Transcript Atrial Fibrillation – QOF Indicators

Atrial Fibrillation Project, SSNAP
July to September 2013 and QOF
Indicators 2012/2013
Guildford and Waverley
CCG
South East Coast SCN -Atrial Fibrillation Project
• Earlier detection and anticoagulation optimisation of patients with atrial
fibrillation
• First step will be agreement on recommendation of NICE anticoagulation
guidelines as best practice. New NICE Guidance will be published on the
11th June 2014
• Task to Finish Group being established to implement the NICE guidance
• Will be followed by the development of a best practice model for earlier
detection and management
• SSNAP Data – July to September 2013 most up to date
• QOF Data from 2012/13 most up to date
• Uses CHADS2 scoring. This will be replaced by CHADSVASC in NICE
Guidance
SSNAP Data – July to September 2013
• Nationally 19.8% of Stroke patients had previous AF. SEC is
20.5 %.Range in SEC is 12.7 to 35.5%
• Best practice is anticoagulant prescribing for AF
• Nationally 24.5% of Stroke patients with AF were not
previously prescribed anticoagulants or anti-platelets. SEC is
26.8%. Range is 7.7 % to 40%
• Nationally 32.5 % of Stroke patients with AF were previously
prescribed anticoagulants only. SEC is 31.4%. Range is 0 –
70%
SSNAP Data – July to September 2013
Admitted Stroke Patients with Previous AF
SSNAP - July to September 2013
AF Strokes = 306
40
35
30
%
25
20
15
10
5
0
Stroke Patients with Previous AF on no anticoagulant or anti-platelet
medication
SSNAP - July - September 2013
AF Strokes = 306
45
40
35
30
%
25
20
15
10
5
0
Stroke Patients with Previous AF- Prescribing prior to admission
SSNAP July to September 2013
AF Strokes = 306
Worthing Hospital
St Richards Hospital
East Surrey Hospital
Royal Surrey County Hospital
Medway Maritime Hospital
Tunbridge Wells Hospital
Maidstone District General Hospital
Frimley Park Hospital
%
Epsom Hospital
Anti-platelet only
Eastbourne District General Hospital
Anticoagulant Only
Conquest Hospital
Both
William Harvey Hospital
Queen Elizabeth the Queen Mother Hospital
Kent and Canterbury Hospital
Darent Valley Hospital
Royal Sussex County Hospital
Princess Royal Hospital Haywards Heath
St Peter's Hospital
National
0
10
20
30
40
50
60
70
80
QOF Atrial Fibrillation Indicators – 2012/13 by
CCG
• Four Indicators
– Prevalence (percentage on QOF AF Register/practice population)
– AF05 – Percentage on AF register who have had a CHADS2 score in the previous 15
months (except those whose previous score was greater than 1)
– AF06 – In those with a CHADS2 score higher than 1 in last 15 months– those who are on
anti-coagulants or anti-platelets (minus exceptions)
– AF07 – In those with a CHADS2 score higher than 1 in last 15 months – those who are on
anti-coagulants (minus exceptions)
• Any correlation between QOF CCG indicator results and AF stroke
admissions and prescribing? E.g. High stroke admissions with AF in local
hospitals and low anticoagulant prescribing for those admissions and low
prevalence and low anticoagulant prescribing (for the known AF’s) in CCG
data
AF Prevalence by CCG in Surrey
SURREY
Percentage of people on practice list on atrial fibrillation register
2.0%
1.8%
1.6%
1.4%
1.2%
1.0%
0.8%
0.6%
0.4%
0.2%
0.0%
East Surrey
Source: QOF 2012/13
Guildford & Waverley
North West Surrey
Practice
SURREY
KSS
England
Surrey Downs
Surrey Heath
AF05 by CCG in Surrey
SURREY
AF05 The percentage of patients with Atrial Fibrillation in whom stroke risk has been assessed using the CHADS2 risk
stratification scoring system in the preceding 15 months (excluding those whose previous CHADS2 score is greater than 1)
98.5%
98.0%
97.5%
97.0%
96.5%
96.0%
95.5%
East Surrey
Source: QOF 2012/13
Guildford & Waverley
North West Surrey
Practice
SURREY
KSS
England
Surrey Downs
Surrey Heath
AF06 by CCG in Surrey
SURREY
AF06 In those patients with Atrial Fibrillation in whom there is a record of a CHADS2 score of 1 (latest in the preceding 15
months), the percentage of patients who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy.
