Abstract
BackgroundClinical audits have emerged as a potential tool to summarize the clinical performance of healthcare over a specified period of time. However, the effectiveness of audit and feedback has shown inconsistent results and the impact of audit and feedback on clinical performance has not been evaluated for COPD exacerbations. In the present study, we analyzed the results of two consecutive nationwide clinical audits performed in Spain to evaluate both the in-hospital clinical care provided and the feedback strategy.MethodsThe present study is an analysis of two clinical audits performed in Spain that evaluated the clinical care provided to COPD patients who were admitted to the hospital for a COPD exacerbation. The first audit was performed from November–December 2008. The feedback strategy consisted of personalized reports for each participant center, the presentation and discussion of the results at regional, national and international meetings and the creation of health-care quality standards for COPD. The second audit was part of a European study during January and February 2011. The impact of the feedback strategy was evaluated in term of clinical care provided and in-hospital survival.ResultsA total of 94 centers participated in the two audits, recruiting 8,143 admissions (audit 1∶3,493 and audit 2∶4,650). The initially provided clinical care was reasonably acceptable even though there was considerable variability. Several diagnostic and therapeutic procedures improved in the second audit. Although the differences were significant, the degree of improvement was small to moderate. We found no impact on in-hospital mortality.ConclusionsThe present study describes COPD hospital care in Spanish hospitals and evaluates the impact of peer-benchmarked, individually written and group-oral feedback strategy on the clinical outcomes for treating COPD exacerbations. It describes small to moderate improvements in the clinical care provided to COPD patients with no impact on in-hospital mortality.
Highlights
The existence of a gap between the healthcare that patients receive and the guidelines for that healthcare is well acknowledged [1]
We evaluated the results of two consecutive clinical audits performed in Spain to assess the clinical care provided to patients who were admitted to the hospital with a physician discharge diagnosis of a Chronic obstructive pulmonary disease (COPD) exacerbation
The present study is an analysis of two clinical audits performed in Spain that evaluated the clinical care provided to COPD patients who were admitted to the hospital for a COPD exacerbation
Summary
The existence of a gap between the healthcare that patients receive and the guidelines for that healthcare is well acknowledged [1]. The variations in clinical practice establish a complex interplay of different factors that impact the resulting outcomes in ways that cannot be explained solely by patient characteristics [2]. In this scenario, clinical audits have emerged as a potential tool to summarize the clinical performance of healthcare over a specified period of time. The impact of audit and feedback should be monitored by auditing clinical practices after implementing an intervention [3]; it should be acknowledged that the potential effect may be influenced by the characteristics of the studied disease. We analyzed the results of two consecutive nationwide clinical audits performed in Spain to evaluate both the in-hospital clinical care provided and the feedback strategy
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