CVD Fellowship QI Project Ideas – Further Information - PowerPoint Presentation

1. CVD FellowshipQI Project Ideas – Further Information

2. 01Project Ideas2

3. QI Project Ideas3Familial Hypercholesterolemia Lipid optimisation for secondary prevention Lipid optimisation for primary prevention (QRISK) Hypertension monitoring & optimisationAtrial Fibrillation + anticoagulation3

4. Familial Hypercholesterolemia4Overall project aim (your specific target will relate to your practice / PCN) To improve the health of patients and prevent heart attacks, strokes and dementia by ensuring that patients are being identified and treatment optimisedTarget group(s):In primary care case finding age <30 years: TC >7.5 mmol/L OR LDL-C >4.9 mmol/L OR non-HDL-C >6 mmol/LIn primary care case finding age >30 years:TC >9.0 mmol/L OR LDL-C >6.4 mmol/L OR non-HDL-C >7.5 mmol/LImplementation plan - this could involve UCLP Searches to identify patients Training of staff in FH and correct codingCheck coding is correct for patients Update codingRefer patients to specialist lipid clinic for managementRerun searches to assess impactOther things to consider Who could be trained to help? What training is needed?Are all staff confident with coding?4

5. 2. Lipid optimisation for secondary prevention5Overall project aim (your specific target will relate to your practice / PCN) To improve the health of patients and prevent heart attacks, strokes and dementia by ensuring that patients are being identified and treatment optimisedTarget groups (see UCLP Frameworks for more details):Priority One - CVD not on statin therapyPriority Two (a) - CVD on suboptimal intensity statin e.g. simvastatinPriority Two (b) - CVD on suboptimal statin dose e.g. on wrong dosage (mg)Priority Three - CVD routine follow up sub-optimal non-HDL (>2.5mmol/l) levels despite maximal statin therapyImplementation plan - this could involve UCLP Searches to identify patients and stratify them into priority groupsCheck coding is correct for patients Update codingReview treatment options for all identified patientsSupport patients with self-management advice and resourcesRerun searches to assess impactOther things to considerWho could be trained to help? What training is needed?Are all staff confident with coding?Patient trust/knowledge may be a factor in hesitancyOther health conditions may be a factor – i.e. muscle pain may cause statin intolerance and alternative treatment may be required5

6. 3. Lipid optimisation for primary prevention (QRISK)6Overall project aim (your specific target will relate to your practice / PCN)To improve the health of patients and prevent heart attacks, strokes and dementia by ensuring that patients are being identified and treatment optimisedTarget groups (see UCLP Frameworks for more details):Priority One - One of: QRISK ≥20%, CKD, or Type 1 Diabetes AND Not on statinPriority Two - QRISK 15-19% AND Not on statinPriority Three - QRISK 10-14% AND Not on statinPriority Four - On statin for primary prevention but not high intensityImplementation plan - this could involve UCLP Searches to identify patients and stratify them into priority groupsCheck coding is correct for patients Update codingCheck treatment options for those patients needing treatmentSupport patients with self-management advice and resourcesRerun searches to assess impactOther things to considerWho could be trained to help? What training is needed?Are all staff confident with coding?Patient trust/knowledge may be a factor in hesitancyOther health conditions may be a factor – i.e. muscle pain may cause statin intolerance and alternative treatment may be required6

7. 4. Hypertension monitoring & optimisation7Aim of the project To improve the health of patients and prevent heart attacks, strokes and dementia by ensuring that patients are being identified and treatment optimisedTarget groups (see UCLP Frameworks for more details):Priority One - Clinic BP ≥ 180/120mmHg; Priority Two - Clinic BP ≥ 160/100mmHg; Clinic BP ≥ 140/90mmHg if BAME AND relevant co-morbidity/risk factor; No BP reading in 18 monthsPriority Three - Clinic BP ≥140/90mmHg if under 80 years OR Clinic BP ≥150/90mmHg if 80 years and over Priority Four - Under 80 years Clinic BP < 140/90mmHg; 80 years and over Clinic BP < 150/90mmHgAnd - those with high blood pressure who are sub optimally treatedImplementation plan - this could involveRun UCLP Searches to identify patients in the target groupsMap patient journeys as they currently are, and develop a strategy to improve journeyText or call patients in target groups to invite them in for a reading, to go to a community pharmacy, or submit own if have a monitorUpdate coding / check coding is correct for patients Check treatment for those patients who need treatmentSupport patients with self-management advice and resourcesRerun searches to assess impactOther things to considerWho else could be trained to help? What training is needed?Are all staff confident with coding?Where can patients go for readings?7

8. 6. Atrial Fibrillation + anticoagulation 8Overall project aim (your specific target will relate to your practice / PCN)To reduce stroke risk by offering anticoagulation to those at risk for stroke due to AFTarget groups includingPeople on the AF RegisterPeople with a CHADSDASc score of >1Patients on / not on (but may require) anticoagulationSee UCLP Framework for further target groupsImplementation plan - this could involveReview AF registerSearches to identify patients whose risks may have increased due to changing CHADSDACs scoresBring in patients to assess if need to be on anticoagulant, or if need review of medicationsOpportunistic screeningOther things to considerWho else could be trained to help? Are all staff confident with coding?8

9. 02Resources9

10. General CVD ResourcesFellowship Data Dashboard BHF data pack for your practice (via your Team co-ordinator)UCLP Searches and search guidesCVD Prevent

11. Condition Specific ResourcesHypertension - CESEL Hypertension guidesUCLP Framework - Hypertension LipidsHeart UKUCLP Framework Lipid Management including Familial HypercholesterolaemiaAFAF ToolkitUCLP Framework Atrial Fibrillation