NHS EXECUTIVE: LONDON RESEARCH AND DEVELOPMENT
Battersea Research Group

IDENTIFYING AND CODING OF CARDIOVASCULAR PATIENTS: The Conduit Experience

Introduction and Aims

The National Service Framework has priorities to identify patients with cardiovascular disease. Previous work has shown how to do this for Ischaemic Heart Disease (BMJ Paper - Gray et al Published 1st September 2000). The Battersea Research Group set out to put this paper into action. Evidence suggests that patients not on a disease register receive a lower standard of care.

Method

To identify IHD patients: We carried out searches for all patients on any one or more of the 5 drugs (atenolol, aspirin, statins, digoxin and nitrates), over the age of 44 years, and excluded patients already coded with a Read Code for IHD or its derivatives (G3 etc). Notes were searched for evidence of IHD and coded onto the computer with most recent cholesterol and blood pressure readings (if not already on the computer).

For all searches, we used the EMIS search engine - EMIS Version 4 or 5. Patient's names were downloaded to spreadsheets and these were used as templates to search the notes for cardiovascular diagnoses. A team of "coders" went into the practices and searched through the notes. An estimate of the numbers of notes required to search is given in our BMJ paper but is about 7% of the list size if G3 coded cases are not reviewed. However, because of errors in coding, these cases will need to be reviewed before any disease management can effectively take place.

Results

Original number of Ischaemic Heart and number found with the second search are shown below

• Number coded G3 before identification process: 1208
• Numbers after identification process: 1754
• Total List size: 88,226

Conclusions

We now have a PCG wide database of all patients Ischaemic Heart Disease, and all latest cholesterol measurements and blood pressures of those with Ischaemic Heart Disease.

We are now able to work with this data. We have produced spreadsheets for individual practices showing which patients are not on suggested treatments such as aspirin or statins, and those who have not had a recent cholesterol or blood pressure measurement.

This enables general practitioners to receive regular feedback of the data from their practices computer systems, to improve patient care, and also provides the necessary data to meet the National Service Framework requirements.

The Battersea Research Group has a team of trained coders that is able to undertake cardiovascular coding work for practices and PCG's. This is a useful service since the work involved in searching the notes is considerable and is best done as a batch process.

Identifyng Patients With Ischaemic Heart Disease In General Practice