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Mark L LevyClinical Lead
National Review of Asthma Deaths (NRAD) An overview
Rosie HoustonProgramme Manager
Supporting partners
Asthma death studies - Pre-1980
Background (1)bull Potentially preventable or avoidable factors contributing to death from
asthma identified nearly 50 years ago
bull Underuse of corticosteroids ndash 1963 1975 1979
bull Lack of Patient Education ndash 1963
bull Underuse of objective measures ndash 1963
bull Failure to recognise severity ndash 1979
bull Inadequate routine management and follow-up ndash 1979
bull Potentially preventable deaths - 1979
BMJ 19762721 BMJ 197611493 BMJ 1980280687 BMJ 1982285(6354)1570-1
bull Potentially preventable factors contributing to death from asthma recent asthma death confidential enquiries
bull Drug treatment ndash Corticosteroids - 67 (2003) excess beta-agonist - 50(2006)
bull Underuse of objective measures ndash 17 (2003)
bull Inadequate routine management and follow-up ndash 29 (1996) 33 GP 21 Hospital (2003)
bull National Guidelines not followed ndash 66 (2003)
Thorax 199954(11)978-84PCRJ 200514(6)303-13 Personal communication with Dr S Nasser 2005
Background (2)
bull Preventable factors can be identified in up to 50-70 of deaths from asthma ndash 50 years after the first asthma death studies
bull Previous published auditsconfidential enquiries have tended to be local population based studies - therefore results may not be fully representative
bull Seems that recommendations from previous asthma death studies and guidelines (eg SIGNBTS) are not being implemented
bull ThereforehellipNational Review of Asthma Deaths (NRAD)
bull Feedback ndash publicity and
bull Implementation of findings
Background (3)
Aim
To improve our understanding of whypeople die from asthma in order thatdeaths can be prevented in the future
Objectives (1)bull Explore the circumstances surrounding each death
from asthma over a one year period from February 2012 to include
Epidemiological amp demographic factors Relevant clinical history (to include previous attacks) Allergic amp environmental factors Lifestyle and psycho-social factors Management Medication
bull To collate and distil out any key factorsthemetrends
Aims amp Objectives (2)bull Propose what would need to change in order to
prevent future deaths
bull Make recommendations for clinical practice amp service provision
bull Raise awareness of and increase understanding of asthma amongst professionals and the public and in people with asthma themselves
Project summary
The project comprises
bull Core data collection on all asthma deaths to include an associated national audit of care
bull A confidential enquiry into all asthma deaths in England over one year including
Reliability of diagnosis Preventable causes An associated academic analysis to identify trigger factors Advice re improving practice
Methodology (1)bull Phase 1 (a) Identification of cases
ndash Notification from health care professional (eg GPnurse hospital cliniciannurse coronerpathologist)
ndash Notification from existing data source (eg ONSDr Foster)
ndash A death where lsquoasthmarsquo appears in Part I (a b amp c) or 2 of the death certificate
ndash A death coded as ICD-10 code J45-46
Methodology (2)bull Our definition of lsquoasthma deathrsquo
(for the purposes of this project)ndash Patients suspectedconfirmed of dying from
asthma
bull Inclusion criteria ndash Any person who died from asthma as per case
definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Supporting partners
Asthma death studies - Pre-1980
Background (1)bull Potentially preventable or avoidable factors contributing to death from
asthma identified nearly 50 years ago
bull Underuse of corticosteroids ndash 1963 1975 1979
bull Lack of Patient Education ndash 1963
bull Underuse of objective measures ndash 1963
bull Failure to recognise severity ndash 1979
bull Inadequate routine management and follow-up ndash 1979
bull Potentially preventable deaths - 1979
BMJ 19762721 BMJ 197611493 BMJ 1980280687 BMJ 1982285(6354)1570-1
bull Potentially preventable factors contributing to death from asthma recent asthma death confidential enquiries
bull Drug treatment ndash Corticosteroids - 67 (2003) excess beta-agonist - 50(2006)
bull Underuse of objective measures ndash 17 (2003)
bull Inadequate routine management and follow-up ndash 29 (1996) 33 GP 21 Hospital (2003)
bull National Guidelines not followed ndash 66 (2003)
Thorax 199954(11)978-84PCRJ 200514(6)303-13 Personal communication with Dr S Nasser 2005
Background (2)
bull Preventable factors can be identified in up to 50-70 of deaths from asthma ndash 50 years after the first asthma death studies
bull Previous published auditsconfidential enquiries have tended to be local population based studies - therefore results may not be fully representative
