Mark L Levy Clinical Lead National Review of Asthma Deaths (NRAD) An overview Rosie Houston...

Mark L LevyClinical Lead

National Review of Asthma Deaths (NRAD) An overview

Rosie HoustonProgramme Manager

Supporting partners

Asthma death studies - Pre-1980

Background (1)bull Potentially preventable or avoidable factors contributing to death from

asthma identified nearly 50 years ago

bull Underuse of corticosteroids ndash 1963 1975 1979

bull Lack of Patient Education ndash 1963

bull Underuse of objective measures ndash 1963

bull Failure to recognise severity ndash 1979

bull Inadequate routine management and follow-up ndash 1979

bull Potentially preventable deaths - 1979

BMJ 19762721 BMJ 197611493 BMJ 1980280687 BMJ 1982285(6354)1570-1

bull Potentially preventable factors contributing to death from asthma recent asthma death confidential enquiries

bull Drug treatment ndash Corticosteroids - 67 (2003) excess beta-agonist - 50(2006)

bull Underuse of objective measures ndash 17 (2003)

bull Inadequate routine management and follow-up ndash 29 (1996) 33 GP 21 Hospital (2003)

bull National Guidelines not followed ndash 66 (2003)

Thorax 199954(11)978-84PCRJ 200514(6)303-13 Personal communication with Dr S Nasser 2005

Background (2)

bull Preventable factors can be identified in up to 50-70 of deaths from asthma ndash 50 years after the first asthma death studies

bull Previous published auditsconfidential enquiries have tended to be local population based studies - therefore results may not be fully representative

bull Seems that recommendations from previous asthma death studies and guidelines (eg SIGNBTS) are not being implemented

bull ThereforehellipNational Review of Asthma Deaths (NRAD)

bull Feedback ndash publicity and

bull Implementation of findings

Background (3)

Aim

To improve our understanding of whypeople die from asthma in order thatdeaths can be prevented in the future

Objectives (1)bull Explore the circumstances surrounding each death

from asthma over a one year period from February 2012 to include

Epidemiological amp demographic factors Relevant clinical history (to include previous attacks) Allergic amp environmental factors Lifestyle and psycho-social factors Management Medication

bull To collate and distil out any key factorsthemetrends

Aims amp Objectives (2)bull Propose what would need to change in order to

prevent future deaths

bull Make recommendations for clinical practice amp service provision

bull Raise awareness of and increase understanding of asthma amongst professionals and the public and in people with asthma themselves

Project summary

The project comprises

bull Core data collection on all asthma deaths to include an associated national audit of care

bull A confidential enquiry into all asthma deaths in England over one year including

Reliability of diagnosis Preventable causes An associated academic analysis to identify trigger factors Advice re improving practice

Methodology (1)bull Phase 1 (a) Identification of cases

ndash Notification from health care professional (eg GPnurse hospital cliniciannurse coronerpathologist)

ndash Notification from existing data source (eg ONSDr Foster)

ndash A death where lsquoasthmarsquo appears in Part I (a b amp c) or 2 of the death certificate

ndash A death coded as ICD-10 code J45-46

Methodology (2)bull Our definition of lsquoasthma deathrsquo

(for the purposes of this project)ndash Patients suspectedconfirmed of dying from

asthma

bull Inclusion criteria ndash Any person who died from asthma as per case

definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013

Methodology (3)bull Phase 1 (b) Confirmation of asthma

deathndash This may require direct contact by clinical

lead or local steeringworking group member with patientrsquos clinician if necessary

ndash Criteria for defining an lsquoasthma deathrsquo to be agreed

Methodology (4)bull Phase 2 - Collect and analyse core data

(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)

AND

bull Collect additional information on all confirmed deaths from asthma (items TBA)

Methodology (3)

bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths

Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and

health care professionals carry out a review of the case notes tondash Assess where how and why standards of care

may not have been met and what the potential impact may be

ndash Draw out environmental social clinical care and management issues

ndash Identify preventable and avoidable factors ndash Highlight good practice

Confidential Enquiry Panels (2)

bull Review all confirmed asthma deaths (est n=800-1000)

bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs

Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member

Proposed timeline 2011 2012 2013 2014

2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14

Planning and developmentNetworking and raising awareness

Phase 1 amp 2 - Core data collection

Planning and development

Data collection 1st Feb 2012 - 31st Jan 2013

Analysis and reporting

Phase 3 - Confidential enquiry panels


Confidential enquiry panels 15 months of panels


Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect

patient identifiable information without consent (EnglandWales)

bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011

By January 2012 -bull Application for ethics approval to interview a sample of

familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets

Project organisational structureCommissioners

bull Healthcare Quality Improvement Partnership (HQIP)

RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)

Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI

Involving families and community contacts working groupbull Meet 3-4 times per year

Steering group bull Meet 3-4 times per year - wider multidisciplinary group

Stakeholders

Reporting amp Dissemination Planbull Quarterly bulletins

bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members

bull Implementationideas bull With SG and College Implementation Groups

bull Interim report on themes from both phases

bull Final report amp papers

For further information please visit wwwrcplondonacuknrad Or contact us

Mark L LevyClinical Lead NRAD

marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522


rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522

National Review of Asthma Deaths (NRAD)

