Chest
SPECIAL FEATURECOPD Performance Measures: Missing Opportunities for Improving Care
Section snippets
Application of Performance Measures
Performance measures underlie nearly all of the existing and emerging international paradigms for improving health-care quality, which include public reporting of providers' health-care outcomes, maintenance of physicians' specialty board certification,15 health-care facility accreditation, and value-based reimbursement. In the United States, physician performance measures inform hospital credentialing and privileging and may in the future determine maintenance of medical licensure16 and
Performance Measures for COPD
Considering the global impact of COPD and widening public interest in developing disease-specific performance measures to improve health care, measures of COPD care would seem likely to have received considerable attention. Paradoxically, relatively few existing performance measures pertain to COPD compared with other conditions that are listed in US measure repositories, and those COPD measures that do exist remain largely unimplemented. In the United Kingdom, NHS and NICE represent a model of
Implications for Pulmonary Physicians
The paucity of COPD measures has negative implications for patients. Performance measures are essential elements in pay-for-reimbursement programs, and both the IOM and NHS have called for more performance-sensitive payment programs to improve quality and clinical efficiency.12, 39 Absent COPD measures, resources may divert to non-COPD conditions that are assessed by measures but have less societal impact. Also, evidence suggests that performance measures may improve health care. Measures may
Role of Respiratory Professional Societies in Performance Measurement
Despite shortcomings, performance measures will be central to worldwide health-care reform. Performance measurement, however, remains an immature science; respiratory professional societies can contribute to the maturation of this science using COPD as a case example. The American College of Chest Physicians has demonstrated interest in influencing the development of these measures.47 Considering the many practice recommendations for patients with COPD proposed by existing COPD clinical
Conclusions
Respiratory societies have begun to expand their interests beyond guideline generation into ensuring that recommendations are translated into the implementation of best practices.24 Performance measures are an important tool in this process. COPD represents an important target condition for fostering measures to improve care and also for developing translational research to improve the effectiveness of the measures themselves. Skepticism should remain regarding the effectiveness of existing
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Calverley has received consulting fees from Altana, AstraZeneca, Boehringer-Ingelheim, and GlaxoSmithKline; speaking fees from Altana, AstraZeneca, Boehringer-Ingelheim, and GlaxoSmithKline; and grant support from Boehringer-Ingelheim, and GlaxoSmithKline. Drs Heffner and Mularski have reported no conflicts.
Other contributions: We thank A. Sonia Buist, MD, for valuable comments.
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