bull Seems that recommendations from previous asthma death studies and guidelines (eg SIGNBTS) are not being implemented
bull ThereforehellipNational Review of Asthma Deaths (NRAD)
bull Feedback ndash publicity and
bull Implementation of findings
Background (3)
Aim
To improve our understanding of whypeople die from asthma in order thatdeaths can be prevented in the future
Objectives (1)bull Explore the circumstances surrounding each death
from asthma over a one year period from February 2012 to include
Epidemiological amp demographic factors Relevant clinical history (to include previous attacks) Allergic amp environmental factors Lifestyle and psycho-social factors Management Medication
bull To collate and distil out any key factorsthemetrends
Aims amp Objectives (2)bull Propose what would need to change in order to
prevent future deaths
bull Make recommendations for clinical practice amp service provision
bull Raise awareness of and increase understanding of asthma amongst professionals and the public and in people with asthma themselves
Project summary
The project comprises
bull Core data collection on all asthma deaths to include an associated national audit of care
bull A confidential enquiry into all asthma deaths in England over one year including
Reliability of diagnosis Preventable causes An associated academic analysis to identify trigger factors Advice re improving practice
Methodology (1)bull Phase 1 (a) Identification of cases
ndash Notification from health care professional (eg GPnurse hospital cliniciannurse coronerpathologist)
ndash Notification from existing data source (eg ONSDr Foster)
ndash A death where lsquoasthmarsquo appears in Part I (a b amp c) or 2 of the death certificate
ndash A death coded as ICD-10 code J45-46
Methodology (2)bull Our definition of lsquoasthma deathrsquo
(for the purposes of this project)ndash Patients suspectedconfirmed of dying from
asthma
bull Inclusion criteria ndash Any person who died from asthma as per case
definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Asthma death studies - Pre-1980
Background (1)bull Potentially preventable or avoidable factors contributing to death from
asthma identified nearly 50 years ago
bull Underuse of corticosteroids ndash 1963 1975 1979
bull Lack of Patient Education ndash 1963
bull Underuse of objective measures ndash 1963
bull Failure to recognise severity ndash 1979
bull Inadequate routine management and follow-up ndash 1979
bull Potentially preventable deaths - 1979
BMJ 19762721 BMJ 197611493 BMJ 1980280687 BMJ 1982285(6354)1570-1
bull Potentially preventable factors contributing to death from asthma recent asthma death confidential enquiries
bull Drug treatment ndash Corticosteroids - 67 (2003) excess beta-agonist - 50(2006)
bull Underuse of objective measures ndash 17 (2003)
bull Inadequate routine management and follow-up ndash 29 (1996) 33 GP 21 Hospital (2003)
bull National Guidelines not followed ndash 66 (2003)
Thorax 199954(11)978-84PCRJ 200514(6)303-13 Personal communication with Dr S Nasser 2005
Background (2)
bull Preventable factors can be identified in up to 50-70 of deaths from asthma ndash 50 years after the first asthma death studies
bull Previous published auditsconfidential enquiries have tended to be local population based studies - therefore results may not be fully representative
bull Seems that recommendations from previous asthma death studies and guidelines (eg SIGNBTS) are not being implemented
bull ThereforehellipNational Review of Asthma Deaths (NRAD)
bull Feedback ndash publicity and
bull Implementation of findings
Background (3)
Aim
To improve our understanding of whypeople die from asthma in order thatdeaths can be prevented in the future
Objectives (1)bull Explore the circumstances surrounding each death
from asthma over a one year period from February 2012 to include
Epidemiological amp demographic factors Relevant clinical history (to include previous attacks) Allergic amp environmental factors Lifestyle and psycho-social factors Management Medication
bull To collate and distil out any key factorsthemetrends
Aims amp Objectives (2)bull Propose what would need to change in order to
prevent future deaths
bull Make recommendations for clinical practice amp service provision
bull Raise awareness of and increase understanding of asthma amongst professionals and the public and in people with asthma themselves
Project summary
The project comprises
bull Core data collection on all asthma deaths to include an associated national audit of care
bull A confidential enquiry into all asthma deaths in England over one year including
Reliability of diagnosis Preventable causes An associated academic analysis to identify trigger factors Advice re improving practice
Methodology (1)bull Phase 1 (a) Identification of cases
ndash Notification from health care professional (eg GPnurse hospital cliniciannurse coronerpathologist)
