QI

Allowing you to achieve incremental and measurable changes to make a real difference to patients

Getting the diagnosis right for patients on the COPD register

Fixing the COPD register (Project ONE of TWO)

QI projects are built as a TWO-PART component

Part 1

Setup

Here you set up and understand the project, ensuring you have everything in place to start your project

Part 2

Project

Here you have all the tools and resources to keep track of your progress towards completing the project successfully

Better setup, better success

Setup

Getting started

Why is this important?

Data collected from GP practices across Wales suggest that only 11.5% patients on the COPD registers have evidence of both:

  • Post-bronchodilator spirometry with FEV1/FVC ratio less than 0.7
  • AND the correct SNOMED code

This QI project will ensure that the COPD register is coded correctly, and every patient who does not have all the evidence they need is lined up for a diagnostic review.

What will I get for completing this project?

Good data entry directly improves patient care, which will also help you identify gaps or errors in the patient record or diagnosis.

On completion of this QI project, you will also get a certificate for your work. You will also be able to use this QI project as evidence towards CPD and professional revalidation.

Who is this project suitable for?

This QI project is aimed at primary care teams who have a register of COPD patients.

The aim of this QI project

The aim is to ensure all patients on the COPD register have an accurate diagnosis of COPD using post-bronchodilator spirometry and the correct SNOMED code.

This is the first of two projects, which involves a review of the COPD register; identifying patients who definitely have COPD and have the appropriate evidence for that diagnosis in their notes, patients who may have COPD but need further confirmatory testing, and those who do not have COPD and should be removed from the register.

This project should be completed before the second project, which focuses on getting patients in for a diagnostic review if they do not have the evidence in their notes to support their diagnosis.

Getting started

Start by working through the set-up phase of this project, setting yourself a goal according to the time you have available to dedicate to this project, ensuring your team are aware of the project and you have been given the authorisation from your practice manager to complete the project.

Progress through the Set-up phase of your QI project before moving down to the Project phase.

Mark Complete

Readiness

Make sure you have the knowledge and expertise to undertake this project successfully.

If you are confident you have the skills and knowledge to make an accurate diagnosis of COPD, select the option below.

 

If you want to check your level of understanding, or need a refresher, check out the associated learning and assessments for this QI project, in line with the All Wales approach.

Mark Complete
Assessments:
Education programmes:
Mark Complete

Your capacity

Capacity is the most important aspect for the successful completion of any project  – ensure you have the capacity, time and ability to complete your project in a suitable timeframe.

Start by outlining how much time you have to commit to this project.

For example: Over the next six weeks, I will commit 2-hours (Monday and Wednesday lunchtimes) to completing this project.

And use the calculator provided to work out how many patients you can review in this time.

It is estimated that each patient action for this QI project will take 15 minutes, but adapt locally.

When estimating the time for each patient action on this QI project, think about how long it takes to review the record of a patient with COPD, locate the spirometry trace, and make amendments to the code.

When will my project start:

When will my project be completed by:

How much time do I have to dedicate to my project each week

Each patient action for the project will take 15 minutes

Recommended time is 15 minutes per patient.

Your current capacity


Please complete form to calculate capacity

* use the capacity calculator to edit or update your time frame

Mark Complete

Alignment

In order for your project to get underway and to be successful, your manager(s) will need to understand the importance of the project and agree your time commitment.

Name

Job title

Email

Contact 1 details not complete.

Sent email
Responded and signed off project

Name

Job title

Email

Contact 2 details not complete.

Sent email
Responded and signed off project
Mark Complete

Communication pack

It’s important that your colleagues know about the project.

You may want to include colleagues in the project, and they may need to know about other demands on your time. Let them know that you are focusing on QI with these useful resources.

Resources

Communication template – manager(s) and GP partners

Mark Complete

Milestone Map

Keep track of your set-up progress and make sure you are on track to getting started with your project with the timeframe you have added in your capacity calculator.

Your Progress

Getting started

Readiness

Your capacity

Alignment

Communication pack

Milestone Map

113

Start Date

Not Set

113

End Date

Not Set

Mark Complete

Project

Project overview

The aim of this QI project

The aim is to ensure all patients on the COPD register have an accurate diagnosis of COPD using post-bronchodilator spirometry and the correct SNOMED code.

This is the first of two projects, which involves a review of the COPD register; identifying patients who definitely have COPD and have the appropriate evidence for that diagnosis in their notes, patients who may have COPD but need further confirmatory testing, and those who do not have COPD and should be removed from the register.

