RT Journal Article
T1 Community Assessment of COPD Health Care (COACH) study: a clinical audit on primary care performance variability in COPD care.
A1 Abad-Arranz, María
A1 Moran-Rodríguez, Ana
A1 Mascarós Balaguer, Enrique
A1 Quintana Velasco, Carmen
A1 Abad Polo, Laura
A1 Núñez Palomo, Sara
A1 Gonzálvez Rey, Jaime
A1 Fernández Vargas, Ana María
A1 Hidalgo Requena, Antonio
A1 Helguera Quevedo, Jose Manuel
A1 García Pardo, Marina
A1 Lopez-Campos, Jose Luis
A1 COACH study investigators, 
K1 COPD
K1 Clinical audit
K1 Primary care
K1 Quality of care
K1 Variability
AB A thorough evaluation of the adequacy of clinical practice in a designated health care setting and temporal context is key for clinical care improvement. This study aimed to perform a clinical audit of primary care to evaluate clinical care delivered to patients with COPD in routine clinical practice. The Community Assessment of COPD Health Care (COACH) study was an observational, multicenter, nationwide, non-interventional, retrospective, clinical audit of randomly selected primary care centers in Spain. Two different databases were built: the resources and organization database and the clinical database. From January 1, 2015 to December 31, 2016 consecutive clinical cases of COPD in each participating primary care center (PCC) were audited. For descriptive purposes, we collected data regarding the age at diagnosis of COPD and the age at audit, gender, the setting of the PCC (rural/urban), and comorbidities for each patient. Two guidelines widely and uniformly used in Spain were carefully reviewed to establish a benchmark of adequacy for the audited cases. Clinical performance was analyzed at the patient, center, and regional levels. The degree of adequacy was categorized as excellent (> 80%), good (60-80%), adequate (40-59%), inadequate (20-39%), and highly inadequate ( 80%), good (60-80%), adequate (40-59%), inadequate (20-39%), and highly inadequate ( During the study 4307 cases from 63 primary care centers in 6 regions of the country were audited. Most evaluated parameters were judged to fall in the inadequate performance category. A correct diagnosis based on previous exposure plus spirometric obstruction was made in an average of 17.6% of cases, ranging from 9.8 to 23.3% depending on the region. During the audited visit, only 67 (1.6%) patients had current post-bronchodilator obstructive spirometry; 184 (4.3%) patients had current post-bronchodilator obstructive spirometry during either the audited or initial diagnostic visit. Evaluation of dyspnea was performed in 11.1% of cases. Regarding treatment, 33.6% received no maintenance inhaled therapies (ranging from 31.3% in GOLD A to 7.0% in GOLD D). The two most frequently registered items were exacerbations in the previous year (81.4%) and influenza vaccination (87.7%). The results of this audit revealed a large variability in clinical performance across centers, which was not fully attributable to the severity of the disease.
YR 2018
FD 2018-07-03
LK http://hdl.handle.net/10668/12670
UL http://hdl.handle.net/10668/12670
LA en
DS RISalud
RD Apr 8, 2025