Oakington Cambridge CB24 3BA Practice Overview COPD Patient COPD QOF diagnosis code Page 1 Contents Patient Demographics COPD Diagnosis COPD Health Status Risk and Exacerbations ID: 660843
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Slide1
COPD Report
5 Coles Lane,
Oakington
, Cambridge, CB24 3BASlide2
Practice Overview
COPD Patient: COPD QOF diagnosis code
Page 1Slide3
Contents
Patient Demographics
COPD Diagnosis COPD Health Status Risk and Exacerbations
COPD Management
&
Reviews
Recommendations
Page 2Slide4
Patient Demographics
Age Distribution
Co-morbidities
Smoking Status
COPD Diagnosis
COPD Health Status
Risk and Exacerbations
COPD Management
&
Reviews
Recommendations
Contents
Page 3Slide5
Patient Demographics
Age Distribution
Page 4Slide6
Patient Demographics
Co-morbidities
Rhinitis: Read code entry in last 2 years or nasal steroid therapy in last year GERD, Depression/Anxiety: Read code entry in last 2 years
Page 5Slide7
Patient Demographics
Smoking Status
Smoking status is obtained from patient questionnaires where available or from routine practice data
Page 6Slide8
Patient Demographics
COPD Diagnosis
Confirming Diagnosis
COPD Severity Status
COPD Health Status
Risk and Exacerbations
COPD Management
&
Reviews
Recommendations
Contents
Page
7Slide9
Confirming COPD Diagnosis*
COPD Diagnosis
COPD Diagnosis:
COPD
QOF diagnosis code
Page
8Slide10
COPD Severity Classification*
COPD Diagnosis
Adapted
from NICE and Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines
Page
9Slide11
COPD Diagnosis
COPD Severity in Patients with Confirmed Diagnosis*
Confirmed COPD diagnosis:
w
here FEV1/FVC
< 0.7
Page
10Slide12
Patient Demographics
COPD Diagnosis
COPD Health Status
MRC Breathlessness Score
COPD Assessment Test (CAT) Score
GOLD Combined Assessment of COPD
Risk and Exacerbations
COPD Management and Reviews
Recommendations
Contents
Page
11Slide13
COPD Health Status
Measuring COPD Health Status
I
nformation from practice recorded data and patient questionnaire responses is used to assess the health status of patients with COPD in three ways:
The Medical Research Council (MRC) breathlessness score
COPD Assessment Test (CAT) score
Combined assessment of COPD using GOLD patient groups*
G
lobal initiative for chronic
O
bstructive
L
ung
D
isease (GOLD) patient groups can be calculated from MRC or CAT scores, reliever use and lung function data
Page
12Slide14
COPD Health Status
MRC Breathlessness Scale
Page
13Slide15
MRC Score* DistributionMRC data is obtained from patient questionnaires where available or from routine practice data
COPD Health Status
Page
14Slide16
MRC Score* and COPD Severity
COPD Health Status
MRC data is obtained from patient questionnaires where available or from routine practice data
OPC Service
Page
15Slide17
COPD Health Status
COPD Assessment Test (CAT)
0
1
2
3
4
5
I never cough
I cough all the time
0
1
2
3
4
5
I have no phlegm (mucus) in my chest at all
My chest is full of phlegm (mucus)
0
1
2
3
4
5
My chest does not feel tight at all
My chest feels very tight
0
1
2
3
4
5
When I walk up a hill or one flight of stairs I am not breathless
When I walk up a hill or one flight of stairs I am very breathless
0
1
2
3
4
5
I am not limited doing any activities at home
I am very limited doing any activities at home
0
1
2
3
4
5
I am confident leaving my home despite my lung condition
I am not at all confident leaving my home despite my lung condition
0
1
2
3
4
5
I sleep soundly
I don’t sleep soundly because of my lung condition
0
1
2
3
4
5
I have lots of energy
I have no energy at all
Page
16Slide18
COPD Health Status
Application of CAT Score
Page
17Slide19
COPD Health Status
CAT Score* Distribution
CAT data is obtained from patient questionnaires where available or from routine practice data
Page
18Slide20
COPD Health Status
GOLD Combined Assessment of COPD*
Adapted
from
Global
initiative for chronic Obstructive Lung Disease (GOLD)
guidelines 2014
The combined assessment of COPD aims to determine severity of disease, its impact on patients’ health status, and risk of future adverse events (exacerbations, hospitalisations, etc.) It provides a rubric for combining the key assessments of COPD to improve management of patients by categorizing them into the
GOLD patients
g
roups A, B, C or D
.
The key assessments include: severity of airflow limitation, symptoms and exacerbations. When assessing risk, choose the highest risk according to airflow limitation or exacerbation history (one or more hospitalisations for exacerbations is considered high risk).
