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Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013. Dartford, Gravesham and Swanley CCG. South East Coast SCN -Atrial Fibrillation Project. Earlier detection and anticoagulation optimisation of patients with atrial fibrillation - PowerPoint PPT Presentation
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Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013
Dartford, Gravesham and Swanley 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
National
St Pete
r's Hospita
l
Princes
s Roya
l Hospita
l Hay
wards H
eath
Royal Su
ssex C
ounty Hospita
l
Darent V
alley
Hospita
l
Kent a
nd Canter
bury Hosp
ital
Queen El
izabeth
the Q
ueen M
other Hosp
ital
William
Harvey
Hospita
l
Conquest Hosp
ital
Eastbourne D
istrict
Genera
l Hosp
ital
Epsom Hospita
l
Frimley
Park Hosp
ital
Maidsto
ne Distr
ict Gen
eral H
ospital
Tunbrid
ge Well
s Hosp
ital
Medway
Mari
time Hosp
ital
Royal Su
rrey C
ounty Hospita
l
East S
urrey H
ospital
St Rich
ards H
ospital
Worthing H
ospita
l05
10152025303540
Admitted Stroke Patients with Previous AFSSNAP - July to September 2013
AF Strokes = 306
%
National
St Pete
r's Hospita
l
Princes
s Roya
l Hosp
ital H
ayward
s Hea
th
Royal Su
ssex C
ounty Hospita
l
Darent V
alley
Hospita
l
Kent a
nd Canter
bury Hosp
ital
Queen El
izabeth
the Q
ueen M
other Hosp
ital
William
Harvey
Hospita
l
Conquest Hosp
ital
Eastbourne D
istrict
Genera
l Hosp
ital
Epsom Hospita
l
Frimley
Park Hosp
ital
Maidsto
ne Distr
ict Gen
eral H
ospital
Tunbrid
ge W
ells Hosp
ital
Medway
Mari
time Hosp
ital
Royal Su
rrey C
ounty Hospita
l
East S
urrey H
ospital
St Rich
ards H
ospital
Worthing H
ospita
l0
5
10
15
20
25
30
35
40
45
Stroke Patients with Previous AF on no anticoagulant or anti-platelet medication
SSNAP - July - September 2013AF Strokes = 306
%
National
St Peter's Hospital
Princess Royal Hospital Haywards Heath
Royal Sussex County Hospital
Darent Valley Hospital
Kent and Canterbury Hospital
Queen Elizabeth the Queen Mother Hospital
William Harvey Hospital
Conquest Hospital
Eastbourne District General Hospital
Epsom Hospital
Frimley Park Hospital
Maidstone District General Hospital
Tunbridge Wells Hospital
Medway Maritime Hospital
Royal Surrey County Hospital
East Surrey Hospital
St Richards Hospital
Worthing Hospital
0 10 20 30 40 50 60 70 80
Stroke Patients with Previous AF- Prescribing prior to admissionSSNAP July to September 2013
AF Strokes = 306
Anti-platelet onlyAnticoagulant OnlyBoth
%
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 Kent
Ashford Canterbury & Coastal
Dartford, Gravesham &
Swanley
Medway South Kent Coast Swale Thanet West Kent
KENT
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
Practice KSS England
KENT
Percentage of people on practice list on atrial fibrillation register
Source: QOF 2012/13
AF05 by CCG in Kent
Ashford Canterbury & Coastal
Dartford, Gravesham &
Swanley
Medway South Kent Coast Swale Thanet West Kent
KENT
93.0%
94.0%
95.0%
96.0%
97.0%
98.0%
99.0%
100.0%
Practice KSS England
KENTAF05 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)
Source: QOF 2012/13
AF06 by CCG in Kent
Ashford Canterbury & Coastal
Dartford, Gravesham &
Swanley
Medway South Kent Coast Swale Thanet West Kent
KENT
90.0%
91.0%
92.0%
93.0%
94.0%
95.0%
96.0%
97.0%
98.0%
Practice KSS England
KENTAF06 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.
