Download Atrial Fibrillation – QOF Indicators

Atrial Fibrillation Project, SSNAP
July to September 2013 and QOF
Indicators 2012/2013
Horsham and Mid
Sussex CCG
South East Coast SCN -Atrial Fibrillation Project
• Earlier detection and anticoagulation optimisation of patients with atrial
fibrillation
• First step will be agreement on recommendation of NICE anticoagulation
guidelines as best practice. New NICE Guidance will be published on the
11th June 2014
• Task to Finish Group being established to implement the NICE guidance
• Will be followed by the development of a best practice model for earlier
detection and management
• SSNAP Data – July to September 2013 most up to date
• QOF Data from 2012/13 most up to date
• Uses CHADS2 scoring. This will be replaced by CHADSVASC in NICE
Guidance
SSNAP Data – July to September 2013
• Nationally 19.8% of Stroke patients had previous AF. SEC is
20.5 %.Range in SEC is 12.7 to 35.5%
• Best practice is anticoagulant prescribing for AF
• Nationally 24.5% of Stroke patients with AF were not
previously prescribed anticoagulants or anti-platelets. SEC is
26.8%. Range is 7.7 % to 40%
• Nationally 32.5 % of Stroke patients with AF were previously
prescribed anticoagulants only. SEC is 31.4%. Range is 0 –
70%
SSNAP Data – July to September 2013
Admitted Stroke Patients with Previous AF
SSNAP - July to September 2013
AF Strokes = 306
40
35
30
%
25
20
15
10
5
0
Stroke Patients with Previous AF on no anticoagulant or anti-platelet
medication
SSNAP - July - September 2013
AF Strokes = 306
45
40
35
30
%
25
20
15
10
5
0
Stroke Patients with Previous AF- Prescribing prior to admission
SSNAP July to September 2013
AF Strokes = 306
Worthing Hospital
St Richards Hospital
East Surrey Hospital
Royal Surrey County Hospital
Medway Maritime Hospital
Tunbridge Wells Hospital
Maidstone District General Hospital
Frimley Park Hospital
%
Epsom Hospital
Anti-platelet only
Eastbourne District General Hospital
Anticoagulant Only
Conquest Hospital
Both
William Harvey Hospital
Queen Elizabeth the Queen Mother Hospital
Kent and Canterbury Hospital
Darent Valley Hospital
Royal Sussex County Hospital
Princess Royal Hospital Haywards Heath
St Peter's Hospital
National
0
10
20
30
40
50
60
70
80
QOF Atrial Fibrillation Indicators – 2012/13 by
CCG
• Four Indicators
– Prevalence (percentage on QOF AF Register/practice population)
– AF05 – Percentage on AF register who have had a CHADS2 score in the previous 15
months (except those whose previous score was greater than 1)
– AF06 – In those with a CHADS2 score higher than 1 in last 15 months– those who are on
anti-coagulants or anti-platelets (minus exceptions)
– AF07 – In those with a CHADS2 score higher than 1 in last 15 months – those who are on
anti-coagulants (minus exceptions)
• Any correlation between QOF CCG indicator results and AF stroke
admissions and prescribing? E.g. High stroke admissions with AF in local
hospitals and low anticoagulant prescribing for those admissions and low
prevalence and low anticoagulant prescribing (for the known AF’s) in CCG
data
AF Prevalence by CCG in Sussex
SUSSEX
Percentage of people on practice list on atrial fibrillation register
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
Brighton & Hove
Source: QOF 2012/13
Coastal West Sussex
Practice
Crawley
KSS
England
Eastbourne,
Hailsham & Seaford
SUSSEX
Hastings & Rother
High Weald Lewes
Havens
Horsham & Mid
Sussex
AF05 by CCG in Sussex
SUSSEX
AF05 The percentage of patients with Atrial Fibrillation in whom stroke risk has been assessed using the
CHADS2 risk stratification scoring system in the preceding 15 months (excluding those whose previous
CHADS2 score is greater than 1)
98.0%
97.5%
97.0%
96.5%
96.0%
95.5%
95.0%
Brighton & Hove
Source: QOF 2012/13
Coastal West Sussex
Practice
Crawley
KSS
England
Eastbourne,
Hailsham & Seaford
SUSSEX
Hastings & Rother
High Weald Lewes
Havens
Horsham & Mid
Sussex
AF06 by CCG in Sussex
SUSSEX
AF06 In those patients with Atrial Fibrillation in whom there is a record of a CHADS2 score of 1 (latest in
the preceding 15 months), the percentage of patients who are currently treated with anti-coagulation
drug therapy or an anti-platelet therapy.
