Quality indicators for the care of chronic obstructive pulmonary disease in vulnerable elders

A practice test and selection of a core set of outcome-based quality indicators in Dutch primary care physical therapy for patients with COPD: a cohort study

Aim

To estimate the comparability and discriminability of outcome-based quality indicators by performing a practice test in Dutch physical therapy primary care, and to select a core set of outcome-based quality indicators that are well accepted by physical therapists based on their perceived added value as a quality improvement tool.

Methods

First, a list of potential quality indicators was defined, followed by determination of the comparability (case-mix adjusted multilevel analysis) and discriminability (intraclass correlation coefficient (ICC)). Second, focus group meetings were conducted with stakeholders (physical therapists and senior researchers) to select a core set of quality indicators.

Results

Overall, 229 physical therapists from 137 practices provided 2651 treatment episodes. Comparability: in 10 of the 11 case-mix adjusted models, the ICC increased compared with the intercept-only model. Discriminability: the ICC ranged between 0.01 and 0.34, with five of the 11 ICCs being >0.10. The majority of physical therapists in each focus group preferred the inclusion of seven quality indicators in the core set, including three process and four outcome indicators based upon the 6-min walk test (6MWT), the Clinical COPD Questionnaire (CCQ), and the determination of quadriceps strength using a hand-held dynamometer.

Conclusion

This is the first study to describe the comparability and discriminability of the outcome-based quality indicators selected for patients with COPD treated in primary care physical therapy practices. Future research should focus on increasing data collection in daily practice and on the development of tangible methods to use as the core set of a quality improvement tool.

The major finding of this study is that all participants in the focus groups accepted the quality indicators as a quality improvement tool based on their perceived added value and selected a core set of seven outcome-based quality indicators for COPD.https://bit.ly/3NJuQtq

Development of primary care quality indicators for chronic obstructive pulmonary disease using a Delphi-derived method

High-quality care for patients with COPD is necessary. To achieve quality improvement in primary care, the general practitioner and the electronic health record (EHR) play an important role. The aim of this study was to develop a set of evidence-based and EHR extractable quality indicators (QIs) to measure and improve the quality of COPD primary care. We composed a multidisciplinary expert panel of 12 members, including patients, and used a RAND-modified Delphi method. The SMART principle was applied to select recommendations and QIs from international guidelines as well as existing sets of QIs, and these recommendations and QIs were added to an individual written questionnaire. Based on the median score, prioritization and degree of agreement, the recommendations and QIs were rated as having a high, uncertain or low potential to measure the quality of COPD primary care and were then discussed in an online consensus meeting for inclusion or exclusion. After a final validation, a core set of recommendations was translated into QIs. From 37 recommendations, obtained out of 10 international guidelines, and 5 existing indicators, a core set of 18 recommendations and 2 QIs was derived after the rating procedure. The expert panel added one new recommendation. Together, the recommendations and QIs were translated and merged into a final set of 21 QIs. Our study developed a set of 21 evidence-based and EHR-extractable QIs for COPD in primary care. These indicators can be used in an automated quality assessment to measure and improve the quality of COPD primary care.

Handgrip strength measurement as a predictor for successful dry powder inhaler treatment: application in older individuals with COPD

BACKGROUND

More than 10% of elderly people suffer from chronic obstructive pulmonary disease (COPD). Drug treatment for COPD involves inhalants. Dry powder inhalers (DPIs) have proven easiest for the elderly to use. Their effectiveness is dependent, however, on the inspiratory flow which can be generated, and it is unclear which geriatric assessment parameter permits inspiratory flow to be assessed.

METHODS

In a randomly generated group of geriatric hospital patients, manual strength was measured as a complement to basic geriatric assessment and inspiratory flow assessed using a Turbohaler trainer.

RESULTS

A total of 87 (27%) men (mean age 81 ± 7 years) and 231 (73%) women (mean age 82 ± 8 years) were included in the study. The threshold value of 40 l/min for minimum inspiratory flow was achieved by 194 (61%) of the patients. Manual strength was the only assessment parameter to correlate with the minimum inspiratory flow achieved. ROC analysis produced a threshold value for manual strength of 10 kg. The sensitivity and specificity for this threshold value were 70% each, while the positive and negative predictive values were 79% and 84%, respectively.

CONCLUSION

A threshold value of 10 kg for manual strength enables the inspiratory flow achievable by elderly patients to be predicted satisfactorily. This is the only parameter which correlates sufficiently with inspiratory flow. Manual strength should be measured in all geriatric patients with COPD and should be taken into account when deciding whether or not to initiate differential treatment.

Bibliography. Current world literature

This bibliography is compiled by clinicians from the journals listed at the end of this publication. It is based on literature entered into our database between 1 November 2007 and 31 October 2008 (articles are generally added to the database about two and a half months after publication). In addition, the bibliography contains every paper annotated by reviewers; these references were obtained from a variety of bibliographic databases and published between the beginning of the review period and the time of going to press. The bibliography has been grouped into topics that relate to the reviews in this issue.