TY - JOUR

T1 - Improving Quality of Care among COPD outpatients in Denmark 2008-2011

AU - Tøttenborg, Sandra Søgaard

AU - Thomsen, Reimar W.

AU - Nielsen, Henrik

AU - Johnsen, Søren Paaske

AU - Hansen, Ejvind Frausing

AU - Lange, Peter

PY - 2013/10

Y1 - 2013/10

N2 - OBJECTIVE: To examine whether the quality of care among Danish patients with chronic obstructive pulmonary disease (COPD) has improved since the initiation of a national multidisciplinary quality improvement program.METHODS:We conducted a nationwide, population-based prospective cohort study using data from the Danish Clinical Register of COPD (DrCOPD). Since 2008 the register has systematically monitored and audited the use of recommended processes of COPD care.RESULTS:Substantial improvements were observed for all processes of care and registration fulfillment increased to well above 85% for all indicators. Compared to 2008, a higher proportion of COPD outpatients in 2011 received annual measurements of the forced expiratory volume in one second in percent of predicted (FEV1% predicted) (RR 2.14, 95% CI, 2.09; 2.19), assessment of BMI (RR 2.24, 95% CI, 2.19; 2.29), assessment of dyspnea using the Medical Research Council (MRC) scale (RR 2.25, 95% CI, 2.20; 2.31), registration of smoking status (RR 2.41, 95% CI, 2.35; 2.47), smoking cessation recommendation (RR 3.40, 95% CI, 3.18; 3.64) and offering of pulmonary rehabilitation (RR 2.78, 95% CI, 2.65; 2.90). Moderate variation in quality of care fulfillment between regions and hospital clinics still existed in 2011. The proportion of patients with mild- to moderate COPD increased during the study period (p<0.0001).CONCLUSION:Based on increased registration practice of important processes of care, the present study indicates a substantial improvement in the quality of care of COPD in Danish hospitals following the initiation of a national multidisciplinary quality improvement program in 2008. In the forthcoming years, it will be interesting to observe if this will translate into a better prognosis of Danish patients with COPD.

AB - OBJECTIVE: To examine whether the quality of care among Danish patients with chronic obstructive pulmonary disease (COPD) has improved since the initiation of a national multidisciplinary quality improvement program.METHODS:We conducted a nationwide, population-based prospective cohort study using data from the Danish Clinical Register of COPD (DrCOPD). Since 2008 the register has systematically monitored and audited the use of recommended processes of COPD care.RESULTS:Substantial improvements were observed for all processes of care and registration fulfillment increased to well above 85% for all indicators. Compared to 2008, a higher proportion of COPD outpatients in 2011 received annual measurements of the forced expiratory volume in one second in percent of predicted (FEV1% predicted) (RR 2.14, 95% CI, 2.09; 2.19), assessment of BMI (RR 2.24, 95% CI, 2.19; 2.29), assessment of dyspnea using the Medical Research Council (MRC) scale (RR 2.25, 95% CI, 2.20; 2.31), registration of smoking status (RR 2.41, 95% CI, 2.35; 2.47), smoking cessation recommendation (RR 3.40, 95% CI, 3.18; 3.64) and offering of pulmonary rehabilitation (RR 2.78, 95% CI, 2.65; 2.90). Moderate variation in quality of care fulfillment between regions and hospital clinics still existed in 2011. The proportion of patients with mild- to moderate COPD increased during the study period (p<0.0001).CONCLUSION:Based on increased registration practice of important processes of care, the present study indicates a substantial improvement in the quality of care of COPD in Danish hospitals following the initiation of a national multidisciplinary quality improvement program in 2008. In the forthcoming years, it will be interesting to observe if this will translate into a better prognosis of Danish patients with COPD.

KW - Faculty of Health and Medical Sciences

U2 - 10.1111/crj.12009

DO - 10.1111/crj.12009

M3 - Journal article

C2 - 23163961

JO - Clinical Respiratory Journal

JF - Clinical Respiratory Journal

SN - 1752-6981

ER -