Source: QOF 2012/13
AF07 by CCG in Kent
Ashford Canterbury & Coastal
Dartford, Gravesham &
Swanley
Medway South Kent Coast Swale Thanet West Kent
KENT
70.0%
72.0%
74.0%
76.0%
78.0%
80.0%
82.0%
84.0%
86.0%
Practice KSS England
KENTAF07 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
Source: QOF 2012/13
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 Practice Codes in Dartford, Gravesham and Swanley CCG
G82710 BENNETT WAY SURGERY
G82088 DEVON ROAD SURGERY
G82809 DOWNS WAY MEDICAL PRACTICE
G82206 DR ARORA R P
G82028 DR JONES D I & PARTNERS
G82221 DR LANGLEY S H & PARTNER
G82032 DR MORAN S G & PARTNERS
G82073 DR MOUNTY J P & PARTNERS
G82722 DR MUTHAPPAN A K
G82212 DR PATEL B C & PARTNERS
G82197 DR PATEL M M & PARTNER
G82690 DR PILLARISETTI S C
G82062 DR SHAH S U D
G82006 DR SHIMMINS C J & PARTNERS
G82648 DR SINGH J
G82743 DR VASUDAVEN B & PARTNER
G82218 FARNINGHAM SURGERY
G82780 GRAVESEND MEDICAL CENTRE
G82048 HORSMAN'S PLACE SURGERY
G82156 IVY BOWER SURGERY
G82097 JUBILEE MEDICAL GROUP
G82143 LOWFIELD MEDICAL CENTRE
G82639 MAPLE PRACTICE
G82808 OAKFIELDS HEALTH CENTRE
G82067 OLD ROAD WEST
G82185 REDWOOD PRACTICE
G82122 SWANSCOMBE HEALTH
G82647 TEMPLE HILL SURGERY
G82096 THE FORGE SURGERY
G82044 THE GATEWAY MEDICAL PRACTICE
G82225 THE OAKS
G82056 THE ORCHARD PRACTICE
G82021 THE SHRUBBERY
G82124 WEST KINGSDOWN MEDICAL CENTRE
G82805 WEST KINGSDOWN MEDICAL CENTRE
Y02826 WHITE HORSE SURGERY
Prevalence by Practice compared to KSS (Red line) and England (Green Line)
G8271
0
G8208
8
G8280
9
G8220
6
G8202
8
G8222
1
G8203
2
G8207
3
G8272
2
G8221
2
G8219
7
G8269
0
G8206
2
G8200
6
G8264
8
G8274
3
G8221
8
G8278
0
G8204
8
G8215
6
G8209
7
G8214
3
G8263
9
G8280
8
G8206
7
G8218
5
G8212
2
G8264
7
G8209
6
G8204
4
G8222
5
G8205
6
G8202
1
G8212
4
G8280
5
Y0282
60.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
Practice KSS England
NHS DARTFORD, GRAVESHAM AND SWANLEY CCG
Percentage of people on practice list on atrial fibrillation register
Source: QOF 2012/13
AFO5 by Practice compared to KSS (Red line) and England (Green Line)
0%
20%
40%
60%
80%
100%
120%
Practice KSS England
NHS DARTFORD, GRAVESHAM AND SWANLEY CCGAF05 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)
Source: QOF 2012/13
AFO6 by Practice compared to KSS (Red line) and England (Green Line)
0%
20%
40%
60%
80%
100%
120%
Practice KSS
NHS DARTFORD, GRAVESHAM AND SWANLEY CCGAF06 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.
Source: QOF 2012/13
AFO7 by Practice compared to KSS (Red line) and England (Green Line)
0%
20%
40%
60%
80%
100%
120%
Practice KSS
NHS DARTFORD, GRAVESHAM AND SWANLEY CCGAF07 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
Source: QOF 2012/13