Getting the diagnosis right for patients on the Asthma register
Fixing the Asthma Register (Project ONE 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 first of two projects, which involves a review of the Asthma register; identifying patients who definitely have Asthma and have the appropriate evidence for that diagnosis in their notes, patients who may have Asthma but need further confirmatory testing, and those who do not have Asthma 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 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 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 Asthma, locate the PEF diary or other evidence, 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 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 first of two projects, which involves a review of the Asthma register; identifying patients who definitely have Asthma and have the appropriate evidence for that diagnosis in their notes, patients who may have Asthma but need further confirmatory testing, and those who do not have Asthma 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 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
Identify all patients on the asthma register.
Step 2
Check all patients for evidence of asthma diagnosis and variability so you can identify all patients without evidence of variability.
Step 1 – Identify your Asthma register
Identify every patient on your Asthma register by running a search. The recommended codes for the diagnosis of Asthma is:
- Read code: H33
- SNOMED code: 195967001
There will be variation between registers.
Step 2 – Check all patients for evidence of asthma diagnosis
Check all patients for evidence that will support their asthma diagnosis. Sort your Asthma patients by those who have evidence of any of the following tests:
- Spirometry
- Spirometry with reversibility
- Peak flow measurement
- Peak flow diary
- Fractional exhaled nitric oxide
For those patients who DO have diagnostic test results on their record, check these results for evidence of objective variability and code accordingly. Objective variability is achieved when test results demonstrate normal and abnormal results, reflecting the airway narrowing which is typical of a diagnosis of asthma, and includes:
- A peak flow diary showing dips in measurements
- A spirometry test showing airflow obstruction
- A spirometry test showing significant improvement following administration of a bronchodilator
- A peak flow diary that show significant improvement following a trial with a steroid inhaler
- An abnormal FeNO measurement
If the patient does have evidence of variability, this confirms their diagnosis of Asthma. Make sure the diagnostic code reflects this:
- Read Code: H33
- SNOMED Code: 195967001
If the patient does not any evidence of variability, they may be misdiagnosed and should be reviewed. Click through the dropdown menu below for more details.
For those patients who DO have evidence of one of the following:
- Spirometry
- Spirometry with reversibility
- Peak flow measurement
- Peak flow diary
- Fractional exhaled nitric oxide
But their test results do not show variable airflow obstruction, they should be invited for a review of their asthma diagnosis (see the next QI project in the series for more details).
In the resources of this QI project, you will find a template patient letter that can adapt for use in your practice.
For those patients who DO NOT have any test results in their records, invite the patient in for a review of their diagnosis (see the next QI project in the series for more details).
In the resources of this QI project, you will find a template patient letter that can adapt for use in your practice.
Recording your progress
For every patient whose record you change, 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
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.