The purpose of this pilot study was to (1) understand the attitudes, knowledge, and beliefs of internists who manage patients with chronic obstructive pulmonary disease (COPD) and (2) evaluate the impact of a multifaceted approach to quality improvement (QI) work involving the management of COPD patients. This pilot study used a pre-post intervention design. The intervention included an online educational toolkit, QI coaching calls led by faculty, and the use of individual physician feedback reports to act as motivators for change. Data were collected using a practice pattern survey and a chart abstraction tool to identify discrepancies between perceived and actual care. Results from the pilot study showed a statistically significant improvement in quality indicators postintervention, suggesting a causal relationship with the multifaceted intervention. Discrepancies were identified between perceived and actual care in the areas of spirometry, pulse oximetry (exertion and resting), influenza and pneumococcal vaccinations, peak flow assessment, and inhaler use instruction.
Murray C., Lopez A.Alternative projections of mortality and disability by cause. Lancet. 1997;349:1498-1504.
2.
The National Heart and Lung and Blood Institute.Data Fact Sheet: Chronic Obstructive Pulmonary Disease . Bethesda, MD: National Heart, Lung, and Blood Institute; 2003. Report No.: 0-52993.
3.
The National Heart, Lung and Blood Institute.2004 NHLBI Morbidity and Mortality Chartbook. Bethesda, MD: National Heart, Lung, and Blood Institute ; 2004.
4.
Andersson F. , Borg S., Jansson SA, et al. The costs of exacerbations in chronic obstructive pulmonary disease (COPD). Respir Med. 2002;96:700-708.
5.
O’Reilly J., Williams A., Rice L.Health status impairment and costs associated with COPD exacerbation managed in hospital. Int J Clin Pract . 2007;61:1112-1120.
Calverley PMCOPD: early detection and intervention. Chest. 2000;117:365S-371S.
8.
Pauwels RA, Rabe KFBurden and clinical features of chronic obstructive pulmonary disease (COPD) . Lancet. 2004;364:613-620.
9.
Starfield B., Lemke KW, Bernhardt T., Foldes SS, Forrest CB, Weiner JPComorbidity: implications for the importance of primary care in "case" management . Ann Fam Med. 2003;1: 8-14.
10.
Yawn BP, Wollan PCKnowledge and attitudes of family physicians coming to COPD continuing medical education. Int J Chron Obstruct Pulmon Dis. 2008;3:311-317.
11.
Ferguson GT, Enright PL, Buist S., Higgins MWOffice spirometry for lung health assessment in adults: a consensus statement from the National Lung Health Education Program. Chest. 2000;117:1146-1161.
12.
Grol R.Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care. 2001;39(8):46-54.
13.
A US study reports similar deficits in care delivery to the UK COPD audits. Respir Med. 2007;3:75.
14.
Wyrwich K., Metz S., Kroenke K., Tierney W., Babu A., Wolinsky F.Measuring patient and clinician perspectives to evaluate change in health-related quality of life among patients with chronic obstructive pulmonary disease . J Gen Intern Med. 2007;22:161-170.
15.
McGlynn E.There is no perfect health system. Health Aff. 2004;23:100-102.
16.
Beasley JW, Hankey TH, Erickson R., et al. How many problems do family physicians manage at each encounter? A WReN study. Ann Fam Med. 2004;2:405-410.
17.
stbye T., Yarnall K., Krause K., Pollak KI, Gradison M., Michener JLIs there time for management of patients with chronic diseases in primary care?Ann Fam Med.2005;3: 209-214.
18.
Foster J., Yawn B., Maziar A., Jenkins T., Rennard SI, Casebeer L.Enhancing COPD management in primary care settings. MedGenMed . 2007;9(3):24.
19.
Dewan NA, Rafique S., Kanwar B., Satpat H.Acute exacerbation of COPD: factors associated with poor treatment outcome . Chest.2000;117:662-671.
20.
Chavannes N. , Schermer T., Akkermans R., et al. Impact of spirometry on GP’s diagnostic differentiation and decision-making. Respir Med . 2004;98:1124-1130.
21.
Halm EA, Lee C., Chassin MRIs volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med. 2002;137: 511-520.
22.
Lohr KN, ed. Medicare: A Strategy for Quality Assurance. Washington, DC: National Academies Press; 1990.
23.
Blumenthal D.Part 1: Quality of care: what is it? N Engl J Med. 1996;335:891-894.
24.
Bodenheimer T., Wagner E., Grumbach K.Improving primary care for patients with chronic illness: The Chronic Care Model, Part 2. JAMA. 2002;288:1909-1914.
25.
Olivarius NF , Beck-Nielsen H., Andreasen AHRandomized controlled trial of structured personal care of type 2 diabetes mellitus. BMJ. 2001;323:970-975.
26.
Kahn L., Fox C., Olawaiye A., Servoss T., McLean-Plunkett E.Facilitating quality improvement in physician management of comorbid chronic disease in an urban minority practice. J Natl Med Assoc. 2007;99:377-383.
27.
Weidinger P. , Nilsson JL, Lindblad U.Adherence to diagnostic guidelines and quality indicators in asthma and COPD in Swedish primary care. Pharmacoepidemiol Drug Saf. 2009;18:393-400.
28.
Deprez R., Kinner A., Millard P., Baggott L., Mellett J., Loo JLImproving quality of care for patients with chronic obstructive pulmonary disease. Popul Health Manag. 2009; 12:209-215.
29.
Qaseem A., Snow V., Shekelle P., et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians . Ann Intern Med. 2007;147:633-638.
