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  • Measure Summary
  • NQMC:010193
  • May 2015
  • NQF-Endorsed Measure

Chronic obstructive pulmonary disease (COPD): percentage of patients aged 18 years and older with a diagnosis of COPD who had spirometry results documented.

American Thoracic Society (ATS). Chronic obstructive pulmonary disease (COPD): spirometry evaluation. New York (NY): American Thoracic Society (ATS); 2015 May 21. 3 p.

This is the current release of the measure.

This measure updates a previous version: Physician Consortium for Performance Improvement®. Clinical performance measures: chronic obstructive pulmonary disease (COPD). Tools developed by physicians for physicians. Chicago (IL): American Medical Association (AMA); 2006. 8 p. [12 references]

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients aged 18 years and older with a diagnosis of chronic obstructive pulmonary disease (COPD) who had spirometry results documented.

Rationale

Evaluation of lung function for a patient with chronic obstructive pulmonary disease (COPD) is vital to determine what treatments are needed and whether those treatments are effective. COPD is often underdiagnosed and misdiagnosed in the primary care setting (Tinkelman et al., 2006). Marked underutilization of spirometry testing has been well documented and is thought to be a contributing factor (Foster et al., 2007; Yawn & Wollan, 2008; Lee et al., 2006; Damarla et al., 2006). A recent study found that only 32% of patients with a new diagnosis of COPD had undergone spirometry within the previous 2 years to 6 months following diagnosis (Han et al., 2007). This measure is for patients already diagnosed with COPD, in order to confirm diagnosis.

Clinical Recommendation Statements:

A clinical diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum production, and a history of exposure to risk factors for the disease. Spirometry is required to make the diagnosis in this clinical context; the presence of a post-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) less than 0.70 confirms the presence of persistent airflow limitation and thus of COPD…Whereas spirometry was previously used to support a diagnosis of COPD, spirometry is now required to make a confident diagnosis of COPD. Spirometry is the most reproducible and objective measurement of airflow limitation available (Global Initiative for Chronic Obstructive Lung Disease [GOLD], 2015).

American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and European Respiratory Society (ERS) [COPD Guidelines] recommend that spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms …Spirometry is a pulmonary function test that is useful to identify airflow obstruction in symptomatic patients who may benefit from pharmacotherapy, long-term oxygen, or pulmonary rehabilitation (or all of these strategies). Symptomatic patients with FEV1 less than 60% predicted will benefit from inhaled treatments (anticholinergics, long-acting beta-agonists, or corticosteroids) (Qaseem et al., 2011).

Evidence for Rationale

American Thoracic Society (ATS). Chronic obstructive pulmonary disease (COPD): spirometry evaluation. New York (NY): American Thoracic Society (ATS); 2015 May 21. 3 p.

Damarla M, Celli BR, Mullerova HX, Pinto-Plata VM. Discrepancy in the use of confirmatory tests in patients hospitalized with the diagnosis of chronic obstructive pulmonary disease or congestive heart failure. Respir Care. 2006 Oct;51(10):1120-4. PubMed External Web Site Policy

Foster JA, Yawn BP, Maziar A, Jenkins T, Rennard SI, Casebeer L. Enhancing COPD management in primary care settings. MedGenMed. 2007;9(3):24. PubMed External Web Site Policy

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Vancouver (WA): Global Initiative for Chronic Obstructive Lung Disease (GOLD); 2015. [613 references]

Han MK, Kim MG, Mardon R, Renner P, Sullivan S, Diette GB, Martinez FJ. Spirometry utilization for COPD: how do we measure up?. Chest. 2007 Aug;132(2):403-9. PubMed External Web Site Policy

Lee TA, Sullivan ST, Buist AS, et al. Estimating the future economic burden of COPD. ATS Proc. 2006;3:A598.

Qaseem A, Wilt TJ, Weinberger SE, Hanania NA, Criner G, van der Molen T, Marciniuk DD, Denberg T, Schunemann H, Wedzicha W, MacDonald R, Shekelle P, American College of Physicians, American College of Chest Physicians, American Thoracic Society, European Respiratory Society. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011 Aug 2;155(3):179-191. [62 references] PubMed External Web Site Policy

Tinkelman DG, Price DB, Nordyke RJ, Halbert RJ. Misdiagnosis of COPD and asthma in primary care patients 40 years of age and over. J Asthma. 2006 Jan-Feb;43(1):75-80. PubMed External Web Site Policy

