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  • Measure Summary
  • NQMC:008298
  • Jan 2013

Chronic obstructive pulmonary disease (COPD): proportion of outpatients with a Medical Research Council (MRC) level of 2 or more, long-acting bronchodilator inhaled therapy and a FEV1 equal to or below 60% of predicted value who are treated with inhaled steroids.

Indicators in the Danish registry for chronic obstructive pulmonary disease (DrCOPD). Aarhus (DK): Competence Centre for Clinical Quality and Health Informatics West; 2013 Jan 2. 7 p.

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in October 2015.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the proportion of outpatients with a Medical Research Council (MRC) level of 2 or more, long-acting bronchodilator inhaled therapy and a forced expiratory volume within the first second of expiration (FEV1) equal to or below 60% of predicted value who are treated with inhaled steroids.

Rationale

Medical treatment is an important part of the treatment of stable chronic obstructive pulmonary disease (COPD). The intensity of the treatment depends on the level of lung function, the severity of the shortness of breath and the frequency of any exacerbations. Inhalation of long-acting bronchodilators (long-acting muscarinic antagonist [LAMA] or long-acting beta2 agonist [LABA]) has a positive effect on lung function, shortness of breath, functional level and may reduce the tendency for exacerbations. In patients with a forced expiratory volume within the first second of expiration (FEV1) below 60% of predicted value and/or frequent exacerbations inhaled bronchodilators are often supplemented with inhaled corticosteroids.

Evidence for Rationale

Indicators in the Danish registry for chronic obstructive pulmonary disease (DrCOPD). Aarhus (DK): Competence Centre for Clinical Quality and Health Informatics West; 2013 Jan 2. 7 p.

Primary Health Components

Chronic obstructive pulmonary disease (COPD); Medical Research Council (MRC) level; forced expiratory volume (FEV1); long-acting bronchodilator inhaled therapy; long-acting muscarinic antagonist (LAMA); long-acting beta2 agonist (LABA); inhaled steroids

Denominator Description

Patients age 30 years and older who were seen at hospital outpatient clinics with the following primary diagnoses for chronic obstructive pulmonary disease (COPD) according to the Danish version of the International Classification of Diseases, Tenth Revision (ICD-10):

  • J44.X

OR

  • J96.X in combination with J44.X as a secondary diagnosis

AND all of the following within the last 12 months of the last day of the monitored calendar period:

  • At least one procedure code ZZ0150CD with an attached value code VPH0002, VPH0003, VPH0004 or VPH0005
  • At least one procedure code ZZ4139 and value code VPH0000 through VPH0059
  • At least one Anatomical Therapeutic Chemical (ATC) code for one or more of the following long-acting beta2 agonists (LABAs) or long-acting muscarinic antagonists (LAMAs): salmeterol (R03AC12), formoterol (R03AC13), indacaterol (R03AC18), salmeterol + fluticasone (R03AK06), formoterol + budesonide or beclomethasone (R03AK07) or at least one of the following LAMAs: tiotropium (R03BB04)

See the related "Denominator Inclusions/Exclusions" field.

Numerator Description

Outpatients with chronic obstructive pulmonary disease (COPD) and a Medical Research Council (MRC) level of 2 or more, long-acting bronchodilator inhaled therapy and a forced expiratory volume within the first second of expiration (FEV1) equal to or below 60% of predicted value who are treated with inhaled steroids (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Accreditation

Collaborative inter-organizational quality improvement

Decision-making by consumers about health plan/provider choice

Decision-making by managers about resource allocation

External oversight/Regional, county, or city agencies

External oversight/State government program

Internal quality improvement

National reporting

Public reporting

Quality of care research

Measurement Setting

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 30 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 monitored calendar year

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Diagnostic Evaluation

Encounter

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Time window precedes index event

Denominator Inclusions/Exclusions

Inclusions
Patients age 30 years and older who were seen at hospital outpatient clinics with the following primary diagnoses for chronic obstructive pulmonary disease (COPD) according to the Danish version of the International Classification of Diseases, Tenth Revision (ICD-10):

  • J44.X

OR

  • J96.X in combination with J44.X as a secondary diagnosis

AND all of the following within the last 12 months of the last day of the monitored calendar period:

  • At least one procedure code ZZ0150CD with an attached value code VPH0002, VPH0003, VPH0004 or VPH0005
  • At least one procedure code ZZ4139 and value code VPH0000 through VPH0059
  • At least one Anatomical Therapeutic Chemical (ATC) code for one or more of the following long-acting beta2 agonists (LABAs) or long-acting muscarinic antagonists (LAMAs): salmeterol (R03AC12), formoterol (R03AC13), indacaterol (R03AC18), salmeterol + fluticasone (R03AK06), formoterol + budesonide or beclomethasone (R03AK07) or at least one of the following LAMAs: tiotropium (R03BB04)

Note: Based on patients who (according to their civil registration number) can be identified in the Danish National Patient Registry (DNPR) as having a "hospital outpatient course" with COPD, i.e., a start date, one or more outpatient visit dates in the monitored calendar year, and eventually an end date in the DNPR.

Exclusions
Outpatient courses consisting of a single contact only ("one-day courses") are excluded.

