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+ Using QCancer in EMIS Web Julia Hippisley-Cox, Professor General Practice, Director QResearch, Director ClinRisk Ltd. EMIS National User Group 2015 Nottingham.

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Presentation on theme: "+ Using QCancer in EMIS Web Julia Hippisley-Cox, Professor General Practice, Director QResearch, Director ClinRisk Ltd. EMIS National User Group 2015 Nottingham."— Presentation transcript:

1 + Using QCancer in EMIS Web Julia Hippisley-Cox, Professor General Practice, Director QResearch, Director ClinRisk Ltd. EMIS National User Group 2015 Nottingham www.qcancer.org

2 Acknowledgements Co-authors QResearch database EMIS & Contributing EMIS practices EMIS National User Group University of Nottingham ClinRisk (software) Oxford University (independent validation) Macmillan Cancer Support (evaluation & clinical reference group)

3 Overview What is QCancer and why has it been developed How to use it in EMIS Web Using the Risk Calculator in a Consultation Activating the Alerts Batch processing/risk stratification Questions

4 QScores –new family of Risk Prediction tools Individual assessment  Who is most at risk of current or preventable disease?  Who is likely to benefit from interventions?  What is the balance of risks and benefits for my patient?  Enable informed consent and shared decisions Population risk stratification  Identification of rank ordered list of patients for recall or reassurance GP systems integration  Allow updates tool over time, audit of impact on services and outcomes

5 Early diagnosis of cancer: The problem 300,000 new cancers each year UK has relatively poor track record when compared with other European countries Partly due to late diagnosis with estimated 7,500+ lives lost annually Later diagnosis due to mixture of late presentation by patient (lack awareness) Late recognition by GP Delays in secondary care Earlier diagnosis cancer improves chances of survival www.qcancer.org

6 NICE guidance on suspected cancer (2015) www.qcancer.org Symptom based approach Lower threshold for intervention to 3% PPV of individual cancers More investigation and referral Didn’t make explicit reference to use of risk assessment tools Used research underpinning QCancer to develop guidance Qcancer provides practical way to identify patients at risk to improve early diagnosis QCancer now in EMIS Web

7 Why symptoms based approach? Many patients present with symptoms GPs need to decide which patients to investigate and refer Decision support tool must mirror setting where decisions made Symptoms based approach needed (rather than cancer based) Must account for multiple symptoms Must have face clinical validity eg adjust for age, sex, smoking, Family history Need to be able to update to meet changing requirements, populations, recorded data www.qcancer.org

8 QCancer– what it needs to do Accurately predict individual level of risk of multiple cancers for based on multiple risk factors and multiple symptoms Discriminate between patients with and without cancer Help guide decision on who to investigate or refer and degree of urgency. Educational tool for sharing information with patient. Sometimes will be reassurance. QCancer combined model published BJGP January 2013 Cancer in women Cancer in men www.qcancer.org

9 Methods – development algorithm Representative cohort from QResearch 2.5 million men & women aged 25-89 years cancer outcome - all new diagnoses on GP record or linked deaths record in 2 years Identify key risk factors Identify key symptoms Established methods to develop risk prediction algorithm Measure of absolute risk of any cancer as well as by cancer type www.qcancer.org

10 QCancer predicts global cancer risk & risk12 types cancers PancreasLung Renal tractOvary Colorectal Gastro Testis Breast Prostate Blood Cervix Uterus These accounts for 85% cancers Plan to extend to rarer cancers when sufficient data www.qcancer.org

11 Key Risk Factors in QCancer www.qcancer.org Age Sex Smoking status Alcohol use Deprivation score Family history of cancer COPD Endometrial hyperplasia/polyp Chronic pancreatitis Type 2 diabetes Anaemia (HB < 11g/DL) Venous thromboembolism Demographics life style Co-morbidities

12 Key symptoms in model www.qcancer.org Haemoptysis Haematemesis Haematuria Rectal bleeding Haematuria Unexplained bruising Loss of appetite Unintentional weight loss Indigestion +/- heart burn Dysphagia Abdominal pain or swelling Constipation Night sweats Cough Neck lump Vaginal Bleeding Breast lump Breast pain Nipple changes Genito-Urinary symptoms (men) -Retention -Nocturia -Frequency -Impotence -Testicular Bleeding general women Men

13 Validation of QCancer www.qcancer.org Essential to demonstrate the tools work and identify right people in an efficient manner Tested performance separate sample of QResearch practices external dataset (Vision practices) Good at identifying those who do and don’t have cancer Good at estimating level of risk Real world testing 2013-14 with Macmillan and CRUK to evaluate its use in > 250 practices across the UK. Currently used in the NHS England ACE program We tested it and it works fine! Don’t forget QCancer works out cancer risk NOT diagnosis

14 Using QCancer in practice www.qcancer.org Standalone web calculator www.qcancer.org Integrated into clinical system Within consultation: GP with patients with symptoms Within consultation QOF style alert Run in batch mode to risk stratify populations

15 QCancer Protocol Alert Under Evaluation  Alert on all sites now (version 5.5)  Deployed in INACTIVE form  Practices need to activate it:  https://www.emisnug.org.uk/activating- qcancer-alerts https://www.emisnug.org.uk/activating- qcancer-alerts  Alert will appear if codes added during consultation on fly e.g. if add haematuria, it will pop up  Click on score will take you to template

16 QCancer symptom checker template Template to capture relevant symptoms & risk factors Saving template files total QCancer score in the record https://www.emisnug.org.uk/using-cancer-symptom- checker-emis-web https://www.emisnug.org.uk/using-cancer-symptom- checker-emis-web

17 QCancer site specific scores (v5.8)

18 QCancer Batch Add Similar to QRISK2 which is in 95% of GP practices– automatic calculation of risk for all patients in practice based on existing data. safety netting - Identify patients with symptoms/adverse risk profile without follow up/diagnosis Enables systematic recall or further investigation Systematic approach - prioritise by level of risk. From web 5.8 includes site specific scores https://www.emisnug.org.uk/batch-add-cancer-risk-score www.qcancer.org


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