Yawn BP, Wollan PC. Knowledge and attitudes of family physicians coming to COPD continuing medical education. Int J Chron Obstruct Pulmon Dis. 2008;3(2):311-7. PubMed External Web Site Policy

Primary Health Components

Chronic obstructive pulmonary disease (COPD); spirometry; forced expiratory volume in 1 second (FEV1); forced vital capacity (FVC)

Denominator Description

All patients aged 18 years and older with a diagnosis of chronic obstructive pulmonary disease (COPD) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients with documented spirometry results in the medical record (forced expiratory volume in 1 second [FEV1] and FEV1/forced vital capacity [FVC]) (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Pay-for-reporting

Public reporting

Measurement Setting

Ambulatory/Office-based Care

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

The reporting period

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients aged 18 years and older with the diagnosis of chronic obstructive pulmonary disease (COPD)

Note: Refer to the original measure documentation for administrative codes.

Exclusions

  • Documentation of medical reason(s) for not documenting and reviewing spirometry results
  • Documentation of patient reason(s) for not documenting and reviewing spirometry results
  • Documentation of system reason(s) for not documenting and reviewing spirometry results

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

System factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patients with documented spirometry results in the medical record (forced expiratory volume in 1 second [FEV1] and FEV1/forced vital capacity [FVC])

Note: Refer to the original measure documentation for administrative codes.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Paper medical record

Registry data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Spirometry evaluation.

Measure Collection Name

Chronic Obstructive Pulmonary Disease (COPD) Measures

Submitter

American Thoracic Society - Medical Specialty Society

Developer

American Thoracic Society - Medical Specialty Society

Funding Source(s)

American Thoracic Society

Composition of the Group that Developed the Measure

William E. Golden, MD, FACP (Co-Chair); Linus Santo Tomas, MD, MS (Co-Chair); Bruce Bagley, MD; Troy T. Fiesinger, MD; David G. Jaimovich, MD; Bruce Krieger, MD; Thomas W. Lukens, MD, PhD, FACEP; Sam J. W. Romeo, MD, MBA; Ralph M Schapira, MD; Sean D. Sullivan, RPh, PhD; Dennis E. Richling, MD; Deborah Patterson, RN

Mark S. Antman, DDS, MBA, American Medical Association; Karen S. Kmetik, PhD, American Medical Association

Becky Kresowik, Consultant; Tim Kresowik, MD, Consultant

Min Gayles Kim, MPH, National Committee for Quality Assurance

Nancy Lawler, RN, Joint Commission on Accreditation of Healthcare Organizations

Carla Herrerias, MPH, American College of Chest Physicians

Janet Leiker, RN, MPH, CPHQ, American Academy of Family Physicians

Nancy Stonis, RN, BSN, MJ, Society of Critical Care Medicine

LT Pauline Karikari-Martin, MPH, MSN, APRN, BC, PAHM, Centers for Medicare & Medicaid Services; Susan Nedza, MD, MBA, FACEP, Centers for Medicare & Medicaid Services

John M. Young, MS, Epidemiologist, Quality Measurement and Health Assessment Group

Financial Disclosures/Other Potential Conflicts of Interest

Financial/potential conflict of interest disclosed in accordance with the American Thoracic Society policy.

Endorser

National Quality Forum

NQF Number

0091

Date of Endorsement

2015 May 21

Measure Initiative(s)

Physician Quality Reporting System

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 May

Measure Maintenance

The American Thoracic Society updates measures annually

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: Physician Consortium for Performance Improvement®. Clinical performance measures: chronic obstructive pulmonary disease (COPD). Tools developed by physicians for physicians. Chicago (IL): American Medical Association (AMA); 2006. 8 p. [12 references]

Source(s)

American Thoracic Society (ATS). Chronic obstructive pulmonary disease (COPD): spirometry evaluation. New York (NY): American Thoracic Society (ATS); 2015 May 21. 3 p.

Measure Availability

Source not available electronically.

For more information, contact the American Thoracic Society (ATS) at 25 Broadway, New York, NY 10004; Phone: 202-315-8600; Fax: 212-315-6498; E-mail: ATSInfo@Thoracic.org; Web site: www.thoracic.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI on August 28, 2006. The information was verified by the measure developer on July 6, 2007.

This NQMC summary was retrofitted into the new template on August 5, 2011.

Stewardship for this measure was transferred from the PCPI to the ATS. ATS informed NQMC that this measure was updated. This NQMC summary was updated by ECRI Institute on July 29, 2015. The information was verified by the measure developer on August 31, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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