whole systems integrated care (wsic) dashboards: copd radar · 2019-01-28 · o the copd radar can...
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Whole Systems Integrated Care (WSIC) Dashboards:
COPD Radar User Guide v0.2
Page | 2
Version History
Date Version Author Notes
28/11/2018 0.1 Tracey Dede and Shilpi Begum First draft
06/12/2018 0.2 Tracey Dede Clinical Uses added – To be reviewed by CL
28/01/2019 1.0 Tracey Dede Final Version
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Contents Version History .................................................................................................................................................... 2
Section 1: Introduction to COPD Radar ............................................................................................................... 5
Introduction ......................................................................................................................................................... 6
Clinical Uses of the COPD Radar .......................................................................................................................... 7
Section 2: Step by Step Guide .............................................................................................................................. 8
COPD Radar | Homepage .................................................................................................................................... 9
COPD Radar | How to use the radar .................................................................................................................. 10
Section 3: Calculation Definitions ...................................................................................................................... 11
COPD Radar | Exacerbation Risk ........................................................................................................................ 12
COPD Radar | Exacerbation Risk Indicators ....................................................................................................... 13
COPD Radar | Mortality Risk.............................................................................................................................. 15
COPD Radar | Mortality Risk Indicators ............................................................................................................. 16
COPD Radar | Co-Morbidity Indicators ............................................................................................................. 18
COPD Radar | Asthma ........................................................................................................................................ 20
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COPD Radar | Asthma Indicators ....................................................................................................................... 21
COPD Radar | Acute COPD Exacerbation .......................................................................................................... 22
COPD Radar | Acute COPD Exacerbation indicators ......................................................................................... 23
COPD Radar | Insufficient Prescriptions ............................................................................................................ 24
COPD Radar | Insufficient Prescriptions Indicators ........................................................................................... 25
COPD Radar | Pulmonary Rehab ....................................................................................................................... 25
COPD Radar | Pulmonary Rehab Indicators ...................................................................................................... 27
COPD Radar | Spirometry Check ....................................................................................................................... 28
COPD Radar | Spirometry Check Indicators ...................................................................................................... 29
COPD Radar | Immunisation for Flu .................................................................................................................. 30
COPD Radar | Inhaler Check .............................................................................................................................. 31
COPD Radar | Self-Management Plan ............................................................................................................... 32
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Section 1: Introduction to COPD Radar
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Introduction
Chronic Obstructive Pulmonary Disease (COPD) is a common, complex disease and this Radar has
been developed with to assist non-specialist clinicians in identifying and prioritizing patients who
may need further attention. This includes those in need of optimization of their medication or
further education; as well as identification of those with risk of poor outcomes and those in need of
specialist referral. The system also helps to identify some of those patients whose diagnosis may
not be clear (for eg no evidence of post bronchodilator quality assured spirometry which is
essential for diagnosis in all but a few patients) and those who may have asthma (either combined
with COPD or as an alternative diagnosis).
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Clinical Uses of the COPD Radar
There are a number of scenarios where we envisage that the COPD Radar may be of use:
1. Prioritising patients for review: o The radar allows the clinician to sort patients by a number of metrics including
number of red flags, risk indicators, COPD admissions, MRC scores or age
2. Virtual clinics: o Sitting down with a specialist clinician and reviewing a list of COPD patients can be a
relatively time efficient way of getting input into a group of poorly controlled / off-target patients. The radar allows the clinicians to review a list of patients sorted by Number of risk indicators (or other parameters) quite rapidly without necessarily having to open every patient’s set of notes in the GP system.
3. Print off for patients: o The COPD radar can create a print off for the patient incorporating their Mortality
risk factors for COPD, spirometry checks and FEV1 , which may help patients get a handle on the latest trends and understand their condition better.
4. Recall for appointments
o The Consider Referral column allows a health professional to see who has not had a
Pulmonary Rehab ever, or in the last 12 months, or since the patients last AECOPD.
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Section 2: Step by Step Guide
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COPD Radar | Homepage
You can access the COPD Radar from the Homepage. Please refer to the ‘How to Use’ section, which explains some of the functionality of the radar. From the landing page choose ‘Long Term Condition Management and select ‘COPD Radar.
On the landing page ‘Click on COPD Radar Clinical Overview’
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COPD Radar | How to use the radar
The COPD Radar displays traffic lights indicating if the item is At Risk (Red), Not at Risk – No Data
(White), Not at Risk – but other risks exist ( ) and Not at Risk – Good Result (Green) Grey
Notes on usage Click on a traffic light to
drill down to more information for each category
Hover over traffic lights to see when an item was last recorded and the most recent result
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Section 3: Calculation Definitions
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Exacerbation
Risk will appear
Red if one or
more of the
listed indicators
within this
category is listed
as red.
