Quality indicators for in-hospital management of exacerbation of chronic obstructive pulmonary disease: results of an international Delphi study

Authors

  • Cathy Lodewijckx,

    1. Cathy Lodewijckx MSc RN
      PhD Candidate
      Clinical Nurse Specialist COPD
      University Hospitals Leuven, Belgium
      and Research Fellow
      School of Public Health, Faculty of Medicine, KU Leuven, Belgium
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  • Walter Sermeus,

    1. Walter Sermeus MSc PhD RN
      Professor in Patient Care Management, Research Methods and Biostatistics,
      School of Public Health, Faculty of Medicine, KU Leuven, Belgium and Treasurer European Pathway Association, Leuven, Belgium
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  • Massimiliano Panella,

    1. Massimiliano Panella MD PhD Professor in Public Health, Department of Clinical and Experimental Medicine, Faculty of Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy, Medical Director, Healthcare District of Vercelli, Italy, and President European Pathway Association, Leuven, Belgium
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  • Svin Deneckere,

    1. Svin Deneckere MSc RN
      PhD Candidate
      Research Fellow School of Public Health, Faculty of Medicine, KU Leuven, Belgium
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  • Fabrizio Leigheb,

    1. Fabrizio Leigheb MD PhD
      Research Fellow
      School of Public Health, Faculty of Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
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  • Thierry Troosters,

    1. Thierry Troosters PhD PT
      Professor
      Respiratory and Respiratory Rehabilitation Department, University Hospitals Leuven, Belgium and Faculty of Kinesiology and Rehabilitation Sciences, Catholic University Leuven, Belgium
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  • Paulo Alexandre Boto,

    1. Paulo Alexandre Boto MSc MD
      Lecturer
      Health Care Quality and Clinical Units Management, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Portugal
      and Health Service Researcher
      Health Policy and Management Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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  • Rita Veloso Mendes,

    1. Rita Veloso Mendes BA MSc
      PhD Candidate, Health Services Researcher
      Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Portugal
      and Programme in Sociology, Instituto Superior de Ciências do Trabalho e da Empresa – Instituto Universitário de Lisboa, Portugal
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  • Marc Decramer,

    1. Marc Decramer MD PhD
      Head Respiratory Department
      University Hospitals Leuven, Belgium,
      Professor
      Faculty of Medicine, KU Leuven, Belgium.
      and President
      European Respiratory Society, Lausanne, Switzerland
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  • Kris Vanhaecht

    1. Kris Vanhaecht MSc PhD RN
      Senior Research Fellow
      School of Public health, Faculty of Medicine, KU Leuven, Belgium
      and Secretary General
      European Pathway Association, Leuven, Belgium
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C. Lodewijckx: e-mail: cathy.lodewijckx@med.kuleuven.be

Abstract

lodewijckx c., sermeus w., panella m., deneckere s., leigheb f., troosters t., boto p.a., mendes r.v., decramer m. & vanhaecht k. (2012) Quality indicators for in-hospital management of exacerbation of chronic obstructive pulmonary disease: results of an international Delphi study. Journal of Advanced Nursing69(2), 348–362. doi: 10.1111/j.1365-2648.2012.06013.x

Abstract

Aim.  To report a Delphi study that was conducted to select process and outcome indicators that are relevant to study quality of care and impact of care pathways for patients hospitalized with exacerbation of chronic obstructive pulmonary disease.

Background.  Management of patients hospitalized with exacerbation of chronic obstructive pulmonary disease is suboptimal and outcomes are poor. To evaluate the impact of care pathways properly, relevant indicators need to be selected.

Design.  Delphi study.

Methods.  The study was conducted over 4 months in 2008, with 35 experts out of 15 countries, including 19 medical doctors, 8 nurses and 8 physiotherapists. Participants were asked to rate, for 72 process and 21 outcome indicators, the relevance for follow-up in care pathways for in-hospital management of exacerbation of chronic obstructive pulmonary disease. Consensus (agreement by at least 75% of the participants) that an indicator is relevant for follow-up was sought in two rounds.

Results.  Consensus was reached for 26 of 72 process indicators (36·1%) and 10 of 21 outcome indicators (47·6%). Highest consensus levels were found for the process indicators regarding oxygen therapy (100%), pulmonary rehabilitation (100%) and patient education (94·5–88·6%) and for the outcome indicators concerning understanding of therapy (91·4–85·7%) and self-management (88·6–88·2%).

Conclusion.  The selected indicators appear to be sensitive for improvement. Therefore, researchers and clinicians that want to study and improve the care for patients hospitalized with exacerbation of chronic obstructive pulmonary disease should primarily focus on these indicators.

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