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Outpatients with chronic obstructive pulmonary disease (COPD) and a Medical Research Council (MRC) level of 2 or more, long-acting bronchodilator inhaled therapy and a forced expiratory volume within the first second of expiration (FEV1) equal to or below 60% of predicted value, who are treated with inhaled steroids*

*Civil registration numbers with at least one Anatomical Therapeutic Chemical (ATC) code for one or more of the following inhaled steroids in the Danish Prescription Database within the last 12 months of the last day of the monitored calendar period: beclomethasone with or without formoterol (R03BA01, R03AK07), budesonide with or without formoterol (R03BA02, R03AK07), fluticasone with or without salmeterol (R03BA05, R03AK06), mometasone (R03BA07).

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

Medical Research Council (MRC) Dyspnea Scale

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

External comparison at a point in, or interval of, time

Internal time comparison

Original Title

Proportion of outpatients with an MRC-level of 2 or more, long-acting bronchodilator inhaled therapy and an FEV1 equal to or below 60% of predicted value, who are treated with inhaled steroids.

Measure Collection Name

The Danish Clinical Registers

Measure Set Name

Clinical Indicators for the Danish registry for Chronic Obstructive Pulmonary Disease (DrCOPD)

Submitter

The Danish registry for Chronic Obstructive Pulmonary Disease - National Government Agency [Non-U.S.]

Developer

Competence Centre for Clinical Quality and Health Informatics West - International Agency

The Danish registry for Chronic Obstructive Pulmonary Disease - National Government Agency [Non-U.S.]

Funding Source(s)

Danish Regions

Composition of the Group that Developed the Measure

The steering committee for The Danish registry for Chronic Pulmonary Obstructive Disease (DrCOPD)

  • Peter Lange, professor, consultant in respiratory medicine, DMSc, Section of Social Medicine, Department of Public Health, University of Copenhagen (chairperson); Danish Society of Respiratory Medicine
  • Anne Sorknæs, research nurse, MSc in Nursing, PhD student, The Pulmonary Ambulatory Clinic, The Hospital of Funen, Svendborg (chairperson); Danish Society for Pulmonary Medicine/Allergy Nurses
  • Jørgen Steen Andersen, general practitioner, Skovlunde (chairperson); The Danish College of General Practitioners
  • Tina Brandt Sørensen, consultant, the Regional Hospital in Horsens; Danish Society of Respiratory Medicine
  • Steffen Kristensen, consultant, head of The Medical Department, the Regional Hospital in Vejle; Danish Society of Respiratory Medicine
  • Jette Elbrønd, general practitioner, Rønnede; The Danish Medical Society
  • Ejvind Frausing Hansen, consultant, head of The Department of Pulmonary Medicine, Hvidovre Hospital (documentalist); Danish Society of Respiratory Medicine
  • Carl Nielsen, lead consultant, Department of Pulmonary Medicine, Aalborg Hospital; Danish Society of Respiratory Medicine
  • Annette Overgaard, respiratory nurse, The COPD team, The Pulmonary Ambulatory Clinic, the Regional Hospital of Viborg, Skive, Silkeborg and Hammel; Danish Society for Pulmonary Medicine/Allergy Nurses
  • Tove Nini Olsen, physiotherapist, Department of Rheumatology, Køge Hospital; Association of Danish Physiotherapists
  • Alice Pedersen, community nurse, RN, Faaborg Municipality; Danish Society for Pulmonary Medicine/Allergy Nurses
  • Anne Brandt, managing director of Danmarks Lungeforening (association for patients with pulmonary diseases)
  • Pernille Faurschou, head of section, MPH, Division of Health Care Services, City of Copenhagen; Danish Nurses' Association
  • Malene Juul Hylle, OT, Department of Occupational Therapy, the Regional Hospital in Horsens; Danish Association of Occupational Therapists
  • Reimar Wernich Thomsen, associate professor, consultant in clinical epidemiology, MD, PhD, Competence Centre for Clinical Epidemiology and Biostatistics North, Aarhus (clinical epidemiologist)
  • Henrik Nielsen, biostatistician, MSc, Competence Centre for Clinical Epidemiology and Biostatistics North, Aarhus (statistician)
  • Hans Peter Graversen, Head of Department, Health – Quality and Informatics, Central Denmark Region, Viborg (local authority responsible for data)
  • Katrine Abildtrup Nielsen, Head of Competence Centre, MHsC, Competence Centre for Clinical Quality and Health informatics West, Aarhus (contact person)

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure is not adapted from another source.

Date of Most Current Version in NQMC

2013 Jan

Measure Maintenance

Every year in connection with the national clinical audit, there may be isolated updates of the indicator sets (e.g., addition of new indicators or new supplementary variables). Every second or third year, there will be a more formalised review with a proper revision of the indicator set, which will also include a complete update of both documentalist report and other documents related to the indicator set.

Date of Next Anticipated Revision

2016 Sep

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in October 2015.

Source(s)

Indicators in the Danish registry for chronic obstructive pulmonary disease (DrCOPD). Aarhus (DK): Competence Centre for Clinical Quality and Health Informatics West; 2013 Jan 2. 7 p.

Measure Availability

Source not available electronically.

For more information, visit The Competence Centre for Clinical Quality and Health Informatics West Web site External Web Site Policy (in Danish).

Companion Documents

The following is available:

  • Manual for the development of disease-specific quality indicators, standards and prognostic factors under the Danish National Indicator Project. Version 3.0. Arhus N: The Danish National Indicator Project (DNIP); 2009 Jun. 31 p.

NQMC Status

This NQMC summary was completed by ECRI Institute on August 5, 2013. The information was verified by the measure developer on October 1, 2013.

The information was reaffirmed by the measure developer on October 30, 2015.

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No copyright restrictions apply.

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