Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013 Crawley CCG.

Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013

Crawley 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 Hosp

ital

Princes

s Roya

l Hosp

ital H

ayward

s Hea

th

Royal S

ussex C

ounty Hosp

ital

Darent V

alley

Hospita

l

Kent a

nd Canter

bury Hosp

ital

Queen El

izabeth

the Q

ueen M

other Hosp

ital

Willi

am Harv

ey Hosp

ital

Conquest Hosp

ital

Eastb

ourne D

istric

t Gen

eral H

ospita

l

Epso

m Hospita

l

Frimley

Park Hosp

ital

Maidsto

ne Dist

rict G

enera

l Hosp

ital

Tunbrid

ge W

ells H

ospita

l

Medway

Mari

time Hosp

ital

Royal S

urrey C

ounty Hosp

ital

East

Surre

y Hosp

ital

St Rich

ards H

ospita

l

Worth

ing Hosp

ital

05

10152025303540

Admitted Stroke Patients with Previous AFSSNAP - July to September 2013

AF Strokes = 306

%

National

St Pete

r's Hosp

ital

Princes

s Roya

l Hosp

ital H

ayward

s Hea

th

Royal S

ussex C

ounty Hosp

ital

Darent V

alley

Hospita

l

Kent a

nd Canter

bury Hosp

ital

Queen El

izabeth

the Q

ueen M

other Hosp

ital

Willi

am Harv

ey Hosp

ital

Conquest Hosp

ital

Eastb

ourne D

istric

t Gen

eral H

ospita

l

Epso

m Hospita

l

Frimley

Park Hosp

ital

Maidsto

ne Dist

rict G

enera

l Hosp

ital

Tunbrid

ge W

ells H

ospita

l

Medway

Mari

time Hosp

ital

Royal S

urrey C

ounty Hosp

ital

East

Surre

y Hosp

ital

St Rich

ards H

ospita

l

Worth

ing Hosp

ital

0

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 Sussex

Brighton & Hove Coastal West Sussex Crawley Eastbourne, Hailsham &

Seaford

Hastings & Rother High Weald Lewes Havens

Horsham & Mid Sussex

SUSSEX

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

Practice KSS England

SUSSEX

Percentage of people on practice list on atrial fibrillation register

Source: QOF 2012/13

AF05 by CCG in Sussex


Seaford



SUSSEX

95.0%

95.5%

96.0%

96.5%

97.0%

97.5%

98.0%


SUSSEXAF05 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



Seaford



SUSSEX

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%


SUSSEXAF06 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



Seaford



SUSSEX

74.0%

76.0%

78.0%

80.0%

82.0%

84.0%

86.0%

SUSSEXAF07 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

Prevalence by Practice compared to KSS (Red line) and England (Green Line)

H82088 Bewbrush Medical CentreH82047 Bridge Medical CentreH82098 Coachmans Medical PracticeH82053 Furnace Green SurgeryH82033 Gossops Green Medical CentreY02531 Health4CrawleyH82050 Ifield Drive PracticeY00351 Langley Corner SurgeryH82012 Leacroft PracticeH82052 Pound Hill SurgeryH82026 Saxonbrook Medical CentreH82064 Southgate Medical GroupH82025 Woodlands Clerklands Practice

H82088H82047H82098H82053H82033Y02531H82050Y00351H82012H82052H82026H82064H82025

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

Practice

NHS CRAWLEY 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)

H82012 Leacroft PracticeH82025 Woodlands Clerklands PracticeH82026 Saxonbrook Medical CentreH82033 Gossops Green Medical CentreH82047 Bridge Medical CentreH82050 Ifield Drive PracticeH82052 Pound Hill SurgeryH82053 Furnace Green SurgeryH82064 Southgate Medical GroupH82088 Bewbrush Medical CentreH82098 Coachmans Medical PracticeY00351 Langley Corner SurgeryY02531 Health4Crawley

H82012H82025H82026H82033H82047H82050H82052H82053H82064H82088H82098Y00351 Y02531

0%

20%

40%

60%

80%

100%

120%

Practice

NHS CRAWLEY CCG

AF05 The percentage of patients with Atrial Fibrillation in whom stroke risk has been assessed using the CHADS2 risk stratification scoring system in the pre-ceding 15 months (excluding those whose previous CHADS2 score is greater than 1)

Source: QOF 2012/13



H82012H82025H82026H82033H82047H82050H82052H82053H82064H82088H82098Y00351 Y02531

0%

20%

40%

60%

80%

100%

120%

Practice

NHS CRAWLEY 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-co-agulation drug therapy or an anti-platelet therapy.

Source: QOF 2012/13


H82012 H82025 H82026 H82033 H82047 H82050 H82052 H82053 H82064 H82088 H82098 Y00351 Y02531

0%

20%

40%

60%

80%

100%

120%

Practice

NHS CRAWLEY CCGAF07 In those patients with Atrial Fibrillation whose latest record of a CHADS2 score is greater than 1, the percentage of patients who are cur-rently treated with anti-coagulation drug therapy

Source: QOF 2012/13


Exception Rates by GP Practice

BEWBUSH

MED

ICAL CEN

TRE

BRIDGE MED

ICAL CEN

TRE

COACHMANS MED

ICAL PRACTIC

E

FURNACE G

REEN SU

RGERY

GOSSOPS G

REEN M

EDICAL C

ENTR

E

HEALTH

4CRAWLEY

IFIELD

DRIVE PRACTIC

E

LANGLEY

CORNER SU

RGERY

LEACROFT

PRACTICE

POUND HILL SU

RGERY

SAXONBROOK M

EDICAL C

ENTR

E

SOUTH

GATE M

EDICAL G

ROUP

WOODLA

NDS CLER

KLANDS P

RACTICE

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Crawley CCG - Exception Rates for AF06 and AF07 2012/2013 QOF Indicators by GP Practice

Exception Rate A06Exception Rate A07

%

Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013 Crawley CCG.

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