title: Improving outcomes for people with COPD by developing networks of general practices: evaluation of a quality improvement project in east London.
abstract: BACKGROUND
  Structured care for people with chronic obstructive pulmonary disease (COPD) can improve outcomes. Delivering care in a deprived ethnically diverse area can prove challenging.
  
  
  OBJECTIVE
  Evaluation of a system change to enhance COPD care delivery in a primary care setting between 2010 and 2013 using observational data.
  
  
  METHODS
  All 36 practices in one inner London primary care trust were grouped geographically into eight networks of 4-5 practices, each supported by a network manager, clerical staff and an educational budget. A multidisciplinary group, including a respiratory specialist and the community respiratory team, developed a 'care package' for COPD management, with financial incentives based on network achievements of clinical targets and supported case management and education. Monthly electronic dashboards enabled networks to track and improve performance.
  
  
  RESULTS
  The size of network COPD registers increased by 10% in the first year. Between 2010 and 2013 completed care plans increased from 53 to 86.5%, pulmonary rehabilitation referrals rose from 45 to 70% and rates of flu immunisation from 81 to 83%, exceeding London and England figures. Hospital admissions decreased in Tower Hamlets from a historic high base.
  
  
  CONCLUSIONS
  Investment of financial, organisational and educational resource into general practice networks was associated with clinically important improvements in COPD care in socially deprived, ethnically diverse communities. Key behaviour change included the following: collaborative working between practices driven by high-quality information to support performance review; shared financial incentives; and engagement between primary and secondary care clinicians.
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Hull
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK.
authors.forename: Rohini
authors.initials: R
authors.lastname: Mathur
authors.affiliation: Barts Health, NHS Trust, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Lloyd-Owen
authors.affiliation: Department of Public Health and Primary Care, King's College London, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Round
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Robson
mesh_terms: D000328:Adult; D019058:Community Networks / Q000458:organization & administration*; D058006:General Practice / Q000458:organization & administration*; D006801:Humans; D008131:London; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D058996:Quality Improvement; D016896:Treatment Outcome