Introducing GRASP-COPD and GRASP-HF

Dr Richard HealiconLiving Longer Lives

NHS IQ

• Free primary care audit tools• Aligned to NICE/ ESC guidance• Compatible with all GP systems in England• Each has a case finder• Care Audit (patient identifiable)• CHART Online (anonymised data)• AF, COPD and HF

Introducing the GRASP Suite

• Voluntary upload of data to CHART online• Web based analysis tool with a variety of comparative

viewing options available:• Secure and restricted access• For both primary care staff and commissioners

CHART Online

GRASP-AF

GRASP-COPD

GRASP-HF

Good Health Subclinical changes

Clinical disease

Recovery

Death

Asymptomatic Increasing symptoms

Screening

GRASP Case

Finders

GRASP Care Toolkits

Diagnosis

Where does GRASP fit in?

GRASP-AF

The case finder audit includes patients who are currently registered at the practice AND have a diagnosis of AF or atrial flutter OR have read coded entries that suggest probable AF or possible AF. Likelihood of AF is determined by the type of entryfound; factors are classified into possible or probable AF.

AF case finder

GRASP-COPD

COPD case finder

The diagnosis of COPD relies on a combination of history, physical examination and confirmation of airflow obstruction using spirometry. The case finder summary sheet is designed to give an indication of patients who may benefit from having their records reviewed in case of a missing diagnosis.A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with exertional breathlessness, chronic cough, regular sputum production, frequent winter ‘bronchitis’ or wheeze.

A table is then provided showing the number of patients over the age of 35 recorded as being current smokers or ex-smokers within the practice. As COPD is predominantly caused by smoking, inclusion of smoking prevalence is useful.

The first part of the summary sheet provides useful preliminary information for the audit including an up-to-date count of the practice population (currently registered patients) and a table summarising the patients that could be targeted for review. A list of the patients identified in each row can be found using the pre-set filters available in the datasheet.

The next part of the summary sheet gives details of patients on medication that might indicate the presence of COPD such as short and long acting beta2 agonist, short and long acting muscarinic antagonist and inhaled corticosteroid.

The next part of the summary sheet looks for evidence of frequent chest problems such as frequent respiratory exacerbation. This, along with other factors/symptoms, may indicate COPD.

The next section of the summary sheet looks for patients with key COPD symptoms or evidence of a COPD monitoring Read code on their electronic record. Patients who present with exertional breathlessness, chronic cough, regular sputum production or wheeze (along with other symptoms) may need reviewing for COPD. The presence of COPD related codes on a patient’s record (such as history of COPD, at risk of COPD, suspected COPD) suggests they should be reviewed for a diagnosis.

The presence of asthma symptoms on the summary sheet is designed to give an indication of the number of patients who have classic asthma symptoms. These patients are less likely to need reviewing to establish whether their symptoms suggest COPD. NICE guidance suggests you should consider a diagnosis of COPD in patients over 35, who are smokers/ex-smokers who have symptoms of COPD but do not have clinical features of asthma (such as those listed above)6.

The lung function test table shows those patients who may have been reviewed with spirometry in the past. These details can be viewed in the datasheet and may help to determine whether the patient has COPD or should be assessed for COPD.

GRASP-HF

HF case finderThe focus of the overall tool is on Heart Failure with LVSD, so the case finder tool is designed to assist in looking for patients who should have this combination of recorded information.

The first part of the summary sheet provides useful preliminary information for the audit including an up-to-date count of the practice population (currently registered patients) and, for reference, an up-to-date count of the number of patients with both heart failure and LVSD diagnoses.

The next two rows summarise the number of patients that either have only heart failure recorded or only LVSD recorded and therefore should be targeted for review. A list of the patients identified in these two rows can be found using the pre-set filters available in the datasheet.

The next two sections of the summary sheet show the number of indicative terms (terms that might suggest the presence of heart failure) and supporting information (supplementary data items that will help GPs assess the likelihood of a missing diagnostic code) that have been recorded in the records of patients who do not have both heart failure and LVSD. The presence of these items in the datasheet is designed to signpost practices to groups of patients most likely to have a missing diagnosis code.

The final two sections of the summary sheet show information about related heart conditions the patient may have and relevant medication the patient may be taking, which may also provide additional supporting information for case finding.

The three GRASP tools relate to conditions that can cause breathlessness

All three GRASP tools have a case finder

Search for Read codes which suggest a diagnosis

Allows GPs to review these patients and facilitate earlier diagnosis

Once diagnosed, GRASP care tools allows audit against NICE guidelines

Summary