title: An International Study of Adherence to Guidelines for Patients Hospitalised with a COPD Exacerbation.
abstract: Guideline adherence rates for the treatment of chronic obstructive pulmonary disease (COPD) exacerbation are low. The aim of this study is to perform an importance-performance analysis as an approach for prioritisation of interventions by linking guidelines adherence rates to expert consensus rates for the in-hospital management of COPD exacerbation. We illustrate the relevance of such approach by describing variation in guideline adherence across indicators and hospitals. A secondary data analysis of patients with an acute COPD exacerbation admitted to Belgian, Italian and Portuguese hospitals was performed. Twenty-one process indicators were used to describe adherence to guidelines from patient record reviews. Expert consensus on the importance for follow-up of these 21 indicators was derived from a previous Delphi study. Three of the twenty-one indicators had high level of expert consensus and a high level of adherence. Eleven of the twenty-one indicators had high level of expert consensus but a low level of adherence. For none of the 378 patients included in this study were all process indicators adhered to, patients received 41.0% of the recommended care on average, and only 34.1% of the patients received 50% or more of the care they should receive. There was also a large variation within and between hospitals regarding the care received. This study confirms the findings of previous studies, indicating that COPD exacerbations are largely undertreated. Importance-performance analysis provides a decision-making tool for prioritising indicators. All hospitals in this study would benefit from having in place a quality framework for systematic follow-up of these indicators.
authors.affiliation: a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.
authors.forename: Deborah
authors.initials: D
authors.lastname: Seys
authors.affiliation: a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.|b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium.
authors.forename: Luk
authors.initials: L
authors.lastname: Bruyneel
authors.affiliation: c Department of Clinical and Experimental Medicine , KU Leuven-University of Leuven , Leuven , Belgium.|d Chief Executive Officer, University Hospitals Leuven , Leuven , Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Decramer
authors.affiliation: a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.
authors.forename: Cathy
authors.initials: C
authors.lastname: Lodewijckx
authors.affiliation: a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.|e Department of Translational Medicine , University of Eastern Piedmont , Vercelli , Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Panella
authors.affiliation: a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: Sermeus
authors.affiliation: f Department of Health Services Policy and Management Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP), Universidade Nova de Lisboa (UNL) , Lisbon , Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Boto
authors.affiliation: a Department of Public Health and Primary Care , Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven , Leuven , Belgium.|b Department of Quality Management , University Hospitals Leuven , Leuven , Belgium.
authors.forename: Kris
authors.initials: K
authors.lastname: Vanhaecht
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D032921:Consensus; D018450:Disease Progression; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006760:Hospitalization; D006761:Hospitals / Q000592:standards; D006801:Humans; D038622:Internationality; D007558:Italy; D008297:Male; D008875:Middle Aged; D011174:Portugal; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D019984:Quality Indicators, Health Care; D000067251:Symptom Flare Up
keywords: Adherence to guidelines; importance-performance analysis; level of performance; quality of care