Getting the diagnosis right for patients on the Asthma register – ICST

QI

Allowing you to achieve incremental and measurable changes to make a real difference to patients

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

Part 1

Setup

Here you set up and understand the project, ensuring you have everything in place to start your project

Part 2

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:
Education programmes:
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.

Your current capacity


Please complete form to calculate capacity

* use the capacity calculator to edit or update your time frame

Mark Complete

Alignment

In order for your project to get underway and to be successful, your manager(s) will need to understand the importance of the project and agree your time commitment.

Name

Job title

Email

Contact 1 details not complete.

Sent email
Responded and signed off project

Name

Job title

Email

Contact 2 details not complete.

Sent email
Responded and signed off project
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.

Resources

NACAP Clinical Audit Report – Wales Primary Care

Communication template – colleagues

Communication with colleagues – Presentation template

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

113

Start Date

Not Set

113

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.

Resources

QI Project Printable Instructions

Resources

Attached below are a selection of resources to support you through your project.

Resources

Recommended Read and SNOMED codes

NACAP Clinical Audit Report – Wales Primary Care

Patient letter template – invitation for diagnostic review

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

* use the capacity calculator to edit or update your time frame

Capacity Calculator

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.

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