Page
19Slide21
FEV1% Predicted< 50%
≥ 2or ≥ 1w
ith hospitalisation
1without hospitalisation
0
C
D
A
B
CAT <10
or
m
MRC 0 – 1
FEV1%
Predicted
≥ 50%
CAT ≥10
or
m
MRC ≥ 2
RISK
RISK
Airflow Limitation
Exacerbation History
SYMPTOMS or BREATHLESSNESS
GOLD Combined Assessment of COPD*
GOLD Patient Groups
COPD Health Status
Adapted
from
Global
initiative for chronic Obstructive Lung Disease (GOLD)
guidelines 2014
Page
20Slide22
GOLD Combined Assessment of COPD
COPD Health Status
Page
21Slide23
Patient Demographics
COPD Diagnosis
COPD Health Status
Risk and Exacerbations
Exacerbations
Future Risk – DOSE Score
COPD Management and Reviews
Recommendations
Contents
Page
22Slide24
Risk and Exacerbations
Exacerbations*
Exacerbations: exacerbation Read code entry or patient reported exacerbation & hospitalisations & number of courses of oral steroids in last 12 months
Page
23Slide25
Risk and Exacerbations
Exacerbations and COPD Severity
OPC Service
Page
24Slide26
Risk and Exacerbations
Future Risk: DOSE Score
DOSE Score = Sum of Points scored for each DOSE
item
Validated research demonstrates that DOSE Score ≥ 4 is indicative
of increased
future risk of exacerbation, hospitalisation and mortality
Page
25Slide27
Risk and Exacerbations
Future Risk: DOSE Score Distribution
Page
26Slide28
Risk and Exacerbations
DOSE Score and COPD Severity
OPC Service
Page
27Slide29
Patient Demographics
COPD Diagnosis
COPD Health Status
Risk and Exacerbations
COPD Management &
Reviews
Smoking
Pharmacotherapy Management
COPD Reviews
Recommendations
Contents
Page
28Slide30
COPD Management & Reviews
Smoking Status and COPD Severity
OPC Service
Page
29Slide31
Pharmacotherapy Management: NICE Guidelines
2010
COPD Management & Reviews
Page
30Slide32
Pharmacotherapy Management
COPD Management & Reviews
Page
31Slide33
COPD Management
Pharmacotherapy Management by COPD Severity:
All patients
Page
32Slide34
Pharmacotherapy Management by MRC Score:
Mild & Moderate Patients (FEV1
% Predicted ≥ 50%)
COPD Management & Reviews
Page
33Slide35
Pharmacotherapy Management by MRC Score:
Severe & Very Severe Patients (FEV1
% Predicted < 50%)
COPD Management & Reviews
Page
34Slide36
Pharmacotherapy Management by Exacerbations:
Mild & Moderate Patients (FEV1
% Predicted ≥ 50%)
COPD Management & Reviews
Page
35Slide37
Pharmacotherapy Management by Exacerbations:
Severe & Very Severe Patients (FEV1
% Predicted < 50%)
COPD Management & Reviews
Page
36Slide38
COPD Reviews & Self-Management Plans*
COPD Reviews and Self-management plans provided in the 12 months prior to the date of extraction and recorded by Read code entry
COPD Management & Reviews
Page
37Slide39
Patient Demographics
COPD Diagnosis
COPD Health Status
Risk and Exacerbations
COPD Management & Reviews
Recommendations
Therapy Recommendation
Management Recommendation
Contents
Page
38Slide40
PLEASE NOTE
Recommendations
The practice
report recommendations have been grouped into ‘
Therapy Recommendations
’ and ‘
Management Recommendations
’. Please consider both
groups of recommendations together, as a holistic approach is vital for effective patient care and optimising patient outcomes.
Patients covered within each recommendation and
the patient
questionnaire responses can be viewed on your
COPD patient level
r
eports
, through the OPC Tools application on your practice computer. Please refer to the ‘Viewing Patient Reports’ user-guide to assist you in this regard. Alternatively, please contact the OPC service delivery team for assistance.
Optimum Patient Care
5 Coles Lane,
Oakington
, Cambridge, CB24 3BA
Tel: 01223 967 855
E-mail
:
services@optimumpatientcare.org
Page
39Slide41
Therapy Recommendations
Recommendations
Adapted
from NICE and Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines
Page
40Slide42
Your Practice Therapy Recommendations
Recommendations
Page
41Slide43
Management Recommendations
Recommendations
Adapted
from NICE and Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines
Page
42Slide44
Management Recommendations
Page
43Slide45
Your Practice Management Recommendations
Recommendations
Page
44