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What is the challenge your project is going to address and how does it connect to your chosen theme?

Atrial fibrillation (AF) is under diagnosed nationally, with thousands of people not receiving appropriate stroke-preventing treatments. People with AF are 5x more likely to have a stroke; anticoagulation therapy reduces stroke risk by 66%. The national ambition by 2029 is that 85% of people with AF will be found and 90% of appropriate patients will receive anticoagulation therapy. CVD will be a priority QI area for QOF.

We worked with multiple partners in the North West Coast to improve the diagnosis and management of AF. We ran two QI Collaboratives in 90 practices resulting in >1700 patients added to AF registers and >1600 patients anticoagulated.  A range of sustainability and spread outputs were developed, (based on insights and evidence across the 90 practices), including an AF QI toolkit, EMIS template, EMIS searches and a QI dashboard. We need to integrate our AF QI tools to deliver a clinical system-based AF QI resource that will build improvement capability in primary care.

What does your project aim to achieve?

The ambition is to develop a systems-based AF QI tool that will unite an improved AF EMIS template with a set of AF EMIS searches and a QI dashboard to provide an integrated support tool for primary care to better diagnose and manage AF patients. At the click of a button the tool will run practice data in real time and upload current data into a QI dashboard. Once baseline data has been run and uploaded, the tool will ask the practice to select their QI targets against DETECT, PROTECT and PERFECT and will track progress against these targets for identification of new patients (the tool will calculate missing patients) and management of known AF patients. The tool will store historical data so that improvements can be tracked in real time. Areas for improvement and progress against targets will be highlighted on the dashboard. We will work with partners to develop the tool including the Health Foundation.

How will the project be delivered?

We estimate that the development and testing time for this QI tool will be 6-12 months. The Innovation Agency has 3 years’ experience working in AF QI in primary care, working with over 100 practices. We would convene a steering committee consisting of in house and external QI experts (and Q members) and primary care staff across several CCGs who would work with us on a consultative basis through the development of the dashboard. We also have several practices who are willing to work with us to test and refine the tool. We currently work with an Excel-based AF QI dashboard and will refine the interface with assistance from the steering committee, before this is taken into development. As 55% of practices are EMIS we will need to consider making sure that we can also make the tool compatible with practices working with TPP also. This will then cover around 90% of all practices.

What and how is your project going to share learning throughout?

This AF QI package will be distributed not just in the North West Coast but also nationally. This QI package will assist primary care with meeting the national CVD ambitions. We will look to distribute the QI tool and associated resources via the STPs, the AHSN Network and other channels such as the RCGP. The tool, together with the improved AF EMIS template and the QI ‘how to’ guide will provide a complete package of education and guidance on improving care for diagnosing and managing people with AF. In guiding primary care through the principles of QI in relation to AF, the tool will build QI capability that can be translated to other therapy areas. The resource will also support the CVD PREVENT programme (we have already had discussions about this) and will dovetail with the STP BP QI work, and work on lipids.

How you can contribute

  • Expert advise on the design and functionality of the database (Primary care QI SIG)
  • Functionality/user testing (primary care QI SIG)

Plan timeline

1 Mar 2019 Tool refinement and retesting (several cycles)
1 Oct 2019 Convene development meeting with steering committee
1 Oct 2019 Design and agree tool interface and functionality (4-6wks)
1 Nov 2019 Tool development (external developer, 8 weeks)
1 Jan 2020 Tool testing & refinement in primary care (10-15 weeks)
1 May 2020 Launch to CCGs (phased) and communciation of tool

Comments

  1. Dear Michelle,

    i used to lead the work in AF in primary care for WEAHSN. I can so see why this dashboard might be useful. We spent a lot of time working on quality metrics and benchmarking with pharmacists in each GP practice. Our learning was that having this data was only half of the story and that with the same quality of data some GP practices got into using QI and some didn’t. We used a realist evaluation approach to explore why and found culture to be a strong determinant of success and that where practices embraced improvement coaching there were statistically significant improved rates of adoption and higher numbers of AF patients, reviewed and treated and involved in their care.

    happy to chat if it would help in anyway.

    best wishes

    Anna

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