CHD REGISTERS

ADELE GRAHAM

PROJECT MANAGER

WEST YORKSHIRE CHD COLLABORATIVE

NSF Standards:Standard Three

General Practitioners and primary care teams should identify all people with established cardiovascular disease and offer them comprehensive advice and appropriate treatment to reduce their risks.

SECONDARYStandard Four

General Practitioners and primary health care teams should identify all people at significant risk of cardiovascular disease but who have not yet developed symptoms and offer them appropriate advice and treatment to reduce their risk

PRIMARY

NSF MILESTONES FOR PCT’s

Milestone 2 - By April 2001

* Every Practice should have a systematically developed and maintained practice-based CHD Register in place and is actively used to provide structured care to people with CHD

This Milestone is two years old

NSF GOALS FOR PCT’s

Milestone 2

* Every practice should have a systematically and maintained practice-based register of people with clinical evidence of CHD, occlusive vascular disease AND of people whose risk of CHD if >30% over ten years and is ….(ditto)

The Benefits of CHD Registers

* Reduces duplicate work

* Ensures that an effective call and recall system can be put in place which captures every patient with CHD in your practice

* Data can be collected which demonstrates the work undertaken with this group of people

* Funding will follow GMS or PMS contracts and these contracts will require this CHD data

* Diabetes Registers - Systematic approach.

THE TOOL

Search 1Search for all patients with Read Code beginning with:

G3 (5 byte read code)

G4 (4 byte read code)

XE2uV (Read code 3 in generation systems)

If a condition relating to the hierarchy code G3 IHD has been entered the computer will recognise this .

I.e. Your computer system will automatically recognise a diagnoses of angina (G33) as part of the G3 group

Therefore there is no need to code this patient with G3 and G33

Search 2

Search for all patients with a Read Code beginning with:

792 (5 byte read code) Coronary Artery Bypass Graft

773 (4 byte read code) Angioplasty

These codes represent patients who have undergone these cardiac procedures

Exclude from this search all patients coded with a G3/G4/XE2UV Code.

Those patients found with a 792 / 773 code need to be coded with the hierarchy of G3 .

Search 3

Search for all patients prescribed a Nitrate (use a time limit ie. within the last 12 months). Again exclude patients already identified with a G3/G4 or XE2UV code.

Any patients identified will need their records checking - this part of the process may require the help of a clinician in order to determine:

•If the patient is on a nitrate,why, if not suffering from a coronary condition.

•If requiring the nitrate what is the correct diagnosis and add this to the CHD Register by giving an appropriate code e.g. G3/G4/XE2UV

Validating your Register

Randomly pick (according to register size) a number of records from those identified on the register.

Check these records to see whether the patient has CHD and is coded correctly.

This process we recommend to be undertaken every 6/12

MAINTAINING YOUR

REGISTER

OUTPATIENT APPOINTMENT

DISCHARGE LETTERS

ROUTINE CONSULTATIONS

* Whilst summarising records

* At new patient health check

* Whilst working on your CHD Register

Cont…….

The Practicalities of Setting up and Maintaining your CHD Register

* All members of staff need to be aware that a register is being constructed and the importance of the register.

* The clinical team need to be fully briefed on the work undertaken to establish the register and how to access it, add or remove patients from it.

* A dedicated member of staff (preferably admin) needs to take responsibility for the register - maintaining / checking.

* Data flow systems put in place to ensure capture of these patients is met.