96.0%
95.5%
95.0%
94.5%
94.0%
93.5%
93.0%
92.5%
92.0%
91.5%
91.0%
East Surrey
Source: QOF 2012/13
Guildford & Waverley
North West Surrey
Practice
SURREY
KSS
England
Surrey Downs
Surrey Heath
AF07 by CCG in Surrey
SURREY
AF07 In those patients with Atrial Fibrillation whose latest record of a CHADS2 score is greater than 1,
the percentage of patients who are currently treated with anti-coagulation drug therapy
88.0%
86.0%
84.0%
82.0%
80.0%
78.0%
76.0%
74.0%
East Surrey
Source: QOF 2012/13
Guildford & Waverley
North West Surrey
Practice
SURREY
KSS
England
Surrey Downs
Surrey Heath
QOF Atrial Fibrillation Indicators – 2012/13 by Practice
• What to look for
– Does the prevalence look low for this practice population and demographics? All other
indicators are based on this. Low numbers may mean that some AF patients have not
been diagnosed
– AF05 – Low rates will indicate that the practice isn’t routinely assessing those on the AF
Register for CHADS2 and changes to their risk
– AF06 – Best practice is for those with identified AF to be on anticoagulant therapy not
anti-platelet therapy. Compare rates with AFO7. High rates on AF06 but lower rates on
AF07 indicates a high usage of anti-platelet therapy .
– AF07 - Best practice is for those with identified AF to be on anticoagulant therapy .
Compare with prevalence and AF05 - high rates but low prevalence and low routine
assessment may indicate that only small numbers are being managed well
GP Practice Codes in Guildford and Waverley CCG
H81052
H81029
H81053
H81022
H81026
H81006
H81077
H81647
H81031
H81090
H81064
H81132
H81010
H81062
H81035
H81044
H81085
H81076
H81084
H81021
H81043
CRANLEIGH MEDICAL PRACTICE
DAPDUNE HOUSE SURGERY
DR A BURNS AND PARTNERS
DR CAMERON-BLACKIE AND PARTNERS
DR COOK AND PARTNERS
DR EWART & PARTNERS
DR G R TYRRELL & PARTNERS
DR L A BARBOUR
DR PR WILKS & PARTNERS
DR S DE LUISIGNAN AND PARTNERS
FAIRLANDS MEDICAL PRACTICE
GUILDFORD RIVERS PRACTICE
GUILDOWNS GROUP PRACTICE
HASLEMERE HEALTH CENTRE
MERROW PARK SURGERY
SPRINGFIELD SURGERY
ST LUKES SURGERY
THE GRAYSHOTT SURGERY
THE HORSLEY MEDICAL PRACTICE
THE MILL MEDICAL PRACTICE
WONERSH SURGERY
Prevalence by Practice compared to KSS (Red line) and
England (Green Line)
NHS GUILDFORD AND WAVERLEY CCG
Percentage of people on practice list on atrial fibrillation register
3.5%
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
H81052 H81029 H81053 H81022 H81026 H81006 H81077 H81647 H81031 H81090 H81064 H81132 H81010 H81062 H81035 H81044 H81085 H81076 H81084 H81021 H81043
Source: QOF 2012/13
Practice
KSS
AFO5 by Practice compared to KSS (Red line) and
England (Green Line)
NHS GUILDFORD AND WAVERLEY CCG
AF05 The percentage of patients with Atrial Fibrillation in whom stroke risk has been assessed using the CHADS2 risk stratification
scoring system in the preceding 15 months (excluding those whose previous CHADS2 score is greater than 1)
120%
100%
80%
60%
40%
20%
0%
H81006 H81010 H81021 H81022 H81026 H81029 H81031 H81035 H81043 H81044 H81052 H81053 H81062 H81064 H81076 H81077 H81084 H81085 H81090 H81132 H81647
Source: QOF 2012/13
Practice
KSS
AFO6 by Practice compared to KSS (Red line) and
England (Green Line)
NHS GUILDFORD AND WAVERLEY CCG
AF06 In those patients with Atrial Fibrillation in whom there is a record of a CHADS2 score of 1 (latest in the preceding 15 months), the
percentage of patients who are currently treated with anti-coagulation drug therapy or an anti-platelet therapy.
120%
100%
80%
60%
40%
20%
0%
H81006 H81010 H81021 H81022 H81026 H81029 H81031 H81035 H81043 H81044 H81052 H81053 H81062 H81064 H81076 H81077 H81084 H81085 H81090 H81132 H81647
Source: QOF 2012/13
Practice
KSS
AFO7 by Practice compared to KSS (Red line) and
England (Green Line)
NHS GUILDFORD AND WAVERLEY CCG
AF07 In those patients with Atrial Fibrillation whose latest record of a CHADS2 score is greater than 1,
the percentage of patients who are currently treated with anti-coagulation drug therapy
120%
100%
80%
60%
40%
20%
0%
H81006 H81010 H81021 H81022 H81026 H81029 H81031 H81035 H81043 H81044 H81052 H81053 H81062 H81064 H81076 H81077 H81084 H81085 H81090 H81132 H81647
Source: QOF 2012/13
Practice
KSS