ndash Notification from existing data source (eg ONSDr Foster)
ndash A death where lsquoasthmarsquo appears in Part I (a b amp c) or 2 of the death certificate
ndash A death coded as ICD-10 code J45-46
Methodology (2)bull Our definition of lsquoasthma deathrsquo
(for the purposes of this project)ndash Patients suspectedconfirmed of dying from
asthma
bull Inclusion criteria ndash Any person who died from asthma as per case
definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Background (1)bull Potentially preventable or avoidable factors contributing to death from
asthma identified nearly 50 years ago
bull Underuse of corticosteroids ndash 1963 1975 1979
bull Lack of Patient Education ndash 1963
bull Underuse of objective measures ndash 1963
bull Failure to recognise severity ndash 1979
bull Inadequate routine management and follow-up ndash 1979
bull Potentially preventable deaths - 1979
BMJ 19762721 BMJ 197611493 BMJ 1980280687 BMJ 1982285(6354)1570-1
bull Potentially preventable factors contributing to death from asthma recent asthma death confidential enquiries
bull Drug treatment ndash Corticosteroids - 67 (2003) excess beta-agonist - 50(2006)
bull Underuse of objective measures ndash 17 (2003)
bull Inadequate routine management and follow-up ndash 29 (1996) 33 GP 21 Hospital (2003)
bull National Guidelines not followed ndash 66 (2003)
Thorax 199954(11)978-84PCRJ 200514(6)303-13 Personal communication with Dr S Nasser 2005
Background (2)
bull Preventable factors can be identified in up to 50-70 of deaths from asthma ndash 50 years after the first asthma death studies
bull Previous published auditsconfidential enquiries have tended to be local population based studies - therefore results may not be fully representative
bull Seems that recommendations from previous asthma death studies and guidelines (eg SIGNBTS) are not being implemented
bull ThereforehellipNational Review of Asthma Deaths (NRAD)
bull Feedback ndash publicity and
bull Implementation of findings
Background (3)
Aim
To improve our understanding of whypeople die from asthma in order thatdeaths can be prevented in the future
Objectives (1)bull Explore the circumstances surrounding each death
from asthma over a one year period from February 2012 to include
Epidemiological amp demographic factors Relevant clinical history (to include previous attacks) Allergic amp environmental factors Lifestyle and psycho-social factors Management Medication
bull To collate and distil out any key factorsthemetrends
Aims amp Objectives (2)bull Propose what would need to change in order to
prevent future deaths
bull Make recommendations for clinical practice amp service provision
bull Raise awareness of and increase understanding of asthma amongst professionals and the public and in people with asthma themselves
Project summary
The project comprises
bull Core data collection on all asthma deaths to include an associated national audit of care
bull A confidential enquiry into all asthma deaths in England over one year including
Reliability of diagnosis Preventable causes An associated academic analysis to identify trigger factors Advice re improving practice
Methodology (1)bull Phase 1 (a) Identification of cases
ndash Notification from health care professional (eg GPnurse hospital cliniciannurse coronerpathologist)
ndash Notification from existing data source (eg ONSDr Foster)
ndash A death where lsquoasthmarsquo appears in Part I (a b amp c) or 2 of the death certificate
ndash A death coded as ICD-10 code J45-46
Methodology (2)bull Our definition of lsquoasthma deathrsquo
(for the purposes of this project)ndash Patients suspectedconfirmed of dying from
asthma
bull Inclusion criteria ndash Any person who died from asthma as per case
definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
bull Potentially preventable factors contributing to death from asthma recent asthma death confidential enquiries
bull Drug treatment ndash Corticosteroids - 67 (2003) excess beta-agonist - 50(2006)
bull Underuse of objective measures ndash 17 (2003)
bull Inadequate routine management and follow-up ndash 29 (1996) 33 GP 21 Hospital (2003)
bull National Guidelines not followed ndash 66 (2003)
Thorax 199954(11)978-84PCRJ 200514(6)303-13 Personal communication with Dr S Nasser 2005
Background (2)
bull Preventable factors can be identified in up to 50-70 of deaths from asthma ndash 50 years after the first asthma death studies
bull Previous published auditsconfidential enquiries have tended to be local population based studies - therefore results may not be fully representative
bull Seems that recommendations from previous asthma death studies and guidelines (eg SIGNBTS) are not being implemented
bull ThereforehellipNational Review of Asthma Deaths (NRAD)
bull Feedback ndash publicity and
bull Implementation of findings
Background (3)
