Performance Measures in the Management of Chronic Obstructive Pulmonary Disease in Primary Care--A Retrospective Analysis

Abstract

Rationale: Adherence to recommendations regarding quality of care for chronic obstructive pulmonary disease (COPD) improves outcome of patients. Performance measures (PM) reflect the quality of care but information about documentation of PM in primary care, is scant.

Aim: To investigate the documentation of COPD PM in primary care practices of the Canton Zurich.

Method: Twelve months retrospective medical chart review with physician of patients diagnosed COPD. PM were assessed by calculating the percentages of documented performance parameters. In addition, PM were compared with a practice running a structured COPD program.

Results: Data from 14 practices, total 115 patients, 57% male, mean age 68 (44–93) years, 46% active smokers, median pack-years 56 (range 22–150) were analyzed. Comorbidities were documented in 73%, GOLD grading in 70% (GOLD I 11%, GOLD II 64%, GOLD III 21%, GOLD IV 4%). On average, patients were reported to have 1,4 exacerbations/year. Documentation of PM ranged between 16% (written action plan for exacerbations) and 95% (smoking status). Documentation was identified for smoking cessation advice (74%), influenza vaccination/recommendation (49%), adequate pharmacotherapy (65%), inhalation instruction (57%), pulmonary rehabilitation advice (27%), collaborative care (60%) and proactive follow up (51%). The practice running the COPD program showed significant better documentation for all PM (p<0,01) but for influenza vaccination.

Conclusion: In Swiss primary care gaps in documentation and tracking of COPD performance exist. Identifying and bridging these gaps is central for health care quality.

Keywords: COPD; Grundversorgung; Leistung; Messgrössen; Qualität; measures; mesures; performance; premier recours; primary care; quality; qualité.