Kavita Oberoi OBE Founder amp Managing Director Agenda AF Prevalence Data Validation Finding the missing AF population What does NICE say ECGs and Diagnosis Using the Kardia AliveCor Mobile ECG Device in Practice ID: 1048157
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1. AF Prevalence & Case Finding Kavita Oberoi OBE Founder & Managing Director
2. AgendaAF Prevalence Data Validation Finding the missing AF populationWhat does NICE say – ECGs and DiagnosisUsing the Kardia AliveCor Mobile ECG Device in Practice
3. Under diagnosis of AF AF is the most common sustained cardiac arrhythmia, affecting 2% of the population and more than 10% of people aged over 80 years in the UK1 The Stroke Organisation estimate that almost one third of patients with AF are currently undiagnosed2 Opportunistic capture of pulse rate can support diagnosis of undetected AF3 AF Prevalence
4. Without preventative treatment 5.8% of AF patients not treated will have a stroke per year4 It is estimated that the UK spends £8.9 billion on stroke each year, 50% of this is direct care costs4 Every stroke prevented could save between £23,315 and £26,70135918,865 patients diagnosed with AF in England6 What is the stroke cost implication of the missing /undiagnosed population?
5. What’s Your AF Prevalence?How it impacts your AF QOF Point Value
6. Reported AF prevalence across EnglandReported AF prevalence across England7AF Prevalence England : 1.71%1667 practices (21.8%) have a reported prevalence for AF that is less than 1%For more information visit: www.GPcontract.co.uk
7. Review your local areawww.gpcontract.co.uk7
8. How prevalence affects QOF income7,8
9. List SizeAF RegisterPrevalenceValue of QOF PointMax Points(2016/17)Potential Income at Max PointsAbove Average 70711792.53%£243.1629£7,051.51Average 58641031.76%£139.9229£4,057.57Below Average 3148120.23%£16.3029£472.73AF QOF Points & Income Ensure your prevalence is reflective of your population
10. Clinical impact of missing AF patientsClinical impact of missing AF patients
11. Why are registers inaccurate ?Data ValidationStep 1 - Ensuring AF Prevalence is reflective of your practice population
12. Why are registers inaccurate ?Why are registers inaccurate ?
13. Data discrepanciesNo defined protocols on Read code usagePractice processesLack of Read code training for medical and non-medical staffExtended external teams using clinical systemPre-defined templates not aligned to correct Read CodesChanges to national guidance in coding during the QOF yearBusiness RulesetsA collection and guidance of Read codes to support consistent data recording for QOFQOF business rule sets – Version 369Data discrepancies
14. Know the simple rules on Read codesDiagnosis coding – 5 byte start with a Capital letter 5 byte CTV3AF G573.. G5730% (excl. G5731) Stroke G61.. X00D1CHD G33.. XE2uVTests, procedures and symptoms – 5 byte start with a number 5 byte CTV3CHADS 2 risk score 38DE. XaP9J Pulse rate 242.. X773sKnow the simple rules on Read codes
15. Know the simple rules on Read codesAvoid hidden Read codes 5 byte CTV3H/O AF 14AN XaDv6H/O Stroke 14A7 XM1R3The codes start with numbers not lettersCorrect coding should be 5 byte CTV3H/O AF G573.. G5730% (exc. G5731) Stroke G61… X00D1 Know the simple rules on Read codes
16. Know the simple rules on Read codesImplantation of intravenous pacemaker for atrial fibrillation 5 byte CTV3 7936A. 7936A.The diagnosis that led to the operation is AF so the codes that should be entered is the diagnosis for AF along with the procedure Know the simple rules on Read codesAlways enter a diagnosis code when entering an operation
17. Know the simple rules on Read codesTake care with admin, monitoring and treatment codes 5 byte CTV3AF annual review 6A9.. XaMGDAF monitoring 9Os.. XallT (Commonly found when it should be the actual diagnosis)Hypertension monitoring 9OI.. XM1YA (A search will identify a number of patients on this code)Diabetic on Diet 66A3. 66A3.Diabetic on oral treatment 66A4. 66A4.Diabetic on insulin 66A5. 66A5. (This is how the patient is being treated, not the diagnosis)Know the simple rules on Read codes
18. Currently registered patients who have a diagnosis of Atrial Fibrillation which has not been subsequently resolved.QOF AF Business Rulesets5ByteCTV3G573% Atrial fibrillation and flutterG5730 Atrial fibrillationG5731 Atrial flutterG5732 Paroxysmal atrial fibrillationG5733 Non-rheumatic atrial fibrillationG5734 Permanent atrial fibrillationG5736 Paroxysmal atrial flutterG5737 Chronic atrial fibrillationG5730% Atrial fibrillationXaeUP Chronic atrial fibrillationXaOft Permanent atrial fibrillationXaOfa Persistent atrial fibrillationXa2E8 Paroxysmal atrial fibrillationX202R Lone atrial fibrillationX202S Non-rheumatic atrial fibrillationXa7nI Controlled atrial fibrillationXaEga Rapid atrial fibrillationG5738 Typical atrial flutterG5739 Atypical atrial flutterG573z Atrial fibrillation and flutter NOSG573% Atrial fibrillation and flutterG573z Atrial fibrillation and flutter NOSG5731% Atrial flutterXaeUR Atypical atrial flutterXaeUQ Typical atrial flutterXaaUH Paroxysmal atrial flutter
19. Version 36 published in April 2017 AF Resolved - takes patients off the AF QOF RegisterCardioversion patients – re-assess coding for these patients Patients with both Atrial Flutter are included on the AF registerBusiness Rulesets9
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