Transcript Clinical Risk - Definitions

Objectives of Training
• To provide you with an overview of MSD
Informatics Software.
• To provide you with sufficient training to
be able to use MSD Informatics Software
in your practice
• To answer any questions that you have
regarding MSD Informatics and our
products
Clinical Risk
• Collaboration with Sandwell PCT & University of
Birmingham
• Produces stratified list of all patients with real or
probable >20% CVD risk over ten years
• CVD Screening Ranking Tool: Filters patient
population – Non CVD / Non Diabetic / Non Hypertensive
– Framingham CVD calculator with additional risk for
FH and ethnicity; unknown data substituted using
‘look up’ tables (Health Survey for England 2003)
Clinical Risk - Definitions
• CVD Risk Definition used in Clinical Risk
– The Framingham CVD Risk Calculator predicts risk
from any cardiovascular disease and uses the CHD
Framingham score based on death from CHD (sudden
or non-sudden), myocardial infarction, angina pectoris
and coronary insufficiency and additionally includes
stroke, transient ischemia, heart failure and peripheral
vascular disease.
– This algorithm tends to be higher than those used by
JBS2 especially if they are not factoring in Family
History and Ethnicity.
Clinical Risk - Definitions
• Excluded Patient Groups
– The following patients should not have their risk
calculated as they are already considered to be at high
enough risk to justify lifestyle and other interventions
(antithrombotic, antihypertensive and lipid lowering
therapies).
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Patients with atherosclerotic cardiovascular disease
Hypertension (≥160/100 mmHg) with target organ damage
Patients with type 1 or 2 diabetes mellitus
Renal dysfunction (including diabetic nephropathy)
Familial hypercholesterolaemia, familial combined
hyperlipidaemia or other inherited dyslipidaemia
• Patients on Lipid Lowering Therapy
Clinical Risk - Definitions
• The South Asian Male Weighting Definition
– Ethnic groups within Britain have differing risk
of coronary heart disease (CHD) and
cardiovascular disease (CVD) at the same level
of risk factors. This calculator uses the Risk
Factor accepted by draft NICE Lipid Guidelines
2007 and adjusts for ethnic groups and is
based on a re-calibration of the Framingham
risk equations.
– The Risk is increased by a factor of 1.4 for
South Asian men
Clinical Risk - Definitions
• Family History of Premature CHD
– A family history of CHD means CHD in a first degree
female relative aged under 65 or CHD in a first degree
male relative aged under 55. This means younger than
55 years in fathers, sons or brothers or younger than 65
years in mothers, daughters or sisters.
– Risk is increased by a factor of 1.5 for individuals with a
family history of premature CHD. This follows
recommendations in the draft NICE lipid guidelines of
2007.
– If a patient has BOTH a Family History and is South
Asian then assume a risk factor of 1.5
Clinical Risk - Definitions
• LVH
– Left ventricular hypertrophy (LVH) is
ascertained from a resting ECG and the
calculator will look for the presence of the
relevant Read codes.
• Smoking Status
– Smoking status reflects the exposure to
tobacco within the last 12 months. The
calculator will look for the presence of the
relevant Read codes.
Training Materials
• Clinical Risk – How
Do I?
1
View Relevant Clinical Notes?
2
Filter Patients?
3
Display Patient Lists?
4
Display Patient Demographics?
5
Display Patient Changes?
6
Display Risk Cohorts?
7
Set-up Mail Merge?
8
Export Data?
Training Materials
• Clinical Audit – How
Do I?
1
View Relevant Clinical Notes?
2
Setup Search Filters?
3
Search on Specific Words?
4
Display Patient Demographics?
5
Display Patient Changes?
6
Display Historical Trends?
7
Set-up Mail Merge?
8
Export Data?
Training Materials
• Contract Manager –
How Do I?
1
Change from Points to Rolling
Points?
2
Prioritise Patients?
3
Display Patient Lists?
4
View Historical Trends?
5
View Indicators in a Disease
Area?