The use of audit tools in primary careGRASP-AF as an example
Dr Richard Healicon
Programme Delivery Lead,
NHS Improving Quality
Plan
•
•
•
•
GRASP-AF in context
What GRASP-AF does
Alternatives to GRASP-AF
Are we doing better?
What is GRASP-AF?
•
•
•
•
•
Free primary care audit tool
Aligned to NICE/ ESC guidance
Compatible with all GP systems in England
Has a ‘case finder’ and ‘care management’ element
Case Finder• Stand alone (patient identifiable)
• Care management• Stand alone (patient identifiable)
• CHART Online (anonymised data)
What was the purpose of GRASP-AF?
• To help GPs improve the management of AF in line with best practice
guidance (NICE, ESC)
• To provide practical help to prioritise who to review
• To help improve the case finding/coding of AF
• Help GPs work collectively to improve AF management
• To allow national benchmarking through CHART Online
GRASP-AF case finder
Possible/Probable AF factors
AF resolved code
ECG: probable AF
ECG: possible AF
CHADS2 risk score record
Irregular pulse
AF related Rx
SVT
H/O AF/Atrial Flutter
AF monitoring
QOF exception
AF procedure
GRASP-AF- Care Management
GRASP-AF- Care Management
CHART Online
• Voluntary upload of data to CHART online
• Web based analysis tool with a variety of comparative viewing
options available
– Benchmark own practice against others in CCG
– Benchmark CCG against others in SCN/ National
• Secure and restricted access
– Practices control who sees their national identifier
• Data can be aggregated at any level to enable groups of GPs to work
together.
• Allowed NHS IQ to develop dashboards to help promote
improvement
CHART Online
CHART Online
CHART Online
CHART Online
Alternatives to GRASP-AF
•
•
•
•
Many alternatives have been developed
We know of over 1000 practices using an alternative
Often based on specific IT systems
Some commercial alternatives have wider compatibility though
perhaps none has universal compatibility of GRASP-AF
• Differ in way audit process organised- extraction, feedback
• Issue around consistency of coding- defining AF, QOF exclusions
• None have online benchmarking functionality- opportunity lost
GRASP-AF Uploads
18th September 2014:
• 2903 practices from both versions (CHADS2 and CHADSVASc)
• 161 CCGs
• 331,410 patients with AF
• 2026 practices from latest version (CHADSVASc)
• 145 CCGs
• 270,847 patients with AF
Data- modelling
Data- dashboards
Data- Are we doing better?
Number of practices uploading
AF Prevalence (%)
End of 2011
123
1.86%
End of 2012
1,117
1.79%
End of 2013
551
1.73%
End of 2014
340
1.94%
End of April 2015
191
2.17%
Data- Are we doing better?
Number of practices
uploading
% of High Risk AF
Patients
(CHADSVASc)
% of High Risk AF Patients
on OAC
End of 2011
123
84.15%
52.76%
End of 2012
1,117
84.20%
54.72%
End of 2013
551
84.43%
58.27%
End of 2014
340
84.97%
63.10%
End of April
2015
191
84.21%
67.95%
Summary
• GRASP-AF (audit) approach offers a feasible, evidence-based and
effective model for improvement.
• NHS IQ moving to promoting audited management of AF
acknowledging other alternatives
• Need for some sort of QA process if running multiple different tools
• Inability to merge data from different systems is an opportunity lost