Quality of COPD care in hospital outpatient clinics in Denmark: The KOLIBRI study

SummaryBackgroundWe studied the quality of care for COPD patients in 22 hospital-based outpatient clinics in Denmark and evaluated if participation by the staff in an educational programme could improve the quality of care and adherence to the COPD guidelines.MethodsWe performed two audits of the hospital records one year apart before and after the educational programme for the participating doctors and nurses. A total of 941 patient records were included in the first audit and 927 in the second. The indicators of quality of care comprised amongst others referral to pulmonary rehabilitation, smoking cessation advice, nutritional advice, instruction in inhalation technique and assessment of BMI, smoking status, pack years, lung function parameters, dyspnoea oxygen saturation and co-morbidities.ResultsIn general, the quality of care for COPD patients in Denmark was suboptimal and not in accordance with the recently published guidelines both in the 1st and the 2nd audit. Yet, we observed a substantial improvement from the 1st to the 2nd audit. For example, referral to rehabilitation improved from 56.3 to 62.7% (p = 0.006) Assessment of BMI improved from 7.8 to 56.1% and assessment of dyspnoea using MRC dyspnoea scale increased from 7.2 to 47.2% (both p < 0.001). When analysing the results with focus on the performance of the individual outpatient clinics we also observed an improvement in the quality.ConclusionWe conclude that it is possible to improve the quality of care for COPD by focusing on a more systematic approach to the patient assessment by education of the staff of the outpatient clinics. A repeated and continuous education and discussion with the clinical staff is probably essential to reach an acceptable level of the quality of care for outpatients with COPD.