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 | |
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Setup Here you set up and understand the project, ensuring you have everything in place to start your project |
Part 2 | |
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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:
Making a Diagnosis of COPDNot Started
Education programmes:
Making a diagnosis of COPD0% Complete
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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.
EditYour current capacity
Please complete form to calculate capacity
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.
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
Start Date
Not Set
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
Attached below are a selection of resources to support you through your project.
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
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.