COPD Radar | Exacerbation Risk
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COPD Radar | Exacerbation Risk Indicators
Red Grey White
Cat Score If result recorded is >10
If result recorded indicates that patient is not at risk
If no result has been recorded
AECOPD Admission
If event has been recorded in the last 12 months
If event was not recorded in the last 12 months
If no event has been recorded
Antibiotic+Steroid If event recorded in last 12 months
If event was not recorded in the last 12 months
If no event has been recorded.
Antibiotic If prescribed in the last 12 months
If prescription did not take place in the last 12 months
If no event has been recorded
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Oral Steroid If prescribed in the last 12 months
If prescription did not take place in the last 12 months
If no event has been recorded
FEV1% Pred If result recorded is < 50%
If result recorded indicates that patient is not at risk
If no result has been recorded
Frailty, Moderate, Severe
eFI score recorded as: Moderate, Severe
eFI score recorded as: Fit, Mild
If no event has been recorded
MRC Score If MRC score is > 2 (3, 4, 5)
If MRC score is 0, 1, 2 If no event has been recorded
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Mortality Risk will appear
Red if one or more of the
listed indicators within this
category is listed as red.
Otherwise this will remain
Grey.
COPD Radar | Mortality Risk
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COPD Radar | Mortality Risk Indicators
Red Grey White
BMI If the BMI recorded is < 21
If the BMI recorded is >=21
If no result has been recorded
COPD Exacerbation
If an event has been recorded in the last 12 months
If no event has been recorded in the last 12 months
If no event has been recorded
AECOPD Admission
If an event has been recorded in the last 12 months
If no event has been recorded in the last 12 months
If no event has been recorded
FEV1% Pred If result recorded is < 30%
If no result has been recorded
MRC Score If MRC score is > 3 (4, 5)
If no event has been recorded
Frailty, Moderate, Severe
eFI score recorded as: Moderate, Severe
eFI score recorded as: Fit, Mild
If no event has been recorded
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Co-Morbidity
will appear Red
if one or more of
the listed
indicators within
this category is
listed as red.
Otherwise this
will remain
Grey.
COPD Radar | Co-Morbidity
Page | 18
COPD Radar | Co-Morbidity Indicators
Red Grey White
Asthma If Asthma LTC exists (QOF)
If Asthma does not exist
Heart Failure If Heart Failure LTC exists (QOF)
If Heart Failure does not exist
Diabetes If Diabetes LTC exists (QOF)
If Diabetes does not exist
Osteoporosis If Osteoporosis LTC exists (QOF)
If Osteoporosis does not exist
Ischaemic Heart Disease
If Ischaemic Heart Disease LTC exists (QOF)
If Ischaemic Heart Disease does not exist
Anxiety If Anxiety LTC exists (QOF)
If Anxiety does not exist
Depression If Depression LTC exists (QOF)
If Depression does not exist
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Brociectasis If event exists within any time period
If no event has been recorded
Reflux GORD If event is recorded in the last 12 months
If event is not recorded in the last 12 months
If no event has been recorded
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Asthma will appear Red if 4
or less total prescriptions
present in the last 12
months. Otherwise, this
will appear Grey if more
than 4 prescriptions.
COPD Radar | Asthma
Page | 21
COPD Radar | Asthma Indicators
Patients with COPD should be treated with bronchodilators in all cases and inhaled corticosteroids in some.
Patients with a diagnosis of asthma must be treated with inhaled corticosteroids. Therefore anyone who has
both asthma and COPD (irrespective of severity) must be on inhaled corticosteroids.
Red Grey White
Asthma (ie co morbidity also known as ACO –Asthma/COPD Overlap)
If Asthma LTC exists (QOF)
If Asthma LTC is not recorded
ICS If no prescription is recorded
If prescription is present within any time period
Spirometry Reversibility
If event exists If no event has been recorded
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Acute COPD Exacerbation
with appear Red if:
- ACO or Asthma exists
and there has been
no prescription of ICS.
