based on EPA Cardio indicators, 15 patients per practice.
13 Recording of risk factors 100% 80% 60% 40% 20% 0% Austria Belgium England Finland France Germany Netherlands Slovenia Spain Switzerland Recorded blood pressure Recorded cholesterol
14 Recording of smoking history and smoking advice 100% 80% 60% 40% 20% 0% Austria Belgium England Finland France Germany Netherlands Slovenia Spain Switzerland Smoking history recorded Smoking advice recorded (in smokers)
15 Recording of BMI and dietary advice 100% 80% 60% 40% 20% 0% Austria Belgium England Finland France Germany Netherlands Slovenia Spain Switzerland Recorded BMI Recorded advice on diet
16 Study 2. Patients with established CHD Medical record audit in general practices, based on EPA Cardio indicators (15 per practice) Diagnosis of CHD based on medical records
17 Recording of risk factors (1) 100% 80% 60% 40% 20% 0% Austria Belgium England Finland France Germany Netherlands Slovenia Spain Switzerland Recorded blood pressure Recorded cholesterol
18 Recorded preventive medical treatments 100% 80% 60% 40% 20% 0% Austria Belgium England Finland France Germany Netherlands Slovenia Spain Switzerland Statins prescribed or offered Anti-platelet therapy/or contra-indication
19 Recording of risk factors (2) 100% 80% 60% 40% 20% 0% Austria Belgium England Finland France Germany Netherlands Slovenia Spain Switzerland Recorded smoking Smoking advice (for smokers)
20 Analysis of CVD improvement programs across Europe Available at 8BB5179C/bst_engl/xcms_bst_dms_27352_27353_2.pdf
21 Overall conclusions Despite country differences, it is possible to develop agreed indicators for cardio-vascular disease care Because of country differences, there are problems in making precise comparisons between countries Indicators for preventive care less easy to develop than those for high risk patients / patients with established CHD, and less well evidence based
22 With thanks to all the EPA Cardio researchers E.Frigola (Spain) M.Goldfracht (Israel) S.Campbell, M.Roland (UK) S.Petek, J.Kersnik (Slovenia) J.Szecsenyi,S.Ludt (Germany) B.Künzi,L.Michlig (Switzerland) R.Glehr, M.Glehr, I.Pichler (Austria) H.Falchoff M.Samuelson, S.Martin (France) V. vd Stighelen, E.Cornelis, L.Seuntjes (Belgium) R.Grol, J.van Lieshout, M.Wensing (Netherlands) G.Elwyn, T.vd Weijden (Experts from UK and NL) E.Volbracht (Bertelsmann Foundation, Project coordinator)
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