Supporting partners


Background (1)

Background (2)

Background (3)

Aim

Objectives (1)

Aims amp Objectives (2)

Slide 10

Slide 11

Project summary

Methodology (1)

Methodology (2)

Slide 15

Methodology (3)

Slide 17

Methodology (4)

Slide 19

Slide 20



Proposed timeline

Section 251 amp Ethics Approval

Project organisational structure

Reporting amp Dissemination Plan

Slide 27

Supporting partners










BMJ 19762721 BMJ 197611493 BMJ 1980280687 BMJ 1982285(6354)1570-1







Background (2)







Background (3)

Aim










Project summary












asthma









AND


Methodology (3)

































Stakeholders












Supporting partners


Background (1)

Background (2)

Background (3)

Aim

Objectives (1)


Slide 10

Slide 11

Project summary

Methodology (1)

Methodology (2)

Slide 15

Methodology (3)

Slide 17

Methodology (4)

Slide 19

Slide 20



Proposed timeline




Slide 27










BMJ 19762721 BMJ 197611493 BMJ 1980280687 BMJ 1982285(6354)1570-1







Background (2)







Background (3)

Aim










Project summary












asthma









AND


Methodology (3)

































Stakeholders












Supporting partners


Background (1)

Background (2)

Background (3)

Aim

Objectives (1)


Slide 10

Slide 11

Project summary

Methodology (1)

Methodology (2)

Slide 15

Methodology (3)

Slide 17

Methodology (4)

Slide 19

Slide 20



Proposed timeline




Slide 27







Background (2)







Background (3)

Aim










Project summary












asthma









AND


Methodology (3)

































Stakeholders












Supporting partners


Background (1)

Background (2)

Background (3)

Aim

Objectives (1)


Slide 10

Slide 11

Project summary

Methodology (1)

Methodology (2)

Slide 15

Methodology (3)

Slide 17

Methodology (4)

Slide 19

Slide 20



Proposed timeline




Slide 27







Background (3)

Aim










Project summary












asthma









AND


Methodology (3)

































Stakeholders












Supporting partners


Background (1)

Background (2)

Background (3)

Aim

Objectives (1)


Slide 10

Slide 11

Project summary

Methodology (1)

Methodology (2)

Slide 15

Methodology (3)

Slide 17

Methodology (4)

Slide 19

Slide 20



Proposed timeline




Slide 27

Aim










Project summary












asthma









AND


Methodology (3)

































Stakeholders












Supporting partners


Background (1)

Background (2)

Background (3)

Aim

Objectives (1)


Slide 10

Slide 11

Project summary

Methodology (1)

Methodology (2)

Slide 15

Methodology (3)

Slide 17

Methodology (4)

Slide 19

Slide 20



Proposed timeline




Slide 27









Project summary












asthma









AND


Methodology (3)

































Stakeholders












Supporting partners


Background (1)

Background (2)

Background (3)

Aim

Objectives (1)


Slide 10

Slide 11

Project summary

Methodology (1)

Methodology (2)

Slide 15

Methodology (3)

Slide 17

Methodology (4)

Slide 19

Slide 20



Proposed timeline




Slide 27








asthma









AND


Methodology (3)

































Stakeholders












Supporting partners


Background (1)

Background (2)

Background (3)

Aim

Objectives (1)


Slide 10

Slide 11

Project summary

Methodology (1)

Methodology (2)

Slide 15

Methodology (3)

Slide 17

Methodology (4)

Slide 19

Slide 20



Proposed timeline




Slide 27







AND


Methodology (3)

































Stakeholders












Supporting partners


Background (1)

Background (2)

Background (3)

Aim

Objectives (1)


Slide 10

Slide 11

Project summary

Methodology (1)

Methodology (2)

Slide 15

Methodology (3)

Slide 17

Methodology (4)

Slide 19

Slide 20



Proposed timeline




Slide 27

Methodology (3)

































Stakeholders












Supporting partners


Background (1)

Background (2)

Background (3)

Aim

Objectives (1)


Slide 10

Slide 11

Project summary

Methodology (1)

Methodology (2)

Slide 15

Methodology (3)

Slide 17

Methodology (4)

Slide 19

Slide 20



Proposed timeline




Slide 27
































Stakeholders












Supporting partners


Background (1)

Background (2)

Background (3)

Aim

Objectives (1)


Slide 10

Slide 11

Project summary

Methodology (1)

Methodology (2)

Slide 15

Methodology (3)

Slide 17

Methodology (4)

Slide 19

Slide 20



Proposed timeline




Slide 27












Supporting partners


Background (1)

Background (2)

Background (3)

Aim

Objectives (1)


Slide 10

Slide 11

Project summary

Methodology (1)

Methodology (2)

Slide 15

Methodology (3)

Slide 17

Methodology (4)

Slide 19

Slide 20



Proposed timeline




Slide 27

Mark L Levy Clinical Lead National Review of Asthma Deaths (NRAD) An overview Rosie Houston...

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