Abstract
BackgroundAccurate spirometry is important in the management of COPD. The UK Quality and Outcomes Framework pay-for-performance scheme for general practitioners includes spirometry related indicators within its COPD domain. It is not known whether high achievement against QOF spirometry indicators is associated with spirometry to BTS standards.MethodsData were obtained from the records of 3,217 patients randomly sampled from 5,649 patients with COPD in 38 general practices in Rotherham, UK. Severity of airflow obstruction was categorised by FEV1 (% predicted) according to NICE guidelines. This was compared with clinician recorded COPD severity. The proportion of patients whose spirometry met BTS standards was calculated in each practice using a random sub-sample of 761 patients. The Spearman rank correlation between practice level QOF spirometry achievement and performance against BTS spirometry standards was calculated.ResultsSpirometry as assessed by clinical records was to BTS standards in 31% of cases (range at practice level 0% to 74%). The categorisation of airflow obstruction according to the most recent spirometry results did not agree well with the clinical categorisation of COPD recorded in the notes (Cohen's kappa = 0.34, 0.30 – 0.38). 12% of patients on COPD registers had FEV1 (% predicted) results recorded that did not support the diagnosis of COPD. There was no association between quality, as measured by adherence to BTS spirometry standards, and either QOF COPD9 achievement (Spearman's rho = -0.11), or QOF COPD10 achievement (rho = 0.01).ConclusionThe UK Quality and Outcomes Framework currently assesses the quantity, but not the quality of spirometry.
Highlights
Accurate spirometry is important in the management of chronic obstructive pulmonary disease (COPD)
The crude prevalence of COPD ranged from 1.0% to 4.0% of the practice population, and the number of people on the Quality and Outcomes Framework" (QOF) COPD register at each practice ranged from 22 to 395
Main findings In 2006–7, practices in Rotherham achieved highly against the two QOF indicators that relate to spirometry, with the COPD 9 criteria met for 97.4% of the patients on COPD registers, and the COPD 10 criteria met for 89.5% of patients
Summary
Accurate spirometry is important in the management of COPD. The UK Quality and Outcomes Framework pay-for-performance scheme for general practitioners includes spirometry related indicators within its COPD domain. It is not known whether high achievement against QOF spirometry indicators is associated with spirometry to BTS standards. Good quality management of chronic obstructive pulmonary disease (COPD) requires the use of spirometry for diagnosis, staging and ongoing monitoring[1]. Chronic obstructive pulmonary disease is included as a clinical domain within the pay-for-performance UK general practitioner "Quality and Outcomes Framework" (QOF) contract, first introduced in 2004. During the period of our study practices were paid through the contract for holding a COPD register, confirming the diagnosis of COPD with spirometry, recording FEV1, checking inhaler technique and offering flu vaccination
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