Patterns of care in the management of high-risk COPD in the US (2011-2019): an observational study for the CONQUEST quality improvement program

Margee Kerr; Yasir Tarabichi; Alexander Evans; Douglas Mapel; Wilson Pace; Victoria Carter; Amy Couper; M Bradley Drummond; Norbert Feigler; Alex Federman; Hitesh Gandhi; Nicola A Hanania; Alan Kaplan; Konstantinos Kostikas; Maja Kruszyk; Marije van Melle; Hana Müllerová; Ruth Murray; Jill Ohar; Michael Pollack; Rachel Pullen; Dennis Williams; Juan Wisnivesky; MeiLan K Han; Catherine Meldrum; David Price

doi:10.1016/j.lana.2023.100546

Patterns of care in the management of high-risk COPD in the US (2011-2019): an observational study for the CONQUEST quality improvement program

Lancet Reg Health Am. 2023 Jul 28:24:100546. doi: 10.1016/j.lana.2023.100546. eCollection 2023 Aug.

Authors

Margee Kerr^{1

2}, Yasir Tarabichi³, Alexander Evans², Douglas Mapel⁴, Wilson Pace^{5

6}, Victoria Carter², Amy Couper¹, M Bradley Drummond⁷, Norbert Feigler⁸, Alex Federman⁹, Hitesh Gandhi⁸, Nicola A Hanania¹⁰, Alan Kaplan^{1

11

12}, Konstantinos Kostikas¹³, Maja Kruszyk^{1

14}, Marije van Melle^{1

15

16}, Hana Müllerová¹⁷, Ruth Murray², Jill Ohar¹⁸, Michael Pollack⁸, Rachel Pullen¹, Dennis Williams^{19

20}, Juan Wisnivesky⁹, MeiLan K Han²¹, Catherine Meldrum²², David Price^{1

2

23}

Affiliations

¹ Observational and Pragmatic Research Institute, Singapore, Singapore.
² Optimum Patient Care, Cambridge, UK.
³ Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH, USA.
⁴ University of New Mexico College of Pharmacy, Albuquerque, NM, USA.
⁵ DARTNet Institute, Aurora, USA.
⁶ University of Colorado, Denver, CO, USA.
⁷ Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA.
⁹ General Internal Medicine, Mount Sinai, New York, NY, USA.
¹⁰ Section of Pulmonary and Critical Care Medicine, and Director of the Airways Clinical Research Center, Baylor College of Medicine, Houston, TX, USA.
¹¹ Family Physician Airways Group of Canada, Stouffville, Ontario, Canada.
¹² University of Toronto, Toronto, Ontario, Canada.
¹³ Respiratory Medicine Department, University of Ioannina, Ioannina, Greece.
¹⁴ Optimum Patient Care, Queensland, Australia.
¹⁵ Connecting Medical Dots BV, Utrecht, the Netherlands.
¹⁶ ORTEC, Zoetermeer, the Netherlands.
¹⁷ BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.
¹⁸ Department of Internal Medicine, WakeForest University, Winston-Salem, NC, USA.
¹⁹ UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA.
²⁰ Allergy and Asthma Network, Vienna, VA, USA.
²¹ University of Michigan, Ann Arbor, MI, USA.
²² Division of Pulmonary & Critical Care at University of Michigan Hospital, Ann Arbor, MI, USA.
²³ Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.

Abstract

Background: In this study, we compare management of patients with high-risk chronic obstructive pulmonary disease (COPD) in the United States to national and international guidelines and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST).

Methods: Patients were identified from the DARTNet Practice Performance Registry and categorized into three high-risk cohorts in each year from 2011 to 2019: newly diagnosed (≤12 months after diagnosis), already diagnosed, and patients with potential undiagnosed COPD. Patients were considered high-risk if they had a history of exacerbations or likely exacerbations (respiratory consult with prescribed medication). Descriptive statistics for 2019 are reported, along with annual trends.

Findings: In 2019, 10% (n = 16,610/167,197) of patients met high-risk criteria. Evidence of spirometry for diagnosis was low; in 2019, 81% (n = 1228/1523) of patients newly diagnosed at high-risk had no record of spirometry/peak expiratory flow in the 12 months pre- or post-diagnosis and 43% (n = 651/1523) had no record of COPD symptom review. Among those newly and already diagnosed at high-risk, 52% (n = 4830/9350) had no evidence of COPD medication.

Interpretation: Findings suggest inconsistent adherence to evidence-based guidelines, and opportunities to improve identification, documentation of services, assessment, therapeutic intervention, and follow-up of patients with COPD.

Funding: This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.

Keywords: COPD; Coordination of care; Diagnosis; Exacerbations; Spirometry; Treatment.