Breakout 4.1 COPD Practice Registers and ‘value’ - Mike Ward

917 views

Published on

Breakout 4.1 COPD Practice Registers and ‘value’ - Mike Ward
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Breakout 4.1 COPD Practice Registers and ‘value’ - Mike Ward

  1. 1. COPD Practice Registers and ‘value’ Mike Ward COPD Practice Registers• Diagnosis• The Register• Searches• Risk Profiling• Rules 1
  2. 2. COPD Diagnosis• Published data• CCG 580• Single Practice and CCG 422 94 39 23 Jones RCM Respiratory Research 2008;9:62 CCG• 21 practices• 145,000 patients – 2697 with COPD• FEV1 >80% predicted 11%• FEV1/FVC >0.7 in 16%• Unknown FEV1 record in 36% 2
  3. 3. Single practice• 298 patients• FEV1 >80% – predicted 17%• FEV1/FVC >0.7 – 18% Single practice• 298 patients• FEV1 >80% predicted 17%• FEV1/FVC >0.7 • Restrictive change – ILD or obesity •Co-morbidity •Bronchiectasis •Asthma 3
  4. 4. The register• FEV1 and FEV1 % predicted and FEV1/FVC• Smokers and never smokers• AECOPD• MRC dyspnoea score• BMI• Oxygen sat• Completed/ refused rehabilitation• Treatment The register - searches• FEV1 >80% predicted and FEV1/FVC >0.7• BMI >35• Never smoker• DOSE score >4• FEV1 > 50% predicted on ICS/LABA or tripleWalters JA Factors associated with misdiagnosis of COPD in primary care. PrimCare Respir J 2011;20:396-402NICE Guidelines 2010 & KCE Reports 108C 2009, & CADTH HTA report 2010 4
  5. 5. The Register - searches• High BMI – 28 – half had normal or high FEV1/FVC• Never smokers – Only 3 confirmed as COP• Current smokers – 28% Practice register – risk profiling• Previous hospital admissions• Low FEV1• Frequent exacerbations• DOSE score >4 DOSE Index Points 0 1 2 3 MRC Dyspnea Scale score 1-2 3 4 5 Obstruction FEV1% predicted >50 30–49 <30 Smoking status Nonsmoker Smoker Exacerbations per year 0–1 2–3 >3 Jones RC AJRCCM 2009 Sundh J Prim Care Resp J 2012,21:295-301 5
  6. 6. Dose score >4 • 49 out of 298 patients • 1 scored 7 – under care of CM • 13 scored 6 – 7 continued to smoke • 35 scored 5 – 20 continued to smoke – 3 had a normal FEV1 – review% of Patients prescribed each drug class by COPDseverityLung Health - National uk Drug Mild % Moderate% Severe % v.Severe % SABA 84.6 77.3 91.7 85.7 LABA 0.0 6.1 8.3 4.8 SAMA 7.7 21.2 8.3 4.8 LAMA 46.2 33.3 50.0 57.1 LABA/ICS 30.8 45.5 62.5 66.7 LABA/ICS 7.7 9.1 25.0 19.1 AS DPI 6
  7. 7. Triangles with good & poor value for money High Low population population health gain health gain Good VfM Poor VfMLow costs High costsRelative Value of COPD interventions IMPRESS 2012 13 7
  8. 8. Practice treatment• Review FEV1 >80% predicted – On ICS or triple therapy – Stopped in 17• Review FEV1 >50% predicted – On ICS or triple therapy – Changed in 24 8
  9. 9. Rules• GP lead in each practice – Templates, guidelines, education• FEV1/FVC data seen before entry onto register• Exception reporting• Risk profiling• Routine searches and pro-active care• Patient self management Wagner E Improving Chronic Illness Care. Health Affairs 2001;20:64 9

×