failure The GRASP Suite Vanessa Brown NHS Improving Quality Living Longer Lives Engaging with clinicians and primary care in the nations biggest killers Raising public awareness of symptoms and supporting early diagnosis of ID: 629666
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A quality improvement approach to clinical audit in COPD and heart failure :The GRASP Suite
Vanessa Brown
NHS Improving QualitySlide2
Living Longer LivesEngaging with clinicians and primary care in the nation’s biggest killersRaising public awareness of symptoms and supporting early diagnosis of diseasee
Supporting implementation of the CVD Outcomes Strategy (and NHS Health Check)Slide3
What is GRASP?Initially commissioned by the WYCN & PRIMIS to improve the management of AF it now also includes COPD and HFSponsored by NHS IQ so FREE to end userBased on PRIMIS’ CHART ‘freeware’ which uses MIQUEST
Compatible with all GP systems in England
Aligned to
NICE/ best practice guidance
Comprises of a case-finder and care management audit tool
Patient identifiable version
Pseudonymised data can be uploaded to CHART Online for benchmarking purposes
NOT a clinical decision support toolSlide4
Why GRASP-COPD?1 person dies from COPD every 20 minutes 1 in 8 people over 35 has COPD that has not been properly identified or diagnosed, and over 15% are only diagnosed when they present to hospital as an emergencyCOPD is the second most common cause of emergency admissions to hospital Over 50% of people currently diagnosed with COPD are under 65 years of ageCOPD costs the NHS more than £800 million each year, (equivalent to £1.3 million per 100,000
population) Slide5
GRASP-COPD Case finderPatients not yet diagnosed with COPDIdentify patients potentially missing a COPD diagnosis codeIdentify patients at risk of developing COPD Prioritise those patients most likely to need a review using pre-set (or user-defined) filtersSlide6Slide7Slide8Slide9
GRASP-COPD Care ManagementIdentifies patients who have been coded with COPD, providing practice prevalenceEnables practices to audit the management of patients with COPD against current NICE guidanceProvides a summary of practice results and patient level detail for case reviewIdentifies where quality of care can be improvedSlide10Slide11Slide12Slide13
What is CHART Online?Voluntary upload of data to CHART onlineWeb based analysis tool with a variety of comparative viewing options available
Benchmark own practice against others in CCG
Benchmark CCG against others in SCN/ National
View change (improvements!) over time
Secure and restricted access
Practices control who sees their national identifier
For both providers and commissionersSlide14Slide15Slide16
5 key actions after running GRASP-COPDUse the COPD case finder to identify patients who may have a missing diagnosis of COPD or who may go on to develop COPDCompare COPD severity with the current treatment regime and target COPD patients for review Target patients with an MRC score of 3+ who have no evidence of pulmonary rehabilitation Target all COPD patients with these cost
effective strategies:
annual
‘flu vaccination
helping
smokers to
quit
Upload data to CHART Online for benchmarking
and comparisonSlide17
An example of implementing GRASP COPD to improve patient careSlide18
An innovative 2 year Local Incentive Scheme
Objectives to:
decrease unplanned admissions and
highlight patients with a primary diagnosis of COPD
3
Components
GP to attend monthly
Locality commissioning
meeting
Casefinder
and GRASP-COPD use and monthly reporting
Practice action planning to improve patient care Practice managers were up skilled to run GRASPClinical templates were designed for use in consultationSlide19Slide20
GRASP COPD
The Blackpool ExperienceSlide21
Blackpool’s experience of GRASP-COPD
CCG quality premium target was to ↑ COPD recorded prevalence by 10% from 2012/2013 baseline
Key objectives of the initiative were to increase and improve identification and management of COPD and reduce COPD related NEL admissions
Practices set individual prevalence targets
In addition to pro-actively screening smokers/ex-smokers through COPD-6 practices were encouraged to utilise GRASP case finder to validate their COPD register
“Patients with a COPD monitoring code ever”
Blackpool achieved and exceeded their target by April 2014 i.e.
recorded prevalence
rose by 11.08% (n 5406 → n6005 patients)
COPD register sizes have continued to
riseSlide22
Why GRASP-HF?Around 900,000 people in the UK have heart failure (HF)Like AF, the incidence and prevalence of HF increase steeply with ageThe prevalence of HF is expected to rise in future as a result of an ageing population, improved survival of people with CHD and more effective treatmentsHF has a poor prognosis: 30–40% of patients diagnosed with heart failure die within a year
HF accounts for a total of 1 million inpatient bed-days – 2% of all NHS inpatient bed-days – and 5% of all emergency medical admissions to hospital
Good heart failure care increases longevity, reduces symptoms and improves quality of life
Evidence suggests that community based (primary care-led) care can reduce readmissions and save money for the NHSSlide23
GRASP-HF Case finderPatients not yet diagnosed Identify patients potentially missing a heart failure and LVSD diagnosis codeIdentify patients who have risk factors indicating LVSD that should be considered for review for possible inclusion in the register and treatmentPrioritise those patients most likely to need a review using pre-set (or user-defined) filtersSlide24Slide25Slide26Slide27
5 key actions after running GRASP-HFRun the case finder to identify patients with missing diagnoses of HF and/ or LVSDEnsure that patients are on the most effective treatment regimenUndertake regular reviews of patientsTarget HF patients with these cost-effective strategies:Annual ‘flu vaccinationCardiac rehabilitationUpload data to CHART Online for benchmarking and comparisonSlide28
GRASP-AFGuidance on Risk Assessment and Stroke Prevention in AFCase finder- accurate coding of possible and probable AF
Identifies patients with a history of atrial fibrillation
Searches for co-morbidities and calculates both a CHADS
2
and CHA
2
DS
2
-VASc score
Searches for current medication- warfarin, aspirin or newer oral anticoagulant
Searches for recorded reasons for NOT treating with warfarin
Highlights those at high risk and not on warfarin or newer oral anticoagulantSlide29
Case finderSlide30Slide31
How to get GRASPRegister for free basic PRIMIS Hub membership (if you are not already a PRIMIS Hub member ) at https://www.primis.nottingham.ac.uk/registration/registration/default.aspSign in to PRIMIS Hub
Visit the
GRASP suite page
in PRIMIS Hub in order
to:
Request access* (if this is the first GRASP tool you have used)
S
ign
the terms and conditions agreement (if you have not done so already)
Ensure you have the latest version of CHART installed - see the
CHART page within the Hub for full details Download and install the GRASP-AF installer file by clicking on 'CHART updates' within the CHART software tool USER GUIDES AVAILABLE FROM PRIMIS AND NHS IQCONTACT THE PRIMIS HELPDESKSlide32
SummaryThe GRASP Suite is a cornerstone of NHS IQ’s programme of work for engaging with clinicians to tackle the five big killersGRASP-AF is improving the way stroke risk in AF is managed; changes are small but potential impact is great
NHS IQ has built on the success of GRASP-AF by developing similar tools for other long term conditions
Each toolkit in the GRASP suite has a number of features and benefits of value to providers and commissioners in primary care
GRASP is free to all practices in England through PRIMIS Hub membershipSlide33
@NHSIQ
#GRASP_suite
Vanessa.Brown@nhsiq.nhs.uk
Technical help:
ian.robson@nhsiq.nhs.uk
www.nhsiq.nhs.uk
Start
using GRASP for FREE by signing up for free PRIMIS Hub membership at:
www.primis.nottingham.ac.uk/hub
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