1. Wales Primary Care COPD Audit 2014-15
Next steps for improvement
National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme
2016

2. The audit programme partnership
Working in strategic partnership:
Supported by:
Commissioned by:

3. Who was in the audit? n=47992 (removal of ages >110) Average age
71.3
Min age 36
Max age
110
Median age 71
Male
25188
Female
22801
Unknown sex (U) 3
Average male age
71.7
Average female age
70.9

4. Recruitment by LHB LHB Name
Patients registered with COPD who participated
Number of participating practices per LHB
Percentage of practices that participated
Abertawe Bro Morgannwg University Local Health Board
11,563 64
85.3
Aneurin Bevan Local Health Board
11,771 71
81.6
Betsi Cadwaladr University Local Health Board
3,964 22
19.3
Cardiff and Vale University Local Health Board
5,093 38
57.6
Cwm Taf Local Health Board
7,108 36
78.3
Hywel Dda Local Health Board
7,684 42
77.8
Powys Teaching Local Health Board
922 7
41.2
Wales
48,105
280
61.0

5. What did the audit recommend?

6. Key results: Diagnosis
Approximately 4 out of 5 (80.3%) patients did not have
the right test (post-bronchodilator FEV1/FVC) performed/recorded
Where the right test was recorded, it was not consistent with COPD (ratio of ) in around 1 in 4 cases (26.9%)

7. High value interventions in COPD
What are they?
The pyramid of value for COPD interventions, developed by the London Respiratory Network with The London School of Economics and Political Science (modified from the IMPRESS guide to the relative value of COPD interventions

8. High value interventions in COPD
Are we delivering them?
The value pyramid providing a representation of the proportion of people who were receiving value-based interventions for COPD in Wales in

9. Key results: High value interventions
19.2% of people were exception reported for the flu vaccine

10. Key results: High value interventions
One third (33.5%) of people with COPD were listed as current tobacco smokers
Approximately 10% of people with COPD who smoke received tobacco dependency treatment in the last year

11. Key results: High value interventions
2 in 3 people with COPD who are eligible for PR have yet to be referred (65.5%)

12. Key results: Optimal therapy
Identify those closer to death or admission to help them live well at home: The DOSE score
Wales
Question 10a: Breathlessness (dyspnoea) – the percentage of people with an MRC scale of 1–5 within the last year
58.2%
Question 10b: Obstruction – the percentage of people with COPD with any spirometry test code within the last year
50.1%
Question 10c: Smoking – the percentage of people with COPD with a smoking status recorded within the last year
71.7%
Question 10d: Exacerbations – the percentage of people with COPD with at least one exacerbation recorded within the last year
10.8%

13. Know your population - Breathlessness
Key results: Optimal therapy
Know your population - Breathlessness

14. Key results: Optimal therapy
Know your population - GOLD
GOLD classifies people with COPD by:
degree of breathlessness,
number of exacerbations in the last year, and
airflow limitation.
Extracted data suggest only 21% of people have data recorded that would allow a prescriber to follow this guideline.
Annual recording of all three metrics is key to providing individualised therapeutic plans.
Global Initiative for Chronic Obstructive Lung Disease. Pocket guide to COPD diagnosis, management and prevention: A guide for healthcare professionals. GOLD,

15. Coding and data recording
Differences were found between QOF figures and the findings from the audit
QOF
Audit findings
The % of patients with COPD in whom the diagnosis has been confirmed by post- bronchodilator spirometry was 90.4%.
The % of people with COPD who have a post- bronchodilator FEV1/FVC ever recorded, where the code was consistent with COPD was 14.4%.

16. Better measures : codes & templates
Diagnosis
Could low number of FEV1/FVC (339m) recorded be due to coding issues?
Analysis of 10 additional Read codes suggested this may be the case (results went from 14.4% to 58%).
Suggestion:
Use 339m: FEV1/FVC ratio after bronchodilator as your diagnostic code.
Use a value <1.0 ( 0.68 not 68%).
Remember if its not <0.7 its probably not COPD.

17. Better measures : codes & templates
Exacerbations
Use H3122: Acute exacerbation of chronic obstructive airways disease to record each acute event
Use 66Yf: Number of COPD exacerbations in past year once a year when counting up the events

18. Quality Improvement
Start small, keep it short, share and reflect
Choose one of the four recommendations to focus on.

19. Quality Improvement Example: Diagnosis
Plan: Investigate the % of patients at your practice who have had a post-bronchodilator FEV1/FVC result recorded
Do: Make changes based on your findings:
*Implement a template
*Ensure Read Code 339m is used
Study: Plot the change over time
Act: Identify gaps in your improvement & speak to those who can help

20. Quality Improvement Example: High value interventions
Plan: Investigate the % of patients at your practice who have had all elements of the DOSE score recorded in the last year 
Do: Agree codes and alerts within a template to ensure this is recorded 
Study: Has the rate improved?
Act: Which element is recorded less? What needs to happen next? 

21. Quality improvement
Through education and networking

22. Involve your patients
Ask your population with COPD if they are getting the right care

23. What next?
Another extraction of data in April Please remember to sign up if you have not already done so!
Development of an Audit+ module for COPD
Reporting dashboards
Mail-merge facilities
Access to aggregated reports via the NWIS Primary Care Information Portal
Comparison and benchmarking at LHB and Wales level

24. National COPD Audit Programme