Clinical decision support system to enhance quality control of spirometry using information and communication technologies

Felip Burgos, Umberto Melia, Montserrat Vallverdú, Filip Velickovski, Magí Lluch-Ariet, Pere Caminal, Josep Roca, Felip Burgos, Umberto Melia, Montserrat Vallverdú, Filip Velickovski, Magí Lluch-Ariet, Pere Caminal, Josep Roca

Abstract

Background: We recently demonstrated that quality of spirometry in primary care could markedly improve with remote offline support from specialized professionals. It is hypothesized that implementation of automatic online assessment of quality of spirometry using information and communication technologies may significantly enhance the potential for extensive deployment of a high quality spirometry program in integrated care settings.

Objective: The objective of the study was to elaborate and validate a Clinical Decision Support System (CDSS) for automatic online quality assessment of spirometry.

Methods: The CDSS was done through a three step process including: (1) identification of optimal sampling frequency; (2) iterations to build-up an initial version using the 24 standard spirometry curves recommended by the American Thoracic Society; and (3) iterations to refine the CDSS using 270 curves from 90 patients. In each of these steps the results were checked against one expert. Finally, 778 spirometry curves from 291 patients were analyzed for validation purposes.

Results: The CDSS generated appropriate online classification and certification in 685/778 (88.1%) of spirometry testing, with 96% sensitivity and 95% specificity.

Conclusions: Consequently, only 93/778 (11.9%) of spirometry testing required offline remote classification by an expert, indicating a potential positive role of the CDSS in the deployment of a high quality spirometry program in an integrated care setting.

Keywords: information communication technologies; primary care; quality control; spirometry; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow of the process followed to elaborate and validate the Clinical Decision Support System (CDSS). ATS=American Thoracic Society; FS=forced spirometry.
Figure 2
Figure 2
Equations for data analysis. F=flow; V=volume; i=1,…,N; N=length of the sequence; true positive (TP) corresponds to curves classified as grade 0 by both CDSS and the evaluator; true negative (TN) corresponds to curves classified as grade 1 by the CDSS and the by the evaluator; false positive (FP) indicates curves classified as grade 0 by the CDSS, but classified in grade 1 by the evaluator; and, false negative (FN) corresponds to curves classified as grade 1 by the CDSS, but as grade 0 by the evaluator.

