Chest
Volume 137, Issue 5, May 2010, Pages 1181-1189
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SPECIAL FEATURE
COPD Performance Measures: Missing Opportunities for Improving Care

https://doi.org/10.1378/chest.09-2306Get rights and content

During the last decade, mounting evidence worldwide has heightened awareness that patients with diverse health conditions commonly do not receive recommended care despite the proliferation of clinical practice guidelines. This is a particular problem for patients with COPD, who only receive recommended care during 30% to 55% of encounters with providers. Considering that COPD is the fourth leading cause of death worldwide, failure to implement guideline-directed care represents a major concern for respiratory professional societies. For other health conditions, inadequacies of care have stimulated public and private agencies to increase provider accountability by linking the results of performance measures to various quality-improvement interventions. Despite limited evidence that these interventions improve care, widespread adoption of value-based reimbursement has occurred in the United States and United Kingdom, and the prominence of these strategies in health-care reform suggest future growth and the likely proliferation of the performance measures upon which they are based. Of note, relatively few performance measures exist for COPD as compared with other conditions that have less impact on global health. The lack of COPD measures diminishes public awareness of COPD, allows diversion of quality improvement resources toward other conditions with existing measures, and negatively impacts COPD care. Respiratory professional societies can play an important role in stimulating the development of valid COPD measures derived from COPD practice guidelines and coordinate future measures to avoid burdensome reporting requirements for physicians if COPD measures are developed by competing payers and agencies in a fragmented or non-patient-centered manner.

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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