The national COPD primary care audit (Wales) 2014–15 collected information to measure the delivery and quality of care which COPD patients received at their GP surgery.
- measure performance and its variation
- improve quality of care for people with COPD
- improve data recording to support measurement against national standards.
The data collection for the primary care element of this audit is designed to support reporting on indicators selected to map to the National Institute for Health and Care Excellence (NICE)’s Quality Standard for COPD. These relate to primary care elements such as: COPD prevalence, spirometry, chest radiograph at diagnosis, annual review, recording of breathlessness, provision of management plan and education, inhaler technique, appropriate medicines management, pulse oximetry, referral for rehabilitation, and appropriate consideration of end of life care.
Dr Noel Baxter leads the primary care audit workstream and the RCP is working closely with the National Wales Informatics Service (NWIS) and the Health and Social Care Information Centre (HSCIC) to deliver this workstream, along with key stakeholders including the Primary Care Respiratory Society UK and the Royal College of General Practitioners.
National COPD primary care audit (Wales) 2015
The first national primary care audit (Wales) took place in late 2015, with data extracted for the period covering 1 January 2014 to 31 March 2015.
61% of practices in Wales, covering a population of 48,029 patients diagnosed with COPD, opted to take part in this first of three cycles of audit.
Who participated in the audit?
All general practices (GP surgeries) in Wales that provide care for COPD patients were invited to take part. The national COPD primary care audit operates with a general practice opt-in model with no data taken from a general practice unless they consent for it to be released. Practices in Wales were contacted by their Local Health Board regarding the process for agreeing to take part in the audit.
Practices who agreed to take part in the audit were required to display an audit poster in their surgery. A national COPD primary care audit patient information leaflet was also made available. If a patient did not want their information to be used in the national COPD primary care audit then they were advised to inform a member of staff at their general practice, who should make sure that their information is excluded from the audit.
Which patients were included?
- The patient is registered with the practice in Wales on the first day of the extraction period.
- There is a recorded COPD diagnosis code with a date up to the end of the reporting period.
- The patient is aged 35 or over on the first day of the extraction period.
The primary care audit involves the extraction of patient-identifiable data, which means that it has been necessary to obtain an exemption under section 251 of the NHS Act 2006 (CAG 8-06(b)/2013) from the Health Research Authority’s Confidentiality Advisory Group (CAG), to collect and process confidential patient data without explicit consent from individual patients.
Section 251 approval was given on the basis that primary care participation is on an ‘opt in’ basis at the level of individual general practices, with email consent of ‘opt in’ required from participating practices. Participating practices were also required to display a poster in their practices advising patients that the audit was taking place, and print out a copy of a patient leaflet if further information was requested by a patient.
Patients’ right to object to their data being used for clinical audit has been supported by the appropriate Read codes. The necessary approvals were also gained from Wales Data Quality System (DQS) Governance Group and the Wales Primary Care Quality Forum.
How will the data be reported?
The data generated as a result of the audit data extraction will be used for outputs which support comparative, data-driven improvements in patient care and other related quality improvement activities. The analysis will be focused on assessment of compliance with NICE standards.
Each practice which takes part in the audit will receive a practice-level report about the standards of care they are providing to their COPD patients, and how these compare with other practices in Wales. This information helps practices to see where they need to improve the care they provide to people with COPD. These reports will be aggregated data, and will not include patient-level data.
GP practices wishing to access their own individual practice report will need to register for access to the Practice Level Reporting system, hosted by the Health and Social Care Information Centre’s (HSCIC) Clinical Audit Support Unit. This system will allow staff at GP practices in Wales to access audit reports which are specific to their GP practice in a secure manner. Further information on how to register for the HSCIC system is available, including a user guide and frequently asked questions (FAQs).
Alternatively, please contact the HSCIC:
- Telephone: +44 (0)300 303 5678
- Email: firstname.lastname@example.org (enter ‘GP Practice Level Reporting’ in the subject field of your email).
Practice-level reports will not be made publically available for this first audit data extraction and will only be accessible to the general practice concerned. This will allow practices to examine their COPD care, their data completeness/quality and coding approach.
Reports will also be produced for clusters and local health boards (LHBs) and additionally a national audit report will be published. These will be made publicly available but will not name individual practices.
The data analysis to support the statistics presented in individual practice reports was undertaken according to a protocol developed by HSCIC information analysts and the National COPD Audit Programme clinical lead for the primary care workstream. For each audit question, numerators and denominators were defined by expressions based on the data fields in the extracted data and the appropriate inclusion and exclusion criteria.
Details of this protocol are available in a separate document below. Information about the data cleaning undertaken is also included in this document. (The data were processed using Microsoft SQL Server algorithms based on these definitions and SSRS (SQL Server Reporting Services) was used to produce the report document.)
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