96.5%
96.0%
95.5%
95.0%
94.5%
94.0%
93.5%
93.0%
92.5%
92.0%
91.5%
91.0%
Brighton & Hove
Source: QOF 2012/13
Coastal West Sussex
Practice
KSS
Crawley
Eastbourne,
Hailsham & Seaford
England
SUSSEX
Hastings & Rother
High Weald Lewes
Havens
Horsham & Mid
Sussex
AF07 by CCG in Sussex
SUSSEX
AF07 In those patients with Atrial Fibrillation whose latest record of a CHADS2 score is greater than 1,
the percentage of patients who are currently treated with anti-coagulation drug therapy
86.0%
84.0%
82.0%
80.0%
78.0%
76.0%
74.0%
Brighton & Hove
Source: QOF 2012/13
Coastal West Sussex
Practice
KSS
Crawley
England
Eastbourne,
Hailsham & Seaford
SUSSEX
Hastings & Rother
High Weald Lewes
Havens
Horsham & Mid
Sussex
QOF Atrial Fibrillation Indicators – 2012/13 by Practice
• What to look for
– Does the prevalence look low for this practice population and demographics? All other
indicators are based on this. Low numbers may mean that some AF patients have not
been diagnosed
– AF05 – Low rates will indicate that the practice isn’t routinely assessing those on the AF
Register for CHADS2 and changes to their risk
– AF06 – Best practice is for those with identified AF to be on anticoagulant therapy not
anti-platelet therapy. Compare rates with AFO7. High rates on AF06 but lower rates on
AF07 indicates a high usage of anti-platelet therapy .
– AF07 - Best practice is for those with identified AF to be on anticoagulant therapy .
Compare with prevalence and AF05 - high rates but low prevalence and low routine
assessment may indicate that only small numbers are being managed well
GP Practices Codes in Horsham and Mid Sussex CCG
H82084
H82028
H82004
H82005
H82044
H82040
H82640
H82010
H82035
H82003
H82057
H82063
H82056
H82100
H82036
H82615
H82017
H82621
H82089
H82027
H82008
H82072
H82092
BROW MEDICAL CENTRE
COURTYARD SURGERY
COWFOLD SURGERY
CUCKFIELD MEDICAL CENTRE
DOLPHINS HEALTH CENTRE
HEALTH CENTRE AT BOWERS PLACE
HOLBROOK SURGERY
JUDGES CLOSE SURGERY
LINDFIELD MEDICAL CENTRE
MEADOWS SURGERY
MID SUSSEX HEALTH CARE
MOATFIELD SURGERY
NEWTONS HEALTH CENTRE
NORTHLANDS WOOD SURGERY
ORCHARD SURGERY HORSHAM
OUSE VALLEY PRACTICE
PARK SURGERY HORSHAM
PARK VIEW HEALTH PARTNERSHIP
RIVERSIDE SURGERY
RUDGWICK MEDICAL CENTRE
SHIP STREET SURGERY
SILVERDALE PRACTICE
THE VILLAGE SURGERY
Prevalence by Practice compared to KSS (Red line) and
England (Green Line)
NHS HORSHAM AND MID SUSSEX CCG
Percentage of people on practice list on atrial fibrillation register
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
Source: QOF 2012/13
Practice
KSS
AFO5 by Practice compared to KSS (Red line) and
England (Green Line)
NHS HORSHAM AND MID SUSSEX CCG
AF05 The percentage of patients with Atrial Fibrillation in whom stroke risk has been assessed using the CHADS2 risk
stratification scoring system in the preceding 15 months (excluding those whose previous CHADS2 score is greater than 1)
120%
100%
80%
60%
40%
20%
0%
Source: QOF 2012/13
Practice
KSS
AFO6 by Practice compared to KSS (Red line) and
England (Green Line)
NHS HORSHAM AND MID SUSSEX CCG
AF06 In those patients with Atrial Fibrillation in whom there is a record of a CHADS2 score of 1 (latest in
the preceding 15 months), the percentage of patients who are currently treated with anti-coagulation
drug therapy or an anti-platelet therapy.
120%
100%
80%
60%
40%
20%
0%
Source: QOF 2012/13
Practice
KSS
AFO7 by Practice compared to KSS (Red line) and
England (Green Line)
NHS HORSHAM AND MID SUSSEX CCG
AF07 In those patients with Atrial Fibrillation whose latest record of a CHADS2 score is greater than 1,
the percentage of patients who are currently treated with anti-coagulation drug therapy
120%
100%
80%
60%
40%
20%
0%
Source: QOF 2012/13
Practice
KSS