Impact of the CAPTURE Chronic Obstructive Pulmonary Disease Screening Tool in U.S. Primary Care: A Cluster-Randomized Trial

Abstract

Rationale: The impact of screening for chronic obstructive pulmonary disease (COPD) on U.S. primary care clinician behavior and patient outcomes is unclear. Objectives: We sought to assess the impact of receiving screening scores for clinical and patient outcomes using the COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) tool. Methods: This cluster-randomized trial included 49 usual-care (COPD education only) and 51 intervention (COPD and CAPTURE education plus screening scores) primary care practices. Twelve-month medical record and patient survey outcome data were collected from patients with elevated screening scores or study spirometric abnormalities. Measurements and Main Results: Among 387 CAPTURE screen-positive (CAPTURE+) patients, no significant difference was noted between usual-care and intervention practices in the primary composite outcomes of 1) spirometry referral/completion, or 2) new COPD diagnosis, or 3) newly prescribed inhaled long-acting respiratory medication, or 4) referral to a respiratory specialist, or 5) pulmonary rehabilitation referral/completion; 45.9% versus 41.9%, respectively (absolute difference, 4.0%; 95% confidence interval, -6.9, 15.0; P = 0.47). Only spirometry referral/completion was higher in the intervention group (absolute difference, 10.4%; 95% confidence interval, 0.1, 20.7; P = 0.0465). No differences were noted for secondary outcomes, composite components, change in COPD Assessment Test scores, rates of respiratory illnesses, or hospitalizations. For the 1,028 CAPTURE screen-negative (CAPTURE-) patients, composite primary and all secondary outcomes were similar in the two arms. In secondary and post hoc analyses evaluating the potential impact of the pandemic, intervention group differences in clinician and patient outcomes were noted for CAPTURE+ and CAPTURE- patients in the prepandemic period that diminished during the pandemic. Conclusions: Within these U.S. primary care practices, COPD and CAPTURE education plus receipt of CAPTURE screening scores did not change clinician COPD assessment or care or patient outcomes for CAPTURE+ patients. However, in the prepandemic period, CAPTURE+ patients were more likely to undergo spirometry referral completion, whereas for CAPTURE- patients, clinicians were significantly less likely to assess for COPD, suggesting that the intervention resulted in a more appropriate use of healthcare resources. Clinical trial registered with www.clinicaltrials.gov (NCT03581227).

Keywords: COPD; COPD screening; primary care; randomized controlled trial.