Transcript Atrial Fibrillation – QOF Indicators
Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013
Eastbourne, Hailsham and Seaford 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 11 th 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%
15 10 5 0 40 35 30 25 20
SSNAP Data – July to September 2013
Admitted Stroke Patients with Previous AF SSNAP - July to September 2013 AF Strokes = 306
45 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
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 Eastbourne District General Hospital Conquest Hospital 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 Anti-platelet only Anticoagulant Only Both
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 Sussex
SUSSEX Percentage of people on practice list on atrial fibrillation register
3,0% 2,5% 2,0% 1,5% 1,0% 0,5% 0,0% Brighton & Hove Coastal West Sussex
Source: QOF 2012/13
Practice KSS Crawley England Eastbourne, Hailsham & Seaford SUSSEX Hastings & Rother High Weald Lewes Havens Horsham & Mid Sussex
AF05 by CCG in Sussex
SUSSEX 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)
98,0% 97,5% 97,0% 96,5% 96,0% 95,5% 95,0% Brighton & Hove
Source: QOF 2012/13
Coastal West Sussex Practice KSS Crawley England Eastbourne, Hailsham & Seaford SUSSEX Hastings & Rother High Weald Lewes Havens Horsham & Mid Sussex
AF06 by CCG in Sussex
SUSSEX 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.
96,5% 96,0% 95,5% 95,0% 94,5% 94,0% 93,5% 93,0% 92,5% 92,0% 91,5% 91,0% Brighton & Hove Coastal West Sussex
Source: QOF 2012/13
Practice KSS Crawley England Eastbourne, Hailsham & Seaford SUSSEX Hastings & Rother High Weald Lewes Havens Horsham & Mid Sussex
AF07 by CCG in Sussex
SUSSEX 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
86,0% 84,0% 82,0% 80,0% 78,0% 76,0% 74,0% Brighton & Hove Coastal West Sussex
Source: QOF 2012/13
Practice KSS Crawley England Eastbourne, Hailsham & Seaford SUSSEX Hastings & Rother High Weald Lewes Havens Horsham & Mid Sussex
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
Y00080 G81008 G81017 G81029 G81004 G81027 G81049 G81098 G81003 G81056 G81685 G81099 G81059 G81012 G81634 G81002 G81050 Y02816 G81032 G81104 G81022 G81060
GP Practice Codes in Eastbourne, Hailsham and Seaford CCG
DR ADOKI & PTNR DR BAIG & PARTNERS DR BARNES J D & PARTNERS DR BARNES M H & PARTNERS DR BEDFORD-TURNER & PARTNERS DR BROWN G C & PARTNERS DR BROWN R D & PARTNERS DR EDWARDS & PARTNER DR EYRE & PARTNERS DR MILLER & PARTNERS DR OEZBURUN DR PALIT & PARTNERS DR PEARCE & PARTNERS DR SAVVAS S & PARTNER DR SIMMONS DR VERGHESE & PARTNERS DR WILLIAMS & PARTNERS EASTBOURNE STATION HEALTH CENTRE GREEN STREET CLINIC PARK PRACTICE SOVEREIGN PRACTICE VICARAGE FIELD PRACTICE
Prevalence by Practice compared to KSS (Red line) and England (Green Line)
2,5% 2,0% 1,5% 1,0% 0,5% 0,0%
NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG Percentage of people on practice list on atrial fibrillation register
4,0% 3,5% 3,0%
Source: QOF 2012/13
Practice KSS
100% 80% 60% 40% 20%
AFO5 by Practice compared to KSS (Red line) and England (Green Line)
NHS EASTBOURNE, HAILSHAM AND SEAFORD 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% 0%
Source: QOF 2012/13
Practice KSS
AFO6 by Practice compared to KSS (Red line) and England (Green Line)
NHS EASTBOURNE, HAILSHAM AND SEAFORD 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%
Source: QOF 2012/13
Practice KSS
AFO7 by Practice compared to KSS (Red line) and England (Green Line)
NHS EASTBOURNE, HAILSHAM AND SEAFORD 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%
Source: QOF 2012/13
Practice KSS