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Recipe Name:

QIM 8 – Cardiovascular Risk

Rationale:

Assessment of absolute CVD risk based on multiple risk factors is more accurate than that based on individual risk factors due to the cumulative nature of risk effects. Basing patient

management decisions on this approach should improve CVD outcomes.

Target:

  • Proportion of regular clients aged 45 to 74 years, who have had all of the following information recorded:
  • Tobacco smoking
  • Diabetes
    • Diabetes status: Type 1 or Type 2 Diabetes
    • Diabetes risk: Fasting Glucose Test result, or a screening for glycosylated haemoglobin (HbA1c test result)
  • Systolic blood pressure
  • Total cholesterol and HDL cholesterol levels
  • Age
  • Sex

CAT Starting Point:

  1. CAT Open - CAT4 view (all reports) loaded
  2. Population Extract Loaded and Extract Pane “Hidden”
    1. Filter Pane open and under the ‘General’ tab ‘Active Patients’ (3x <2 years) selected

The CV even risk report in CAT4 shows the risk level of patients based on the National Vascular Disease Prevention Alliance (NVDPA) guidelines: https://www.cvdcheck.org.au/australian-absolute-cardiovascular-disease-risk-calculator

The report will show the patients with all recorded values and their calculated risk and a second report will show those patients with incomplete data and which data items are missing. The second report in particular can be used to plan a quality improvement activity addressing cardiovascular risk and related measures.

The criteria used by the NVDPA don’t align 100% with the improvement measure as defined above. The main difference is the inclusion of patients with a diagnosed cardiovascular condition (excluded by the NVDPA) and the inclusion of diabetes screening (Fasting blood glucose or screening HbA1c). We will work on providing an easy way to match up the QIM with our reports but recommend for now to use the report and filters described in this chapter as any improvement to the data shown in this report will affect the QIM as well.


CAT4 starting point

 

RECIPE Steps Filters:

  • In the “General” Tab, enter Start Age = 45 and End Age = 74


  • Click "Recalculate"
  • Click ‘Hide Filters’

 

Report Steps

  • Select the "CV Event Risk" tab

This report will show you the CV Event risk status of your selected patient group and will allow you to measure improvement over time by comparing your reports.

The title of the report shows the number of patients matching the search criteria, in this case 2002 regular patients aged between 45 and 74 years. Out of those 1848 are eligible for the risk calcuation as they don’t have a diagnosis of a cardiovascular condition. Out of the 1848 eligible patients 1299 or 70.3% have all measures in place to calculate their CV Event risk.


The next tab shows excluded and incomplete patient records:


In this example there are 154 patients with a diagnosed condition who were excluded (2002-154= 1848) and 549 were excluded due to missing data items as listed in the graph. This graph makes it easy to measure change as part of a QI activity. Patients can be easily identify by clicking on the graph and their records can be updated or a Topbar prompt can be created for the missing data items.


To Export Patient List to Microsoft Excel:

1.  Click on the “Export Icon”  at the top of the Patient Reidentification window.

2.  Click on “Excel”

3.   Choose a file name and a location to save to (eg. Create a folder C:/ClinicalAudit/CAT Patient FollowUp)

4.  Click “Save”

 

The steps above will produce a list of patients with contact details in MS Excel which can then be used to:

1.   Go back through the individual patient records in the GP Clinical Desktop System (CDS) and update known records

2.  Phone patients to update their record

3.  Produce a mail merge to recall patients for follow up

Optional: Use Recall CAT SMS and voice messages for patient recall


Full details are here: Recall CAT

After you have applied one or more filters and/or cross tabulations and have selected the group of patients of interest, you will see the choices for SMS Recall and other options at the bottom of the patient re-identification report. This can be applied to all of our CAT Recipes or any custom search you want to perform.

CAT Starting Point:
The Patient Reidentification window displays your list of filtered patients


Customising Steps


You can refine the selection manually by clicking the 'Refine Selection' button.



If you click on "SMS Recall", the "SMS Recall" window will be displayed with the name of your clinic. Enter a message that relates to the purpose of the notification. There are a number of options under the inclusion criteria:

  • Patients who have opted out of receiving SMS from your clinic are removed by default
  • Linking your online booking system to the SMS recall
  • Include the opt-out message in the SMS for patient to "STOP" receiving SMS notifications sent through CAT4

Clicking on "Send" will send the message to all patients with a valid mobile phone number in their record. A confirmation message will prompt you with the number of messages to be sent and the required credits. Click yes to send the SMS recall.



After sending a SMS or Voice Message you will see a message like this one (for SMS)




For full details on the prompt history, click on 'Prompts' and select 'SMS and Voicemail'



Recall CAT - Message History: http://help.pencs.com.au/display/CG/Recall+CAT+-+Message+History

Optional: Create a prompt to display in Topbar

 

Remember you need to be in the CAT4 Daily View to be able to create prompts. Other pre-requisites are:

  • Topbar is installed
  • CAT4 is linked to Topbar via Edit/Preferences/Topbar - check here for details: Linking CAT4 to Topbar

 To start CAT4 in the Daily View, click on the 'Daily View' icon in the dashboard:



Once you have applied the filter(s) and displayed the patients of interest as described above, you can create a prompt that will be shown to all clinicians using Topbar if a patient meeting the prompt criteria is opened in their clinical system. The full guide is available at CAT PLUS PROMPTS and a short guide on how to create prompts in CAT4 can be found at  Creating a Prompt in CAT4

To start you have to use the drop-down menu at the bottom of the patient details report and select "Prompt at Consult - Topbar" then click on "Go" to give the new prompt a name.

 


The name you enter is the prompt text displayed in Topbar, so choose a simple but clear name that tells the clinician seeing the prompt what should be done.