Aim
To improve our understanding of whypeople die from asthma in order thatdeaths can be prevented in the future
Objectives (1)bull Explore the circumstances surrounding each death
from asthma over a one year period from February 2012 to include
Epidemiological amp demographic factors Relevant clinical history (to include previous attacks) Allergic amp environmental factors Lifestyle and psycho-social factors Management Medication
bull To collate and distil out any key factorsthemetrends
Aims amp Objectives (2)bull Propose what would need to change in order to
prevent future deaths
bull Make recommendations for clinical practice amp service provision
bull Raise awareness of and increase understanding of asthma amongst professionals and the public and in people with asthma themselves
Project summary
The project comprises
bull Core data collection on all asthma deaths to include an associated national audit of care
bull A confidential enquiry into all asthma deaths in England over one year including
Reliability of diagnosis Preventable causes An associated academic analysis to identify trigger factors Advice re improving practice
Methodology (1)bull Phase 1 (a) Identification of cases
ndash Notification from health care professional (eg GPnurse hospital cliniciannurse coronerpathologist)
ndash Notification from existing data source (eg ONSDr Foster)
ndash A death where lsquoasthmarsquo appears in Part I (a b amp c) or 2 of the death certificate
ndash A death coded as ICD-10 code J45-46
Methodology (2)bull Our definition of lsquoasthma deathrsquo
(for the purposes of this project)ndash Patients suspectedconfirmed of dying from
asthma
bull Inclusion criteria ndash Any person who died from asthma as per case
definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
bull Preventable factors can be identified in up to 50-70 of deaths from asthma ndash 50 years after the first asthma death studies
bull Previous published auditsconfidential enquiries have tended to be local population based studies - therefore results may not be fully representative
bull Seems that recommendations from previous asthma death studies and guidelines (eg SIGNBTS) are not being implemented
bull ThereforehellipNational Review of Asthma Deaths (NRAD)
bull Feedback ndash publicity and
bull Implementation of findings
Background (3)
Aim
To improve our understanding of whypeople die from asthma in order thatdeaths can be prevented in the future
Objectives (1)bull Explore the circumstances surrounding each death
from asthma over a one year period from February 2012 to include
Epidemiological amp demographic factors Relevant clinical history (to include previous attacks) Allergic amp environmental factors Lifestyle and psycho-social factors Management Medication
bull To collate and distil out any key factorsthemetrends
Aims amp Objectives (2)bull Propose what would need to change in order to
prevent future deaths
bull Make recommendations for clinical practice amp service provision
bull Raise awareness of and increase understanding of asthma amongst professionals and the public and in people with asthma themselves
Project summary
The project comprises
bull Core data collection on all asthma deaths to include an associated national audit of care
bull A confidential enquiry into all asthma deaths in England over one year including
Reliability of diagnosis Preventable causes An associated academic analysis to identify trigger factors Advice re improving practice
Methodology (1)bull Phase 1 (a) Identification of cases
ndash Notification from health care professional (eg GPnurse hospital cliniciannurse coronerpathologist)
ndash Notification from existing data source (eg ONSDr Foster)
ndash A death where lsquoasthmarsquo appears in Part I (a b amp c) or 2 of the death certificate
ndash A death coded as ICD-10 code J45-46
Methodology (2)bull Our definition of lsquoasthma deathrsquo
(for the purposes of this project)ndash Patients suspectedconfirmed of dying from
asthma
bull Inclusion criteria ndash Any person who died from asthma as per case
definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Aim
To improve our understanding of whypeople die from asthma in order thatdeaths can be prevented in the future
Objectives (1)bull Explore the circumstances surrounding each death
from asthma over a one year period from February 2012 to include
Epidemiological amp demographic factors Relevant clinical history (to include previous attacks) Allergic amp environmental factors Lifestyle and psycho-social factors Management Medication
bull To collate and distil out any key factorsthemetrends
Aims amp Objectives (2)bull Propose what would need to change in order to
prevent future deaths
bull Make recommendations for clinical practice amp service provision
bull Raise awareness of and increase understanding of asthma amongst professionals and the public and in people with asthma themselves
