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National Review of Asthma Deaths (NRAD)

National Review of Asthma Deaths (NRAD). An overview. Rosie Houston Programme Manager. Supporting partners. Asthma death studies - Pre-1980. Background (1). Potentially preventable or avoidable factors contributing to death from asthma identified nearly 50 years ago :

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National Review of Asthma Deaths (NRAD)

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  1. National Review of Asthma Deaths (NRAD) An overview Rosie Houston Programme Manager Mark L Levy Clinical Lead

  2. Supporting partners

  3. Asthma death studies - Pre-1980

  4. Background (1) • Potentially preventable or avoidable factors contributing to death from asthma identified nearly 50 years ago: • Underuse of corticosteroids – 1963, 1975, 1979 • Lack of Patient Education – 1963 • Underuse of objective measures – 1963 • Failure to recognise severity – 1979 • Inadequate routine management and follow-up – 1979 • Potentially preventable deaths - 1979 BMJ 1976;2:721; BMJ 1976;1:1493; BMJ 1980;280:687; BMJ 1982;285(6354):1570-1

  5. Background (2) • Potentially preventable factors contributing to death from asthma recent asthma death confidential enquiries: • Drug treatment – Corticosteroids - 67% (2003); excess beta-agonist - 50%(2006) • Underuse of objective measures – 17% (2003) • Inadequate routine management and follow-up – 29% (1996); 33% GP, 21% Hospital (2003) • National Guidelines not followed – 66% (2003) Thorax. 1999;54(11):978-84;PCRJ 2005;14(6):303-13; Personal communication with Dr S Nasser, 2005.

  6. Background (3) • Preventable factors can be identified in up to 50-70% of deaths from asthma – 50 years after the first asthma death studies • Previous published audits/confidential enquiries have tended to be local population based studies - therefore results may not be fully representative • Seems that recommendations from previous asthma death studies and guidelines (e.g. SIGN/BTS) are not being implemented • Therefore…National Review of Asthma Deaths (NRAD) • Feedback – publicity and • Implementation of findings

  7. Aim • To improve our understanding of why • people die from asthma in order that • deaths can be prevented in the future.

  8. Objectives (1) • Explore the circumstances surrounding each death from asthma over a one year period from February 2012, to include: • Epidemiological & demographic factors • Relevant clinical history (to include previous attacks) • Allergic & environmental factors • Lifestyle and psycho-social factors • Management • Medication • To collate and distil out any key factors/theme/trends

  9. Aims & Objectives (2) • Propose what would need to change in order to prevent future deaths • Make recommendations for clinical practice & service provision • Raise awareness of and increase understanding of asthma amongst professionals and the public and in people with asthma themselves

  10. Project summary • The project comprises: • Core data collection on all asthma deaths to include an associated national audit of care • 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

  11. Methodology (1) • Phase 1 (a) Identification of cases • Notification from health care professional (e.g. GP/nurse, hospital clinician/nurse, coroner/pathologist) • Notification from existing data source (e.g. ONS/Dr Foster) • A death where ‘asthma’ appears in Part I (a, b & c) or 2 of the death certificate • A death coded as ICD-10 code J45-46

  12. Methodology (2) • Our definition of ‘asthma death’ (for the purposes of this project) • Patients suspected/confirmed of dying from asthma • Inclusion criteria • Any person who died from asthma as per case definition • Age range: all ages • Between 1st February 2012 – 31st January 2013

  13. Methodology (3) • Phase 1 (b) Confirmation of asthma death • This may require direct contact by clinical lead or local steering/working group member with patient’s clinician if necessary • Criteria for defining an ‘asthma death’ to be agreed

  14. Methodology (4) • 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 • Collect additional informationon all confirmed deaths from asthma (items TBA)

  15. Methodology (3) • Phase 3 - In-depth multidisciplinary confidential enquiry panelson all confirmed asthma deaths

  16. Confidential Enquiry Panels (1) • Panels, formed of practicing clinicians and health care professionals, carry out a review of the case notes to: • Assess where, how and why standards of care may not have been met and what the potential impact may be • Draw out environmental, social, clinical care and management issues • Identify preventable and avoidable factors • Highlight good practice.

  17. Confidential Enquiry Panels (2) • Review all confirmed asthma deaths (est n=800-1000) • 10 England regions + 3 Devolved Nations • ~10 panel members per meeting (GPs, Respiratory Physicians, Asthma nurses etc) • 2-4 cases per panel member

  18. Proposed timeline

  19. Section 251 & Ethics Approval • By November 2011 - • Application to NIGB for Section 251 approval to collect patient identifiable information without consent (England/Wales) • Application to Privacy Advisory Committee & Caldicott Guardians (Scotland/Northern Ireland) – by November 2011 • By January 2012 - • Application for ethics approval to interview a sample of families • Develop methodology • Develop semi structured interview schedule • Develop family information sheets

  20. Project organisational structure • Commissioners • Healthcare Quality Improvement Partnership (HQIP) • RCP project management team • Rosie Houston, Mark L Levy & project co-ordinator (TBA) • Working/implementation group • Meet monthly - Asthma UK, BTS, NCEPOD RCP, RCPCH, RCGP/PCRS, BSACI • Involving families and community contacts working group • Meet 3-4 times per year • Steering group • Meet 3-4 times per year - wider multidisciplinary group • Stakeholders

  21. Reporting & Dissemination Plan • Quarterly bulletins • A summary of data against agreed set of 5-10 key indicators will be provided to the Steering Group members • Implementation/ideas • With SG and College Implementation Groups • Interim report on themes from both phases • Final report & papers

  22. For further information please visit: www.rcplondon.ac.uk/nrad Or contact us: Rosie Houston Programme Manager rosie.houston@rcplondon.ac.uk +44 (0) 20 3075 1500 or 1522 Mark L Levy Clinical Lead, NRAD marklevy@animalswild.com +44 (0) 20 3075 1500 or 1522

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