title: Improving quality of care among COPD outpatients in Denmark 2008-2011.
abstract: OBJECTIVE
  To examine whether the quality of care among Danish patients with chronic obstructive pulmonary disease (COPD) has improved since the initiation of a national multidisciplinary quality improvement program.
  
  
  METHODS
  We conducted a nationwide, population-based prospective cohort study using data from the Danish Clinical Register of COPD. Since 2008, the register has systematically monitored and audited the use of recommended processes of COPD care.
  
  
  RESULTS
  Substantial improvements were observed for all processes of care and registration fulfillment increased to well above 85% for all indicators. Compared with 2008, a higher proportion of COPD outpatients in 2011 received annual measurements of the forced expiratory volume in 1 s in percent of predicted [relative risk (RR) 2.14, 95% confidence interval (CI), 2.09; 2.19], assessment of body mass index (RR 2.24, 95% CI, 2.19; 2.29), assessment of dyspnea using the Medical Research Council scale (RR 2.25, 95% CI, 2.20; 2.31), registration of smoking status (RR 2.41, 95% CI, 2.35; 2.47), smoking cessation recommendation (RR 3.40, 95% CI, 3.18; 3.64) and offering of pulmonary rehabilitation (RR 2.78, 95% CI, 2.65; 2.90). Moderate variation in quality of care fulfillment between regions and hospital clinics still existed in 2011. The proportion of patients with mild to moderate COPD increased during the study period (P < 0.0001).
  
  
  CONCLUSIONS
  Based on increased registration practice of important processes of care, the present study indicates a substantial improvement in the quality of care of COPD in Danish hospitals following the initiation of a national multidisciplinary quality improvement program in 2008. In the forthcoming years, it will be interesting to observe if this will translate into a better prognosis for Danish patients with COPD.
authors.affiliation: Department of Social Medicine, Institute of Public Health, Copenhagen University, Copenhagen, Denmark.
authors.forename: Sandra Søgaard
authors.initials: SS
authors.lastname: Tøttenborg
authors.forename: Reimar Wernich
authors.initials: RW
authors.lastname: Thomsen
authors.forename: Henrik
authors.initials: H
authors.lastname: Nielsen
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
authors.forename: Ejvind
authors.initials: E
authors.lastname: Frausing Hansen
authors.forename: Peter
authors.initials: P
authors.lastname: Lange
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy*; D058996:Quality Improvement; D011787:Quality of Health Care; D012042:Registries; D012307:Risk Factors