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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.

[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row el_class="qitaskouterrow"][vc_column][vc_row_inner el_class="qigrey"][vc_column_inner][vc_column_text]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.[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row el_class="qitaskouterrow"][vc_column][vc_row_inner el_class="qigrey"][vc_column_inner][vc_column_text]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.[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_tta_accordion active_section="0" collapsible_all="true"][vc_tta_section title="Scenario 1: Correct spirometry code, missing FEV1/FVC ratio" tab_id="1614005719562-799eea7b-bf9e"][vc_column_text]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).[/vc_column_text][/vc_tta_section][vc_tta_section title="Scenario 2: Correct spirometry code, incorrect FEV1/FVC ratio" tab_id="1614007801075-37b13c21-2c13"][vc_column_text]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.[/vc_column_text][/vc_tta_section][vc_tta_section title="Scenario 3: No spirometry code or incorrect spirometry code" tab_id="1614007814682-8aed3a7d-138e"][vc_column_text]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).[/vc_column_text][/vc_tta_section][/vc_tta_accordion][/vc_column][/vc_row][vc_row el_class="qitaskouterrow"][vc_column][vc_row_inner el_class="qiaqua"][vc_column_inner][vc_column_text]

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.

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Related Resources

QI Project Printable Instructions

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