This project should be completed before the second project, which focuses on getting patients in for a diagnostic review if they do not have the evidence in their notes to support their diagnosis.

A recap on the evidence

Data collected from GP practices across Wales suggest that only 11.5% patients on the COPD registers have evidence of both:

  • Post-bronchodilator spirometry with FEV1/FVC ratio less than 0.7
  • AND the correct SNOMED code

This QI project will ensure that the COPD register is coded correctly, and every patient who does not have all the evidence they need is lined up for a diagnostic review.

What will I get for completing this project?

Good data entry directly improves patient care, which will also help you identify gaps or errors in the patient record or diagnosis.

On completion of this QI project, you will also get a certificate for your work. You will also be able to use this QI project as evidence towards CPD and professional revalidation.

Instructions

Project steps

Step 1

Identify every patient on the COPD register.

Step 2

Check all patients for evidence of COPD diagnostic testing (ensuring correct code for post-bronchodilator spirometry and check ratio) so you can identify all patients without sufficient evidence to support their diagnosis.

Step 1 – Identify your COPD register

Identify every patient on your COPD register by running a search. The recommended codes for the diagnosis of COPD is:

  • Read code: H3…00
  • SNOMED code: 13645005

There will be variation between practices.

Step 2 – Check all patients for evidence of COPD diagnostic testing

Sort your COPD patients by those who have the correct code for post-bronchodilator spirometry:

  • Read Code: 339m
  • Or SNOMED code: 407603001

Also check that they have the correct FEV1/FVC ratio recorded, and this result is less than 0.7. This should be a decimal number, not a percentage.

  • For example, 0.65
  • NOT 65%

If the patient does have the correct code for post-bronchodilator spirometry AND a ratio recorded less than 0.7, this confirms their diagnosis of COPD. No further action required.

If the patient does not have the correct code for post-bronchodilator spirometry AND/OR does not have a FEV1/FVC ratio recorded less than 0.7, they may be misdiagnosed and should be reviewed. Click through the dropdown menu below for more details.

For those patients who DO have the correct code for post-bronchodilator spirometry (either a Read Code or SNOMED code), check that they have the correct FEV1/FVC ratio recorded. This should be a decimal number, not a percentage.

  • For example, 0.65
  • NOT 65%
  • To convert a percentage to a ratio, divide by 100.

If the ratio is missing or in the wrong format, go into the patient’s records, locate the patient’s FEV1/FVC ratio in their spirometry test result, and amend the ratio to ensure it is a number starting with 0. (e.g. 0.34).

For those patients who do have post-bronchodilator spirometry in their notes, but the FEV1/FVC ratio is greater than 0.7, remove the patient from your COPD register and invite the patient in for a review of their diagnosis.

For those patients who DO NOT have the correct code (either a Read Code or SNOMED code) for post-bronchodilator spirometry, check whether they have ANY record of spirometry.

Where there is evidence of post-bronchodilator spirometry, change the code:

  • Read Code: 339m
  • SNOMED code: 407603001

 

Where there is no evidence of post-bronchodilator spirometry, ensure this patient is invited to perform post-bronchodilator spirometry in their next consultation (see the next QI project for more details).

Recording your progress

For every patient whose record you change, whether that’s changing a patient’s code to reflect their spirometry results, or removing them from the COPD register because they don’t have the appropriate evidence to support their diagnosis, be sure to record this in the ‘Progress’ section of the QI platform.

Resources

Wales primary care_clinical audit report_2020_FINAL_March 2021_0 (3)

Resources

Attached below are a selection of resources to support you through your project.

Resources

Patient letter template – invitation for COPD diagnostic review

Recommended Read and SNOMED codes

NACAP Clinical Audit Report – Wales Primary Care

Quality Assured Diagnostic Spirometry for Chronic Obstructive Pulmonary Disease

Progress

Add the number of patients that you have addressed according to this project.

You should see your progress bars increase as you get closer to your goal.

Your current capacity


Please complete form to calculate capacity

* use the capacity calculator to edit or update your time frame

Capacity Calculator

Click on the chevrons for more information on your progress

Project data not set. Please complete your project's capacity settings.

Project data not set. Please complete your project's capacity settings.

Certificate

Your dynamic certificate can be found below. You can generate a certificate at any point during your QI project, and the certificate will be updated when you make further progress.

Sign Off

This QI project can be signed off by yourself.

Please sign off by clicking the button below. This will make your certificate available.

Download Certificate

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