Project summary
The project comprises
bull Core data collection on all asthma deaths to include an associated national audit of care
bull A confidential enquiry into all asthma deaths in England over one year including
Reliability of diagnosis Preventable causes An associated academic analysis to identify trigger factors Advice re improving practice
Methodology (1)bull Phase 1 (a) Identification of cases
ndash Notification from health care professional (eg GPnurse hospital cliniciannurse coronerpathologist)
ndash Notification from existing data source (eg ONSDr Foster)
ndash A death where lsquoasthmarsquo appears in Part I (a b amp c) or 2 of the death certificate
ndash A death coded as ICD-10 code J45-46
Methodology (2)bull Our definition of lsquoasthma deathrsquo
(for the purposes of this project)ndash Patients suspectedconfirmed of dying from
asthma
bull Inclusion criteria ndash Any person who died from asthma as per case
definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Objectives (1)bull Explore the circumstances surrounding each death
from asthma over a one year period from February 2012 to include
Epidemiological amp demographic factors Relevant clinical history (to include previous attacks) Allergic amp environmental factors Lifestyle and psycho-social factors Management Medication
bull To collate and distil out any key factorsthemetrends
Aims amp Objectives (2)bull Propose what would need to change in order to
prevent future deaths
bull Make recommendations for clinical practice amp service provision
bull Raise awareness of and increase understanding of asthma amongst professionals and the public and in people with asthma themselves
Project summary
The project comprises
bull Core data collection on all asthma deaths to include an associated national audit of care
bull A confidential enquiry into all asthma deaths in England over one year including
Reliability of diagnosis Preventable causes An associated academic analysis to identify trigger factors Advice re improving practice
Methodology (1)bull Phase 1 (a) Identification of cases
ndash Notification from health care professional (eg GPnurse hospital cliniciannurse coronerpathologist)
ndash Notification from existing data source (eg ONSDr Foster)
ndash A death where lsquoasthmarsquo appears in Part I (a b amp c) or 2 of the death certificate
ndash A death coded as ICD-10 code J45-46
Methodology (2)bull Our definition of lsquoasthma deathrsquo
(for the purposes of this project)ndash Patients suspectedconfirmed of dying from
asthma
bull Inclusion criteria ndash Any person who died from asthma as per case
definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Aims amp Objectives (2)bull Propose what would need to change in order to
prevent future deaths
bull Make recommendations for clinical practice amp service provision
bull Raise awareness of and increase understanding of asthma amongst professionals and the public and in people with asthma themselves
Project summary
The project comprises
bull Core data collection on all asthma deaths to include an associated national audit of care
bull A confidential enquiry into all asthma deaths in England over one year including
Reliability of diagnosis Preventable causes An associated academic analysis to identify trigger factors Advice re improving practice
Methodology (1)bull Phase 1 (a) Identification of cases
ndash Notification from health care professional (eg GPnurse hospital cliniciannurse coronerpathologist)
ndash Notification from existing data source (eg ONSDr Foster)
ndash A death where lsquoasthmarsquo appears in Part I (a b amp c) or 2 of the death certificate
ndash A death coded as ICD-10 code J45-46
Methodology (2)bull Our definition of lsquoasthma deathrsquo
(for the purposes of this project)ndash Patients suspectedconfirmed of dying from
asthma
bull Inclusion criteria ndash Any person who died from asthma as per case
definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Project summary
The project comprises
bull Core data collection on all asthma deaths to include an associated national audit of care
bull A confidential enquiry into all asthma deaths in England over one year including
Reliability of diagnosis Preventable causes An associated academic analysis to identify trigger factors Advice re improving practice
Methodology (1)bull Phase 1 (a) Identification of cases
ndash Notification from health care professional (eg GPnurse hospital cliniciannurse coronerpathologist)
ndash Notification from existing data source (eg ONSDr Foster)
ndash A death where lsquoasthmarsquo appears in Part I (a b amp c) or 2 of the death certificate
ndash A death coded as ICD-10 code J45-46
Methodology (2)bull Our definition of lsquoasthma deathrsquo
(for the purposes of this project)ndash Patients suspectedconfirmed of dying from
asthma
