Authorship and contributorship
Improving quality of care among COPD outpatients in Denmark 2008–2011
Article first published online: 22 JAN 2013
© 2012 John Wiley & Sons Ltd
The Clinical Respiratory Journal
Volume 7, Issue 4, pages 319–327, October 2013
How to Cite
Tøttenborg, S. S., Thomsen, R. W., Nielsen, H., Johnsen, S. P., Frausing Hansen, E. and Lange, P. (2013), Improving quality of care among COPD outpatients in Denmark 2008–2011. The Clinical Respiratory Journal, 7: 319–327. doi: 10.1111/crj.12009
Study concept and design: SST, PL, RWT. Acquisition of data: PL, RWT, HN, SPJ. Analysis and interpretation of data: SST, RWT, HN, PL. First drafting of the manuscript: SST. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: HN. Obtained funding: PL. Study supervision: PL, RWT, SPJ.
The study was approved by the Danish Data Protection Agency (record no. 2012-41-0438), The Danish National Indicator Project and the Danish Regions and the Ministry of Health.
Conflict of interest
Sandra Søgaard Tøttenborg, Reimar Wernich Thomsen, Henrik Nielsen, Søren Paaske Johnsen and Ejvind Frausing Hansen: none. Peter Lange has received research grants from Boehringer Ingelheim, GlaxoSmithKline and Pfizer; received fee for speaking from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Nycomed and Pfizer; received fee for consulting from Almirall, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Mundipharma, Novartis, Nycomed and Pfizer.
Data access and responsibility
Prof Peter Lange and statistician Henrik Nielsen had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The manuscript has not been published and is not being considered for publication elsewhere, in whole or in part, in any language, except as an abstract. We are not aware of any conflicts of interest.
- Issue published online: 23 SEP 2013
- Article first published online: 22 JAN 2013
- Accepted manuscript online: 19 NOV 2012 09:47PM EST
- Manuscript Accepted: 12 NOV 2012
- Manuscript Revised: 15 OCT 2012
- Manuscript Received: 6 SEP 2012
- chronic obstructive pulmonary disease;
- processes of care;
- treatment and care
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.
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.
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).
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.