Breakout 4.1 COPD Practice Registers and ‘value’ - Mike Ward
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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
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Breakout 4.1 COPD Practice Registers and ‘value’ - Mike Ward
- 1. COPD Practice Registers and ‘value’ Mike Ward COPD Practice Registers • Diagnosis • The Register • Searches • Risk Profiling • Rules 1
- 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. 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. 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 triple Walters JA Factors associated with misdiagnosis of COPD in primary care. Prim Care Respir J 2011;20:396-402 NICE Guidelines 2010 & KCE Reports 108C 2009, & CADTH HTA report 2010 4
- 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. 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 COPD severity Lung 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. Triangles with good & poor value for money High Low population population health gain health gain Good VfM Poor VfM Low costs High costs Relative Value of COPD interventions IMPRESS 2012 13 7
- 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. 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