Clinical audit of COPD patients requiring hospital admissions in Spain: AUDIPOC study

Francisco Pozo-Rodríguez, Jose Luis López-Campos, Carlos J Alvarez-Martínez, Ady Castro-Acosta, Ramón Agüero, Javier Hueto, Jesús Hernández-Hernández, Manuel Barrón, Victor Abraira, Anabel Forte, Juan Miguel Sanchez Nieto, Encarnación Lopez-Gabaldón, Borja G Cosío, Alvar Agustí, AUDIPOC Study Group

Abstract

Backgrounds: AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive pulmonary disease (ECOPD), assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients' characteristics, and adherence to guidelines.

Methodology/principal findings: An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible) were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0-35%). Among discharged patients, 37% required readmission (0-62%) and 6.5% died (0-35%). The overall mortality rate was 11.6% (0-50%). Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (<50%) addressed guidance on healthy life-styles.

Conclusions/significance: The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Eddy DM (1984) Variations in physician practice: the role of uncertainty. Health Aff (Millwood) 3: 74–89.
    1. Evidence-Based Medicine Working Group (1992) Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 268: 2420–2425.
    1. Flottorp SA, Jamtvedt G, Gibis B, McKee M (2010) Using audit and feedback to health professionals to improve the quality and safety of health care. Copenhagen: World Health Organization.
    1. NICE and the Healthcare Commission (2002) Principles for best practice in clinical audit. London: Radcliffe Medical Press Ltd.
    1. Mathers CD, Loncar D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3: e442.
    1. Soriano JB, Ancochea J, Miravitlles M, García-Río F, Duran-Tauleria E, et al. (2010) Recent trends in COPD prevalence in Spain: a repeated cross-sectional survey 1997–2007. Eur Respir J 36: 758–765.
    1. Donaldson GC, Wedzicha JA (2006) COPD exacerbations. 1: Epidemiology. Thorax 61: 164–168.
    1. Price LC, Lowe D, Hosker HS, Anstey K, Pearson MG, et al. (2006) UK National COPD Audit 2003: Impact of hospital resources and organisation of care on patient outcome following admission for acute COPD exacerbation. Thorax 61: 837–842.
    1. Royal College of Physicians of London; British Thoracic Society; British Lung Foundation: Report of the National Chronic Obstructive Pulmonary Disease Audit 2008. Available: . Accessed: 2011 June 6.
    1. Liaaen ED, Henriksen AH, Stenfors N (2010) A Scandinavian audit of hospitalizations for chronic obstructive pulmonary disease. Respir Med 104: 1304–1309.
    1. Pretto JJ, McDonald VM, Wark PA, Hensley MJ (in Press)A multicentre audit of inpatient management of acute exacerbations of COPD: comparison with clinical guidelines. Intern Med J.
    1. Hurst JR, Donaldson GC, Quint JK, Goldring JJ, Baghai-Ravary R, et al. (2009) Temporal clustering of exacerbations in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 179: 369–374.
    1. Holt JB, Zhang X, Presley-Cantrell L, Croft JB (2011) Geographic disparities in chronic obstructive pulmonary disease (COPD) hospitalization among Medicare beneficiaries in the United States. Int J Chron Obstruct Pulmon Dis 6: 321–328.
    1. Calderón-Larrañaga A, Carney L, Soljak M, Bottle A, Partridge M, et al. (2011) Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study. Thorax 66: 191–196.
    1. Pozo-Rodríguez F, Alvarez CJ, Castro-Acosta A, Melero Moreno C, Capelastegui A, et al. (2010) Clinical audit of patients admitted to hospital in Spain due to exacerbation of COPD (AUDIPOC study): method and organisation. Arch Bronconeumol 46: 349–357.
    1. Instituto Nacional de Estadística. INEbase. Available: . Accessed: 2011 April 6.
    1. Instituto Nacional de Estadística. Available: . Accessed 2011 November 6.
    1. Ron Cody (2005) Cody’s Data Cleaning Techniques using SAS Software. Cary, NY: SAS Institute.
    1. The Global Initiative for Chronic Obstructive Lung Disease (GOLD). Available: . Accessed: 2011 March 6.
    1. NICE clinical guideline 12. Management of chronic obstructive pulmonary disease in adults in primary and secondary care. Available: . Accessed: 2011 April 6.
    1. Guía de práctica clínica de diagnóstico y tratamiento de la Enfermedad Pulmonar Obstructiva Crónica. SEPAR-ALAT, 2009. Available: . Accessed: 2010 August 6.
    1. Berger Z (2010) Bayesian and frequentist models: legitimate choices for different purposes of clinical research. J Eval Clin Pract 16: 1045–1047.
    1. Lynch SM (2007) Introduction to Applied Bayesian Statistics and Estimation for Social Scientist. London: Springer Science.
    1. Spiegelhalter DJ, Best NG (2003) Bayesian approaches to multiple sources of evidence and uncertainty in complex cost-effectiveness modelling. Stat Med 22: 3687–3709.
    1. Barba R, Zapatero A, Losa JE, Marco J, Plaza S, et al. (2012) The impact of weekends on outcome for Acute Exacerbations of COPD. Eur Respir J 39: 46–50.
    1. Agabiti N, Belleudi V, Davoli M, Forastiere F, Faustini A, et al. (2010) Profiling hospital performance to monitor the quality of care: the case of COPD. Eur Respir J 35: 1031–1038.
    1. Lindenauer PK, Pekow P, Gao S, Crawford AS, Gutierrez B, et al. (2006) Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 144: 894–903.
    1. Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, et al. (2010) Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res 11: 122.
    1. Davidoff F (1999) Standing statistics right side up. Ann Intern M 130: 1019–1021.
    1. Hernández-García I, González-Celador R (2011) [Quality of the hospital discharge reports in a university hospital]. Rev Clin Esp 211: 219–221.
    1. Conthe Gutiérrez P, García Alegría J, Pujol Farriols R, Alfageme Michavilla I, Artola Menéndez S, et al. (2010) [Consensus for hospital discharge reports in medical specialities]. Med Clin (Barc) 134: 505–510.

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