Getting the diagnosis right for patients on the Asthma register
The Asthma Diagnostic Review (Project TWO of TWO)
QI projects are built as a TWO-PART component
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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 |
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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 76.3% adult patients and 67.4% children and young adult patients on the Asthma registers have evidence of any tests results that can be used to support their diagnosis.
This QI project will ensure that the Asthma register is coded correctly, and every patient who has no evidence of a diagnostic test is invited in 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 Asthma patients (adult and paediatric).
The aim of this QI project
The aim of this Quality Improvement Project is to record evidence and code appropriately objective variability for 80% or more of people diagnosed with asthma, as demonstrated by at least one of the following:
- two-week peak flow diary
- reversible spirometry
- peak flow steroid trial
- fractional exhaled nitric oxide (FeNO)
This is the second of two projects, which involves inviting patients in for a review of the Asthma diagnosis if they don’t have any record of any diagnostic tests.
This project should be completed after the first project, which focuses on reviewing the Asthma register.
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 Asthma, mark this section as complete using the button 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 AsthmaNot Started
Making a diagnosis of Asthma in ChildrenNot Started
Education programmes:
Making a diagnosis of AsthmaIn Progress (31%)
Making a diagnosis of Asthma in Children0% Complete
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 one 4-hour clinic (Wednesday afternoon) 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 30 minutes, but adapt locally.
When estimating the time for each patient action on this QI project, think about how long it takes to review a patient’s diagnosis and enter the correct code into the patient’s notes.
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 30 minutes
Recommended time is 30 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 of this Quality Improvement Project is to record evidence and code appropriately objective variability for 80% or more of people diagnosed with asthma, as demonstrated by at least one of the following:
- two-week peak flow diary
- reversible spirometry
- peak flow steroid trial
- fractional exhaled nitric oxide (FeNO)
This is the second of two projects, which involves inviting patients in for a review of the Asthma diagnosis if they don’t have any record of any diagnostic tests.
This project should be completed after the first project, which focuses on reviewing the Asthma register.
A recap on the evidence
Data collected from GP practices across Wales suggest that only 76.3% adult patients and 67.4% children and young adult patients on the Asthma registers have evidence of any tests results that can be used to support their diagnosis.
This QI project will ensure that the Asthma register is coded correctly, and every patient who has no evidence of a diagnostic test is invited in 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
Invite all patients without evidence of variability currently on the asthma register (gathered in part one).
Step 2
Perform a test to support the patient’s asthma diagnosis or continue investigations and code appropriately.
Step 1 – Invite patients for a diagnostic review
Ensure you have completed the first QI project in this series ‘Fixing the Asthma register’. From this first project, you should have a list of patients who need a review of their Asthma diagnosis:
- Those who have no record of diagnostic testing
- Those who have inconclusive test results to support the diagnosis of Asthma
Step 2 – Perform a test to support the patient’s diagnosis
Start by undertaking a structured clinical assessment to assess the probability of asthma. This should be based on:
- a history of recurrent episodes (attacks) of symptoms, ideally corroborated by variable peak flows when symptomatic and asymptomatic
- symptoms of wheeze, cough, breathlessness and chest tightness that vary over time
- recorded observation of wheeze heard by a healthcare professional
- personal/family history of other atopic conditions (in particular, atopic eczema/ dermatitis, allergic rhinitis)
- no symptoms/signs to suggest alternative diagnoses
The next step is to ask the patient to complete a two week Peak Flow Diary, taking one measurement in the morning and one measurement in the evening, and recording the results. This record can be a paper diary, or you can advise your patient to download the Asthmahub or Asthmahub for parents app, with an in-built peak flow diary.
Once the patient returns the PEF diary, record these results in the patient’s notes with the correct code for a peak flow diary:
- Read Code: 66YY
- Or SNOMED code: 401011001
Check the Peak Flow Diary for evidence of “dips”; if there are “dips” in the peak flow measurement of more than 20%, the diagnosis of Asthma has been confirmed. Make sure the diagnostic code reflects this:
- Read Code: H33
- SNOMED Code: 195967001
For those patients who did not experience significant “dips” in their Peak Flow measurement, try an alternative diagnostic test:
- Spirometry
- Spirometry with reversibility
- Peak flow with reversibility
- Fractional exhaled nitric oxide
Of course, some patients will be stable on their medication and will not show evidence of objective variability for this reason. Click through the scenarios below for more details.
If you there is a high probability of Asthma following a structured clinical review and the patient demonstrates variable airflow obstruction, you have confirmed the diagnosis of Asthma and should continue managing their asthma.
Make sure the diagnostic code reflects this:
- Read Code: H33
- SNOMED Code: 195967001
If you there is a high probability of Asthma following a structured clinical review but the patient does not demonstrate variable airflow obstruction, continue managing the patient according to the Asthma Management Plan.
Remember, tests influence the probability of asthma but do not prove a diagnosis.
If there is a low probability of asthma and/or an alternative diagnosis is more likely, investigate for the alternative diagnosis, reconsidering asthma if the clinical picture changes or an alternative diagnosis is not confirmed. If reconsidering asthma, undertake or refer for further tests to investigate for a diagnosis of asthma.
Recording your progress
For every patient whose record you change, whether that’s changing a patient’s code to reflect their Peak Flow Diary results, or performing a spirometry with reversibility test, be sure to record this in the ‘Progress’ section of the QI platform.
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
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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.