RCGP RSC Atrial Fibrillation Dashboard Help

RCGP RSC Atrial Fibrillation Dashboard Help

Atrial Fibrillation (AF) is a common arrhythmia that leads to strokes, TIA’s and peripheral embolisms. The correct management of AF can reduce the risk of thromboembolic complications. This dashboard has been developed to help monitor performance in AF management and provide feedback according to the NICE Guidelines.

To diagnose AF the NICE guidelines recommend:

  • Palpation of pulse in any patient presenting the following symptoms:
  • Breathlessness/dyspnoea
  • Palpitations
  • Syncope
  • Dizziness
  • Chest discomfort

Assessment of stroke and bleeding risks using the CHADVASc and HASBLED scoring system.
Offer anticoagulation to all AF patients with a CHADVASc 2 and above. [NICE, 2019].

Accessing the Dashboard
  1. Open the following link: https://clininf.eu/index.php/mypracticedashboard/
  2. There will be multiple tabs across the top, each will be for a different dashboard, please select the tab named Atrial Fibrillation.
  3. Type in your unique practice key in the box at the top middle of the page, as shown below. The unique practice key for your practice is the same for all dashboards. Please remember to press <Enter> then tick the box next to your practice key when it appears. (Please see image below for reference)
  4. If you do not know your unique practice key please contact one of the Practice liaison officers contact details are available on the last page.
1) General AF management performance Smiley face

After logging in you will see the dashboard as shown below, on the top left of your dashboard there is a general performance indicating smiley face. The smiley face represents your practices performance in AF management as a whole.

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1) General AF management performance Smiley face

After logging in you will see the dashboard as shown below, on the top left of your dashboard there is a general performance indicating smiley face. The smiley face represents your practices performance in AF management as a whole.

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2) Incidence and Prevalence of Atrial Fibrillation

The first section of the dashboard provides feedback on the prevalence and incidence of AF within your practice. This section also compares the prevalence and incidence to the rest of the RCGP RSC network.

  1. In this section you will find the Age standardised AF prevalence for your practice and your current QOF AF prevalence the latter is found in a purple box. If your QOF AF prevalence is lower than your AF prevalence, this may indicate there are patients in your practice whose AF has either not yet been recognised or has not been correctly coded.
  2. Shows incidence and prevalence data in table format.
  3. There is also a smiley face performance indicator which shows how you are performing in terms of maintaining an AF register. The level of performance shown depends on your practices AF recording compared to the rest of the network.
  4. Information on potential QOF earnings for maintaining an AF register in the purple shaded box. [QOF 2017/18,2019]
  5. The red box shows your potential earnings if all AF patients are registered correctly.
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3) Risk Scores

NICE Guidelines require practitioners to complete CHADVASc scores and HASBLED scores for AF patients. [NICE, 2019]

  1. In this section you will find a dropdown box to select historic data
  2. A smiley face to show overall risk scoring performance for AF patients. This compares your practice’s scoring performance with the rest of the RSC network.
  3. A box outlining the QOF indicator for AF risk scoring; below which is a red box with possible QOF income from that specific indicator.[QOF 2017/18,2019]
  4. A bar graph displaying the rate of recording CHADVASc scores in your practice. We have also derived CHADSVASc scores for all of your AF patients, derived scores are also shown. Any significant difference between these scores may indicate CHADVASc scores are not being recorded optimally within your practice. The same can be found for HASBLED scores, you will also be able to compare these rates to the rest of the RCGP RSC network.
  5. The graph has colour blocking depending on the CHADVASc and HASBLED score achieved. AF patients with a CHADVASc ≥2 should be offered anticoagulation and the bleeding risk should be assessed using the HASBLED tool. The bar graph separates HASBLED scores into two categories, 3 and above and below three. [NICE, 2019].
    The colour blocking can be identified using the Key.
  6. Shows data from the bar graph in table format.
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4) Anticoagulant Prescribing

According to NICE Guidelines all AF patients with a CHADVASc score ≥2 should be offered anticoagulation; unless they have an increased bleeding risk. [NICE, 2019].

  1. In this section you will find a dropdown box to select historic data
  2. A smiley face performance indicator for overall anticoagulation performance. This shows how your practice is performing compared with the rest of the RSC network.
  3. A box outlining the QOF indicator for AF anticoagulant prescribing; below which is a red box with possible QOF income from that specific indicator. [QOF 2017/18,2019]
  4. A graph outlining anticoagulant prescription in your practice compared with the rest of the RSC network. The graph shows the rate of AF patients with a CHADVASc score ≥2 that are anticoagulated and not anticoagulated; and patients with CHADVASc scores ≥2 that are prescribed DOACs or Warfarin.
  5. Shows data from the bar graph in table format.
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5) Prescription of Anticoagulants at Suboptimal Doses

This section of the dashboard provides feedback on whether DOAC anticoagulation is prescribed sub-optimally.

Here you will find:

  1. A smiley face indicator showing your practices anticoagulant dosing performance compared with the rest of the RCGP RSC.
  2. A dropdown box to select for historic data
  3. A selection box to select a DOAC drug to view
  4. After selecting the drug there will be a graph showing the dosing prescribed to patients with different conditions such as Creatinine clearance levels and contraindications, this is also compared with the rest of the network. The colour banding is explained through the keys on the right, which specify the creatinine clearance level, the contraindications if any and whether the dose needs to be changes.
  5. There is a further link to the mgp dosing guidelines that will give you further details on optimal dosing and contraindications.
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References:

NICE. (2019). Atrial fibrillation: management | Guidance and guidelines | NICE. [online] Available at: https://www.nice.org.uk/guidance/cg180/chapter/1-Recommendations#assessment-of-stroke-and-bleeding-risks-2 [Accessed 17 Jan. 2019].

SUMMARY OF CHANGES TO QOF 2017/18 - ENGLAND. (2019). [ebook] NHS Employers, p.1. Available at: https://www.nhsemployers.org/-/media/Employers/Documents/Primary-care-contracts/QOF/2017-18/201718-Quality-and-outcomes-framework-summary-of-changes.pdf?la=en&hash=D08AB4F7CE88F5D76E836E2F57FB6DCF241C8BC6 [Accessed 17 Jan. 2019].