Identifier to cite or link to this item: http://hdl.handle.net/20.500.13003/15502
Community Assessment of COPD Health Care (COACH) study: a clinical audit on primary care performance variability in COPD care
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ISSN: 1471-2288
WOS ID: 000437296000002
Scopus EID: 2-s2.0-85049489702
PMID: 29970023
Embase PUI: L626306514
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Abad-Arranz, Maria; Moran-Rodriguez, Ana; Mascaros Balaguer, Enrique; Quintana Velasco, Carmen; Abad Polo, Laura; Nunez Palomo, Sara; Gonzalvez Rey, Jaime; Fernandez Vargas, Ana Maria; Hidalgo Requena, Antonio; Helguera Quevedo, Jose Manuel; Garcia Pardo, Marina

Publication date
2018-07-03Document type
research articleCitation
Abad-Arranz M, Moran-Rodriguez A, Mascaros Balaguer E, Quintana Velasco C, Abad Polo L, Nunez Palomo S, et al. Community Assessment of COPD Health Care (COACH) study: a clinical audit on primary care performance variability in COPD care. BMC Med Res Methodol. 2018 Jul 03;18:68.Abstract
Background: A thorough evaluation of the adequacy of clinical practice in a designated health care setting and temporal context is key for clinical care improvement. This study aimed to perform a clinical audit of primary care to evaluate clinical care delivered to patients with COPD in routine clinical practice. Methods: The Community Assessment of COPD Health Care (COACH) study was an observational, multicenter, nationwide, non-interventional, retrospective, clinical audit of randomly selected primary care centers in Spain. Two different databases were built: the resources and organization database and the clinical database. From January 1, 2015 to December 31, 2016 consecutive clinical cases of COPD in each participating primary care center (PCC) were audited. For descriptive purposes, we collected data regarding the age at diagnosis of COPD and the age at audit, gender, the setting of the PCC (rural/urban), and comorbidities for each patient. Two guidelines widely and uniformly used in Spain were carefully reviewed to establish a benchmark of adequacy for the audited cases. Clinical performance was analyzed at the patient center, and regional levels. The degree of adequacy was categorized as excellent (> 80%), good (6080%), adequate (40-59%), inadequate (20-39%), and highly inadequate (<20%). Results: During the study 4307 cases from 63 primary care centers in 6 regions of the country were audited. Most evaluated parameters were judged to fall in the inadequate performance category. A correct diagnosis based on previous exposure plus spirometric obstruction was made in an average of 17.6% of cases, ranging from 9.8 to 23.3% depending on the region. During the audited visit, only 67 (1.6%) patients had current post-bronchodilator obstructive spirometry; 184 (4.3%) patients had current post-bronchodilator obstructive spirometry during either the audited or initial diagnostic visit. Evaluation of dyspnea was performed in 11.1% of cases. Regarding treatment, 33.6% received no maintenance inhaled therapies (ranging from 31.3% in GOLD A to 7.0% in GOLD D). The two most frequently registered items were exacerbations in the previous year (81.4%) and influenza vaccination (87.7%). Conclusions: The results of this audit revealed a large variability in clinical performance across centers, which was not fully attributable to the severity of the disease.
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https://dx.doi.org/10.1186/s12874-018-0528-4MeSH
Aged, 80 and overAged
Clinical Audit
Spain
Pulmonary Disease, Chronic Obstructive
Humans
Observational Studies as Topic
Middle Aged
Male
Female
Multicenter Studies as Topic
Primary Health Care
Spirometry
Guideline Adherence
Retrospective Studies
DeCS
EspirometríaEstudios Multicéntricos como Asunto
Femenino
Estudios Observacionales como Asunto
Masculino
Enfermedad Pulmonar Obstructiva Crónica
Humanos
Persona de Mediana Edad
Auditoría Clínica
Anciano
Anciano de 80 o más Años
Atención Primaria de Salud
Estudios Retrospectivos
Adhesión a Directriz
España