- No referral made and
(MRC score >= 3 or
AECOPD Admission or
AECOPD Exacerbation
present), otherwise
this will remain Grey
COPD Radar | Acute COPD Exacerbation
Page | 23
COPD Radar | Acute COPD Exacerbation indicators
Red Grey White
Oral Steroid If prescribed in the last 12 months
If prescription did not take place in the last 12 months
If no prescription recorded
Antibiotic If antibiotic has been prescribed in the last 12 months
If no prescription took place in the last 12 months
If no prescription recorded
Lower Resp Tract Infection
If event has been recorded in last 12 months
If no event has been recorded in the last 12 months
If no event has been recorded
Chest Infection If event has been recorded in the last 12 months
If no event has been recorded in the last 12 months
If no event has been recorded
Pneumonia If event has been recorded in the last 12 months
If no event has been recorded in the last 12 months
If no event has been recorded
AECOPD Admission
If event recorded in the last 12 months
If no event took place in the last 12 months
If no event has been recorded
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Insufficient
Prescriptions will
appear Red if total
number of prescriptions
is less than 5 (4 or less)
COPD Radar | Insufficient Prescriptions
Page | 25
COPD Radar | Insufficient Prescriptions Indicators
Red Grey
LABA If no prescription present
If prescribed in the last 12 months
LAMA If no prescription present
If prescribed in the last 12 months
ICS If no prescription present
If prescribed in the last 12 months
LABA+LAMA If no prescription present
If prescribed in the last 12 months
LABA+LAMA+ICS If no prescription present
If prescribed in the last 12 months
LABA+ICS If no prescription present
If prescribed in the last 12 months
SABA If no prescription present
If prescribed in the last 12 months
SAMA If no prescription present
If prescribed in the last 12 months
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Consider Referral will
be Red if:
Rehab has not
been completed
in the last 12
months
Rehab not done
If any indicator is
red
Grey if:
Rehab done in
the last 12
months
White if:
No referral
No activity
COPD Radar | Pulmonary Rehab
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COPD Radar | Pulmonary Rehab Indicators
Red Grey White
AECOPD Admission
If event recorded in the last 12 months
If no event recorded
COPD Exacerbation
If there are 2+ events in the last 12 months
If no event recorded
Pulmonary Rehab If there has been no referral
Referral made No event is recorded
MRC Score If MRC Score is > 2(3,4,5)
If MRC Score is 0, 1, 2 No score recorded
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Spirometry Check will
appear Red if all results
are not done.
If FEV/FVC ratio is >0.7
and no other tests are
done also Red.
If any result is done then
will appear Grey.
COPD Radar | Spirometry Check
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COPD Radar | Spirometry Check Indicators
The FEV1/FVC Ratio is set to >0.7 to identify that the check may need to be done again to check the diagnosis
Red Grey White
FEV1% Pred If no result present If result exists
Spirometry If no result present If result exists
FEV1 If no result present If result exists
FVC If no result present If result exists
FEV1/FVC Ratio If result is >0.7 If no event recorded
Spirometry Reversibility
If event exists If no event recorded
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Immunisation for Flu will
appear Red if:
No event is recorded
No event recorded in
the last 12 months
Green if:
If event recorded in
the last 12 months
COPD Radar | Immunisation for Flu
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COPD Radar | Inhaler Check
Inhaler Check will be Red
if:
Result recorded is
Poor, Moderate or
No event
Green if:
Result recorded is
Good Technique
Page | 32
COPD Radar | Self-Management Plan
Self-Management Plan will
appear Red if:
No Event recorded
Grey if:
Event not in the last
12 months
Green if:
Event in the last 12
months
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Click icon to view individual
patient chart
COPD Radar | Individual Patient Chart
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COPD Radar | Individual Patient Chart
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Click icon to view Possible
Problems Radar
COPD Radar | Possible Problems
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COPD Radar | Possible Problems
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COPD Radar | Possible Problems Indicators
Over
treatment 1 Over
treatment2 Over
treatment3 Unconfirmed Diagnosis 1
Unconfirmed Diagnosis 2
Undiagnosed(over 35 years)
Over Diagnosed
COPD Event recorded
Event recorded
Event recorded
Event recorded
Event recorded
Event not recorded
Event recorded
Asthma Event not recorded
Event not recorded
Emphysema Event recorded
Event not recorded
Event not recorded
Event not recorded
Brochiectasis No event recorded
COPD Exacerbation
Event not recorded
Event not recorded
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FEV1/FVC Ratio
Event not recorded
FEV1 % Pred (>0.7 or >70)
Event recorded
Event recorded
Event recorded
Event not recorded
Event recorded
MRC Score (1,2)
Event recorded
LABA Event recorded
Event recorded
LAMA Event recorded
Event recorded
ICS Event recorded
Page | 39
LABA+LAMA Event recorded
Event recorded
LABA-ICS Event recorded
Event recorded
LABA-LAMA-ICS
Event recorded
Smoker or Ex Smoker
Event recorded
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