bull Inclusion criteria ndash Any person who died from asthma as per case
definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Methodology (1)bull Phase 1 (a) Identification of cases
ndash Notification from health care professional (eg GPnurse hospital cliniciannurse coronerpathologist)
ndash Notification from existing data source (eg ONSDr Foster)
ndash A death where lsquoasthmarsquo appears in Part I (a b amp c) or 2 of the death certificate
ndash A death coded as ICD-10 code J45-46
Methodology (2)bull Our definition of lsquoasthma deathrsquo
(for the purposes of this project)ndash Patients suspectedconfirmed of dying from
asthma
bull Inclusion criteria ndash Any person who died from asthma as per case
definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Methodology (2)bull Our definition of lsquoasthma deathrsquo
(for the purposes of this project)ndash Patients suspectedconfirmed of dying from
asthma
bull Inclusion criteria ndash Any person who died from asthma as per case
definitionndash Age range all ages ndash Between 1st February 2012 ndash 31st January 2013
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Methodology (3)bull Phase 1 (b) Confirmation of asthma
deathndash This may require direct contact by clinical
lead or local steeringworking group member with patientrsquos clinician if necessary
ndash Criteria for defining an lsquoasthma deathrsquo to be agreed
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Methodology (4)bull Phase 2 - Collect and analyse core data
(mainly questionnaires) on all confirmed deaths from asthma over 1 year from TBC to include assessment of management against quality indicators (~1250 cases)
AND
bull Collect additional information on all confirmed deaths from asthma (items TBA)
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Methodology (3)
bull Phase 3 - In-depth multidisciplinary confidential enquiry panels on all confirmed asthma deaths
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Confidential Enquiry Panels (1)bull Panels formed of practicing clinicians and
health care professionals carry out a review of the case notes tondash Assess where how and why standards of care
may not have been met and what the potential impact may be
ndash Draw out environmental social clinical care and management issues
ndash Identify preventable and avoidable factors ndash Highlight good practice
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Confidential Enquiry Panels (2)
bull Review all confirmed asthma deaths (est n=800-1000)
bull 10 England regions + 3 Devolved Nationsbull ~10 panel members per meeting (GPs
Respiratory Physicians Asthma nurses etc)bull 2-4 cases per panel member
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Proposed timeline 2011 2012 2013 2014
2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14 2nd frac14 3rd frac14 4th frac14 1st frac14
Planning and developmentNetworking and raising awareness
Phase 1 amp 2 - Core data collection
Planning and development
Data collection 1st Feb 2012 - 31st Jan 2013
Analysis and reporting
Phase 3 - Confidential enquiry panels
Planning and development
Confidential enquiry panels 15 months of panels
Analysis and reporting
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Section 251 amp Ethics ApprovalBy November 2011 - bull Application to NIGB for Section 251 approval to collect
patient identifiable information without consent (EnglandWales)
bull Application to Privacy Advisory Committee amp Caldicott Guardians (ScotlandNorthern Ireland) ndash by November 2011
By January 2012 -bull Application for ethics approval to interview a sample of
familiesbull Develop methodology bull Develop semi structured interview schedulebull Develop family information sheets
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Project organisational structureCommissioners
bull Healthcare Quality Improvement Partnership (HQIP)
RCP project management teambull Rosie Houston Mark L Levy amp project co-ordinator (TBA)
Workingimplementation groupbull Meet monthly - Asthma UK BTS NCEPOD RCP RCPCH RCGPPCRS BSACI
Involving families and community contacts working groupbull Meet 3-4 times per year
Steering group bull Meet 3-4 times per year - wider multidisciplinary group
Stakeholders
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
Reporting amp Dissemination Planbull Quarterly bulletins
bull A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members
bull Implementationideas bull With SG and College Implementation Groups
bull Interim report on themes from both phases
bull Final report amp papers
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522
For further information please visit wwwrcplondonacuknrad Or contact us
Mark L LevyClinical Lead NRAD
marklevyanimalswildcom+44 (0) 20 3075 1500 or 1522
Rosie HoustonProgramme Manager
rosiehoustonrcplondonacuk+44 (0) 20 3075 1500 or 1522