References

    1. Celli BR. The importance of spirometry in COPD and asthma: Effect on approach to management. Chest. 2000 Feb;117(2 Suppl):15S–19S.
    1. Burgos F, Disdier C, de Santamaria EL, Galdiz B, Roger N, Rivera ML, Hervàs R, Durán-Tauleria E, Garcia-Aymerich J, Roca J, e-Spir@p Group Telemedicine enhances quality of forced spirometry in primary care. Eur Respir J. 2012 Jun;39(6):1313–1318. doi: 10.1183/09031936.00168010.
    1. Castillo D, Burgos F, Giner J, Estrada M, Soriano JB, Flor X. Arch Bronconeumologia. 2011. [2014-10-03]. Cribado de EPOC: nuevas herramientas y circuitos sanitarios. Resultados preliminares del Farmaepoc II. (FARMAEPOC) .
    1. Eustat - population and housing census in Euskadi. 2011. [2014-09-11]. .
    1. Marina Malanda N. Agencia de Evaluación de Tecnologías Sanitarias del País Vasco. Informes de evaluación de tecnologías sanitarias: OSTEBA Nº; 2012. [2014-09-25].
    1. Marina Malanda N, López de Santa María E, Gutiérrez A, Bayón Jc, Garcia L, Gáldiz Jb. Telemedicine spirometry training and quality assurance program in primary care centers of a public health system. Telemed J E Health. 2014 Apr;20(4):388–392. doi: 10.1089/tmj.2013.0111.
    1. Salas T, Rubies C, Gallego C, Muñoz P, Burgos F, Escarrabill J. Technical requirements of spirometers in the strategy for guaranteeing the access to quality spirometry. Arch Bronconeumol. 2011 Sep;47(9):466–469. doi: 10.1016/j.arbres.2011.06.005.
    1. Tresserras R, en nombre del Grupo de Trabajo de Planes Directores Planning driven by health priorities. Master planning criteria. Med Clin (Barc) 2008 Dec;131 Suppl 4:42–46.
    1. ATS Am Rev Respir Dis. 1979. May, [2014-09-25]. ATS statement--snowbird workshop on standardization of spirometry .
    1. Am Rev Respir Dis. 1987. Nov, [2014-09-25]. Standardization of spirometry: A summary of recommendations from the American Thoracic Society: The 1987 update .
    1. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten Cp, Gustafsson P, Jensen R, Johnson Dc, MacIntyre N, McKay R, Navajas D, Pedersen Of, Pellegrino R, Viegi G, Wanger J, ATS/ERS Task Force Standardisation of spirometry. Eur Respir J. 2005 Aug;26(2):319–338. doi: 10.1183/09031936.05.00034805.
    1. Müller-Brandes C, Krämer U, Gappa M, Seitner-Sorge G, Hüls A, von Berg A, Hoffmann B, Schuster A, Illi S, Wisbauer M, Berdel D. LUNOKID: Can numerical American Thoracic Society/European Respiratory Society quality criteria replace visual inspection of spirometry? Eur Respir J. 2014 May;43(5):1347–1356. doi: 10.1183/09031936.00058813.
    1. Masa JF, González Mt, Pereira R, Mota M, Riesco JA, Corral J, Zamorano J, Rubio M, Teran J, Farré R. Validity of spirometry performed online. Eur Respir J. 2011 Apr;37(4):911–918. doi: 10.1183/09031936.00011510.
    1. Bellia V, Pistelli R, Catalano F, Antonelli-Incalzi R, Grassi V, Melillo G, Olivieri D, Rengo F. Quality control of spirometry in the elderly. The SA.R.A. study. Salute respiration nell'Anziano = Respiratory health in the elderly. Am J Respir Crit Care Med. 2000 Apr;161(4 Pt 1):1094–1100. doi: 10.1164/ajrccm.161.4.9810093.
    1. Spirometry monitoring technology - SPIROLA Centers for Disease Control and Prevention. [2014-10-02]. NIOSH - Spirometry in occupational medicine .
    1. Montes de Oca M, Tálamo C, Perez-Padilla R, Jardim JR, Muiño A, Lopez MV, Valdivia G, Pertuzé J, Moreno D, Halbert Rj, Menezes Am, PLATINO Team Chronic obstructive pulmonary disease and body mass index in five Latin America cities: The platino study. Respir Med. 2008 May;102(5):642–650. doi: 10.1016/j.rmed.2007.12.025.
    1. Pérez-Padilla R, Vázquez-García Jc, Márquez Mn, Menezes AM, PLATINO Group Spirometry quality-control strategies in a multinational study of the prevalence of chronic obstructive pulmonary disease. Respir Care. 2008 Aug;53(8):1019–1026.
    1. Janssens W, Liu Y, Liu D, Kesten S, Tashkin DP, Celli BR, Decramer M. Quality and reproducibility of spirometry in COPD patients in a randomized trial (UPLIFT®) Respir Med. 2013 Sep;107(9):1409–1416. doi: 10.1016/j.rmed.2013.04.015.
    1. Enright PL. How to make sure your spirometry tests are of good quality. Respir Care. 2003 Aug;48(8):773–776.
    1. Enright PL, Skloot GS, Cox-Ganser JM, Udasin IG, Herbert R. Quality of spirometry performed by 13,599 participants in the World Trade Center Worker and Volunteer Medical Screening Program. Respir Care. 2010 Mar;55(3):303–309.
    1. Steenbruggen I, Mitchell S, Severin T, Palange P, Cooper BG, Spirometry HERMES Task Force Harmonising spirometry education with HERMES: Training a new generation of qualified spirometry practitioners across Europe. Eur Respir J. 2011 Mar;37(3):479–481. doi: 10.1183/09031936.00187810.
    1. Escarrabill J, Roger N, Burgos N, Giner J, Molins A, Tresserras R. Diseño de un programa de formación básico para conseguir espirometrías de calidad. Educ. méd. 2012 Jun;15(2):103–107. doi: 10.4321/S1575-18132012000200008.
    1. Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten Cp, Gustafsson P, Jensen R, Johnson Dc, MacIntyre N, McKay R, Navajas D, Pedersen Of, Pellegrino R, Viegi G, Wanger J, ATS/ERS Task Force General considerations for lung function testing. Eur Respir J. 2005 Jul;26(1):153–161. doi: 10.1183/09031936.05.00034505.
    1. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten Cp, Gustafsson P, Hankinson J, Jensen R, Johnson Dc, MacIntyre N, McKay R, Miller Mr, Navajas D, Pedersen Of, Wanger J. Interpretative strategies for lung function tests. Eur Respir J. 2005 Nov;26(5):948–968. doi: 10.1183/09031936.05.00035205.
    1. Pellegrino R, Brusasco V, Viegi G, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten Cp, Gustafsson P, Hankinson J, Jensen R, Johnson Dc, Macintyre N, McKay R, Miller Mr, Navajas D, Pedersen Of, Wanger J. Definition of COPD: Based on evidence or opinion? Eur Respir J. 2008 Mar;31(3):681–682. doi: 10.1183/09031936.00154307.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir