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Type and Title of Submission


Title:

Systematically implementing CG36 Atrial Fibrillation across a PCT/CCG

Description:

Using automated prompts in GPs clinical systems to prompt clinicians to screen for AF annually in patients 65 and over, across a PCT/CCG. Using a CHADS2 algorithm to automatically calculate the CHADS2 score for all patients in AF not on warfarin and to prompt clinicians to consider starting those patients with a CHADS2 score of 2 or above on warfarin.

Category:

2011-12 Shared Learning Awards

Does the submission relate to the general implementation of all NICE guidance?

No

Does the submission relate to the implementation of a specific piece of NICE guidance?

Yes

Full title of NICE guidance:

CG36 - Atrial Fibrillation

Category(s) that most closely reflects the nature of the submission:

Is the submission industry-sponsored in any way?

No


Description of submission


Aim

To improve the detection of AF and improve the management of AF across a PCT/CCG without adding to clinical workload.

Objectives

To prevent patients having a stroke as a result of undetected or poorly managed AF.

Context

NICE and NHS Innovations had identified the sub-optimal management of AF in primary care, resulting in avoidable morbidity for patients and costs to the NHS. GRASP AF was developed to try to address this by each practice running a Miquest query and then looking retrospectively at the results. GRASP AF showed limited effectiveness.

Methods

We licensed software (from BMJ Informatica) that would enable us to write and deploy audits across all GP IT systems (except system one/TPP) which allowed us to add QOF style prompts into the clinical systems to remind clinicians to check and record the pulse rhythm of all patients 65yo and older annually. We also added a prompt to remind clinicians to consider initiating warfarin in all patients in AF who were not already on warfarin and had a CHADS2 score of 2 or above. The software does the CAHDS2 calculation for each individual at risk patient based on the data held in the clinical system. As well as clinicians seeing prompts appropriate for each individual patient, practices can produce lists of those who are at risk and need assessment, and the PCT/CCG can see how each practice is performing. The report updates at practice level daily and at patient level when the patients notes are entered. The practices don't need to do anything the reports run automatically.

Results and evaluation

In the last 14 months for a population of 275,000 covering 57 of 61 practices in the PCT/CCG Prevalence of AF has increased by 0.01% 90 more patients are on warfarin Over 71% of patients in AF with a CHADS2 score of 2 or above are on warfarin Over 4% of patients in AF with a CHADS2 score of 2 or above have a current recording of a contraindication to warfarin or that the patient has declined treatment. 90 additional patients are on warfarin, this equates to saving almost 3 strokes with a financial saving of 11,500 per stoke for the first year of care. The cost of licensing the software was 60,000 but this is only one of a whole range of audits we're running (and developing) others include Familial Hypercholesterolaemia, COPD, Heart Failure, CKD, Hypertension, Lithium monitoring, Tobacco, Alcohol, BMI, Learning disabilities, prevalence, audits to support screening programmes and niche audits to support better management of rare conditions that because of their rarity are both unlikely to be prioritised by NICE or included in QOF.

Key learning points

Making it simpler for clinicians in primary care to do a better job by providing prompts that work real time when they see the patients, supported by practice reporting systems works to improve the quality of care provided. Using the software to automatically calculate the CHADS2 score adds to the effectiveness. Data extraction systems only tell you what you should have done but didn't. The addition of prompts helps clinicians do the right thing at the right time for the right patient, get it right first time. Prompts work. We've empowered clinicians to work smarter not harder for better outcomes. Clinicians want to practice good medicine this makes it easier for clinicians to do what they want to do. Provides better care to patient and is cost effective for the NHS.

Contact Details

Name:Peter Green
Job Title:Medical Director
Organisation:NHS Kent and Medway
Address:50 Pembroke Court, Chatham Maritime
Town:Chatham
County:Kent
Postcode:ME4 4EL
Phone:01634 335020
Email:peter.green@nhs.net

 

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This page was last updated: 14 January 2012

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.