An International Study of Adherence to Guidelines for Patients Hospitalised with a COPD Exacerbation

Deborah Seys, Luk Bruyneel, Marc Decramer, Cathy Lodewijckx, Massimiliano Panella, Walter Sermeus, Paulo Boto, Kris Vanhaecht

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Guideline adherence rates for the treatment of chronic obstructive pulmonary disease (COPD) exacerbation are low. The aim of this study is to perform an importance-performance analysis as an approach for prioritisation of interventions by linking guidelines adherence rates to expert consensus rates for the in-hospital management of COPD exacerbation. We illustrate the relevance of such approach by describing variation in guideline adherence across indicators and hospitals. A secondary data analysis of patients with an acute COPD exacerbation admitted to Belgian, Italian and Portuguese hospitals was performed. Twenty-one process indicators were used to describe adherence to guidelines from patient record reviews. Expert consensus on the importance for follow-up of these 21 indicators was derived from a previous Delphi study. Three of the twenty-one indicators had high level of expert consensus and a high level of adherence. Eleven of the twenty-one indicators had high level of expert consensus but a low level of adherence. For none of the 378 patients included in this study were all process indicators adhered to, patients received 41.0% of the recommended care on average, and only 34.1% of the patients received 50% or more of the care they should receive. There was also a large variation within and between hospitals regarding the care received. This study confirms the findings of previous studies, indicating that COPD exacerbations are largely undertreated. Importance-performance analysis provides a decision-making tool for prioritising indicators. All hospitals in this study would benefit from having in place a quality framework for systematic follow-up of these indicators.

Original languageEnglish
Pages (from-to)156-163
Number of pages8
JournalCOPD: Journal of Chronic Obstructive Pulmonary Disease
Volume14
Issue number2
DOIs
Publication statusPublished - 2017

Keywords

  • Adherence to guidelines
  • importance-performance analysis
  • level of performance
  • quality of care

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