Jordan Terasaki1, Gurinder Singh2, Wei Zhang2, Penny Wagner2, Gulshan Sharma2. 1. Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States. Electronic address: jmterasaki@gmail.com. 2. Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States.
Abstract
BACKGROUND: Clinical practice guidelines are underutilized in the outpatient management of chronic obstructive pulmonary disease (COPD). We hypothesize that a structured approach using the electronic medical record (EMR) will improve compliance with clinical practice guidelines for the evaluation and management of patients with stable COPD. METHODS: Clinical records were evaluated in a pre- and post-intervention analysis of patients with COPD seen in our pulmonary clinics at a single tertiary care academic setting. Patient charts were retrospectively screened for the diagnosis of COPD and individually assessed for a diagnosis of COPD by spirometry. We then developed and implemented a COPD Flowsheet based on clinical practice guidelines into each outpatient clinic encounter for COPD with repeat chart review of clinic patients. Improvement in the pre- to post-intervention quality metrics were compared using t-test and Chi squared as indicated. A p-value of <0.05 was considered significant. RESULTS: A total of 200 patients were screened in the pre-intervention period and 347 in the post-intervention period. Of these, 144 (72%) and 267 (77%) met criteria for COPD based on FEV(1)/FVC < 0.70, respectively. There was a significant increase in the use of severity assessment by BODE index (13.2% vs 32.2%, p-value < 0.001), inhaler technique teaching (35.4% vs 65.2%, p-value < 0.001), osteoporosis screening (20.8% vs 44.9%, p-value < 0.001) and influenza vaccination (74.3% vs 83.5%, p-value = 0.03) in post intervention period. CONCLUSIONS: Implementation of a standardized COPD Flowsheet developed from clinical practice guidelines improves advanced assessment of patients with COPD and other quality of care measures.
BACKGROUND: Clinical practice guidelines are underutilized in the outpatient management of chronic obstructive pulmonary disease (COPD). We hypothesize that a structured approach using the electronic medical record (EMR) will improve compliance with clinical practice guidelines for the evaluation and management of patients with stable COPD. METHODS: Clinical records were evaluated in a pre- and post-intervention analysis of patients with COPD seen in our pulmonary clinics at a single tertiary care academic setting. Patient charts were retrospectively screened for the diagnosis of COPD and individually assessed for a diagnosis of COPD by spirometry. We then developed and implemented a COPD Flowsheet based on clinical practice guidelines into each outpatient clinic encounter for COPD with repeat chart review of clinic patients. Improvement in the pre- to post-intervention quality metrics were compared using t-test and Chi squared as indicated. A p-value of <0.05 was considered significant. RESULTS: A total of 200 patients were screened in the pre-intervention period and 347 in the post-intervention period. Of these, 144 (72%) and 267 (77%) met criteria for COPD based on FEV(1)/FVC < 0.70, respectively. There was a significant increase in the use of severity assessment by BODE index (13.2% vs 32.2%, p-value < 0.001), inhaler technique teaching (35.4% vs 65.2%, p-value < 0.001), osteoporosis screening (20.8% vs 44.9%, p-value < 0.001) and influenza vaccination (74.3% vs 83.5%, p-value = 0.03) in post intervention period. CONCLUSIONS: Implementation of a standardized COPD Flowsheet developed from clinical practice guidelines improves advanced assessment of patients with COPD and other quality of care measures.
Authors: Thomas L Keller; Jennifer Wright; Lucas M Donovan; Laura J Spece; Kevin Duan; Nadiyah Sulayman; Alexandria Dominitz; J Randall Curtis; David H Au; Laura C Feemster Journal: Chronic Obstr Pulm Dis Date: 2022-01-27
Authors: Judith E Goldstein; Xinxing Guo; Bonnielin K Swenor; Michael V Boland; Kerry Smith Journal: Transl Vis Sci Technol Date: 2022-10-03 Impact factor: 3.048
Authors: Swati Gulati; Aline N Zouk; Jonathan P Kalehoff; Christopher S Wren; Peter N Davison; Denay Porter Kirkpatrick; Surya P Bhatt; Mark T Dransfield; James Michael Wells Journal: Int J Chron Obstruct Pulmon Dis Date: 2018-07-27