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Risk Stratification

National Services for Health Improvement (NSHI) Ltd are an independent service provider committed to delivering both in-practice and remote health care services that make a real difference to patients.

Risk Stratification
  • According to Asthma UK there are approximately 5.4 million people currently receiving treatment for asthma, which consists of 1.1 million children (1 in 11) and 4.3 million adults (1 in 12).
  • The NHS spends approximately £1 billion a year in treating and caring for people with this condition.
  • However, despite our growing knowledge of how to manage asthma effectively and the availability of BTS/SIGN guidelines since 1990, outcomes for patients remains highly variable with a worrying increase in both non-elective hospital admissions and deaths. According to the National Report on Asthma Deaths (NRAD), in 2014, 46% of asthma deaths were identified as being avoidable if the appropriate guidelines were followed.
  • Recommendations from major asthma audits haven’t changed in 50 years.

The Office for National Statistics (ONS) reported on Wednesday 18 July 2018, that asthma deaths had increased by more than 25% in the last decade. “It is shocking to see that asthma deaths in England and Wales are the highest they have been this century, with a worrying trend upwards since 2009″.

NHS requirements to change the status quo
  • Proactive ‘risk stratification’
  • Effective guideline implementation
  • Increase patient compliance with ‘inhaled therapy’
  • ‘Do we have uncontrolled asthma or uncontrolled compliance?’.

In collaboration with Bedfordshire CCG, NSHI’s Respiratory Audit Tool, was utilised in a patient Identification and risk stratification study as GP computer systems used in primary care currently do not have the functionally, without the need for manual audit, to implement the NRAD recommendations, starting with the identification of patients at risk.

This audit demonstrated, within one CCG, the feasibility of identifying patients at risk of preventable asthma attacks in 50 general practices caring for nearly 30,000 people with asthma, and the considerable variation in care of patients.

Levy, Mark L., et al. “A review of asthma care in 50 general practices in Bedfordshire, United Kingdom.” NPJ primary care respiratory medicine 28.1 (2018): 29.

Our work appeared in the NHS White Paper, Respiratory Medicine (GIRFT Report), as a case study on page 65.