title: Clinical Audits in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Workflow.
abstract: OBJECTIVE
  Previous clinical audits for chronic obstructive pulmonary disease (COPD) have provided valuable information on the clinical care delivered to patients admitted to medical wards because of COPD exacerbations. However, clinical audits of COPD in an outpatient setting are scarce and no methodological guidelines are currently available. Based on our previous experience, herein we describe a clinical audit for COPD patients in specialized outpatient clinics with the overall goal of establishing a potential methodological workflow.
  
  
  METHODS
  A pilot clinical audit of COPD patients referred to respiratory outpatient clinics in the region of Andalusia, Spain (over 8 million inhabitants), was performed. The audit took place between October 2013 and September 2014, and 10 centers (20% of all public hospitals) were invited to participate. Cases with an established diagnosis of COPD based on risk factors, clinical symptoms, and a post-bronchodilator FEV1/FVC ratio of less than 0.70 were deemed eligible. The usefulness of formally scheduled regular follow-up visits was assessed. Two different databases (resources and clinical database) were constructed. Assessments were planned over a year divided by 4 three-month periods, with the goal of determining seasonal-related changes. Exacerbations and survival served as the main endpoints.
  
  
  CONCLUSIONS
  This paper describes a methodological framework for conducting a clinical audit of COPD patients in an outpatient setting. Results from such audits can guide health information systems development and implementation in real-world settings.
authors.affiliation: Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.|CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: López-Campos
authors.affiliation: Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Abad Arranz
authors.affiliation: Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.|CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Calero Acuña
authors.affiliation: Hospital Puerta del Mar, Cádiz, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Romero Valero
authors.affiliation: Hospital Juan Ramón Jiménez, Huelva, Spain.
authors.forename: Ruth
authors.initials: R
authors.lastname: Ayerbe García
authors.affiliation: Hospital Puerta del Mar, Cádiz, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Hidalgo Molina
authors.affiliation: Hospital Juan Ramón Jiménez, Huelva, Spain.
authors.forename: Ricardo Ismael
authors.initials: RI
authors.lastname: Aguilar Pérez-Grovas
authors.affiliation: Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: García Gil
authors.affiliation: Hospital Universitario San Cecilio, Granada, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Casas Maldonado
authors.affiliation: Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Caballero Ballesteros
authors.affiliation: Hospital Universitario San Cecilio, Granada, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Sánchez Palop
authors.affiliation: Hospital Infanta Margarita, Cabra, Córdoba, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Pérez-Tejero
authors.affiliation: Hospital Infanta Margarita, Cabra, Córdoba, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Segado
authors.affiliation: Hospital Torrecárdenas, Almería, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Calvo Bonachera
authors.affiliation: Hospital Torrecárdenas, Almería, Spain.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Hernández Sierra
authors.affiliation: Hospital Regional Universitario de Málaga, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Doménech
authors.affiliation: Hospital Regional Universitario de Málaga, Spain.
authors.forename: Macarena
authors.initials: M
authors.lastname: Arroyo Varela
authors.affiliation: Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: González Vargas
authors.affiliation: Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Cruz Rueda
mesh_terms: D000554:Ambulatory Care Facilities / Q000592:standards*; D019985:Benchmarking; D054869:Clinical Audit / Q000379:methods*; D003625:Data Collection; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive; D057188:Workflow