Identification of key opportunities for optimising the management of high-risk COPD patients in the UK using the CONQUEST Quality Standards: an observational longitudinal study

David M.G. Halpin; Andrew P  Dickens; Derek Skinner; Ruth B Murray; Mukesh  Singh; Katherine  Hickman; Victoria Carter; Amy  Couper; Alexander  Evans; Rachel  Pullen; Shruti  Menon; Tamsin Morris; Hana  Muellerova; Mona Bafadhel; James Chalmers; Graham Devereux; Martin  Gibson; John R. Hurst; Rupert  Jones; Konstantinos  Kostikas; Jennifer Quint; Dave  Singh; Marije  van Melle; Tom M.A.  Wilkinson; David Price

doi:10.1016/j.lanepe.2023.100619

Identification of key opportunities for optimising the management of high-risk COPD patients in the UK using the CONQUEST Quality Standards: an observational longitudinal study

David M.G. Halpin, Andrew P Dickens, Derek Skinner, Ruth B Murray, Mukesh Singh, Katherine Hickman, Victoria Carter, Amy Couper, Alexander Evans, Rachel Pullen, Shruti Menon, Tamsin Morris, Hana Muellerova, Mona Bafadhel, James Chalmers, Graham Devereux, Martin Gibson, John R. Hurst, Rupert Jones, Konstantinos KostikasJennifer Quint, Dave Singh, Marije van Melle, Tom M.A. Wilkinson, David Price^* (Corresponding Author)

^*Corresponding author for this work

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Abstract

Background: This study compared management of high-risk COPD patients in the UK to national and international management recommendations and quality standards, including the Collaboration on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). The primary comparison was in 2019, but trends from 2000 to 2019 were also examined.
Methods: Patients identified in the Optimum Patient Care Research Database were categorised as newly diagnosed (≤12 months after diagnosis), already diagnosed, and potential COPD (smokers having exacerbation-like events). High-risk patients had a history of ≥2 moderate or ≥1 severe exacerbations in the previous 12 months.
Findings: For diagnosed patients, the median time between diagnosis and first meeting the high-risk criteria was 617 days (Q1-Q3: 3246). The use of spirometry for diagnosis increased dramatically after 2004 before plateauing and falling in recent years. In 2019, 41% (95% CI 39-44%; n=550/1343) of newly
diagnosed patients had no record of spirometry in the previous year, and 45% (95% CI 43-48%;n=352/783) had no record of a COPD medication review within 6 months of treatment initiation or change. In 2019, 39% (n=6,893/17,858) of already diagnosed patients had no consideration of exacerbation rates, 46% (95% CI 45-47%; n=4,942/10,725) were not offered or referred for pulmonary
rehabilitation, and 41% (95% CI 40-42%; n=3,026/7,361) had not had a COPD review within 6 weeks of respiratory hospitalization.
Interpretation: Opportunities for early diagnosis of COPD patients at high risk of exacerbation are being missed. Newly and already diagnosed patients at high-risk are not being assessed or treated promptly. There is substantial scope to improve the assessment and treatment optimisation of these patients.
Funding: This study is conducted by the Observational & Pragmatic Research International Ltd and was co-funded by Optimum Patient Care and AstraZeneca. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.

Original language	English
Article number	100619
Number of pages	14
Journal	The Lancet Regional Health - Europe
Volume	29
Early online date	21 Apr 2023
DOIs	https://doi.org/10.1016/j.lanepe.2023.100619
Publication status	Published - 1 Jun 2023

Bibliographical note

Funding: This study is conducted by the Observational & Pragmatic Research International Ltd and was co-funded by Optimum Patient Care and AstraZeneca. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.
Acknowledgments
We acknowledge Jonathan Marshall, Clementine Nordon, Mehul Patel, Michael Pollack, and Yang Xu, of AstraZeneca, for their contributions to the development and review of the protocol, and Kathleen Heil, of AstraZeneca, for project management support. We would also like to acknowledge Ms Shilpa Suresh (MSc) and Ms Andrea Lim (BSc) of the Observational and Pragmatic Research Institute (OPRI), Singapore, for editorial and formatting assistance which supported the development of this publication.

Keywords

COPD
Diagnosis
Spirometry
Exacerbations
Treatment
Pulmonary rehabilitation

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© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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Cite this

Halpin, D. M. G., Dickens, A. P., Skinner, D., Murray, R. B., Singh, M., Hickman, K., Carter, V., Couper, A., Evans, A., Pullen, R., Menon, S., Morris, T., Muellerova, H., Bafadhel, M., Chalmers, J., Devereux, G., Gibson, M., Hurst, J. R., Jones, R., ... Price, D. (2023). Identification of key opportunities for optimising the management of high-risk COPD patients in the UK using the CONQUEST Quality Standards: an observational longitudinal study. The Lancet Regional Health - Europe, 29, Article 100619. https://doi.org/10.1016/j.lanepe.2023.100619

Identification of key opportunities for optimising the management of high-risk COPD patients in the UK using the CONQUEST Quality Standards: an observational longitudinal study. / Halpin, David M.G.; Dickens, Andrew P ; Skinner, Derek et al.
In: The Lancet Regional Health - Europe, Vol. 29, 100619, 01.06.2023.

Research output: Contribution to journal › Article › peer-review

Halpin, DMG, Dickens, AP, Skinner, D, Murray, RB, Singh, M, Hickman, K, Carter, V, Couper, A, Evans, A, Pullen, R, Menon, S, Morris, T, Muellerova, H, Bafadhel, M, Chalmers, J, Devereux, G, Gibson, M, Hurst, JR, Jones, R, Kostikas, K, Quint, J, Singh, D, van Melle, M, Wilkinson, TMA & Price, D 2023, 'Identification of key opportunities for optimising the management of high-risk COPD patients in the UK using the CONQUEST Quality Standards: an observational longitudinal study', The Lancet Regional Health - Europe, vol. 29, 100619. https://doi.org/10.1016/j.lanepe.2023.100619

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title = "Identification of key opportunities for optimising the management of high-risk COPD patients in the UK using the CONQUEST Quality Standards: an observational longitudinal study",

abstract = "Background: This study compared management of high-risk COPD patients in the UK to national and international management recommendations and quality standards, including the Collaboration on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). The primary comparison was in 2019, but trends from 2000 to 2019 were also examined.Methods: Patients identified in the Optimum Patient Care Research Database were categorised as newly diagnosed (≤12 months after diagnosis), already diagnosed, and potential COPD (smokers having exacerbation-like events). High-risk patients had a history of ≥2 moderate or ≥1 severe exacerbations in the previous 12 months.Findings: For diagnosed patients, the median time between diagnosis and first meeting the high-risk criteria was 617 days (Q1-Q3: 3246). The use of spirometry for diagnosis increased dramatically after 2004 before plateauing and falling in recent years. In 2019, 41% (95% CI 39-44%; n=550/1343) of newlydiagnosed patients had no record of spirometry in the previous year, and 45% (95% CI 43-48%;n=352/783) had no record of a COPD medication review within 6 months of treatment initiation or change. In 2019, 39% (n=6,893/17,858) of already diagnosed patients had no consideration of exacerbation rates, 46% (95% CI 45-47%; n=4,942/10,725) were not offered or referred for pulmonaryrehabilitation, and 41% (95% CI 40-42%; n=3,026/7,361) had not had a COPD review within 6 weeks of respiratory hospitalization.Interpretation: Opportunities for early diagnosis of COPD patients at high risk of exacerbation are being missed. Newly and already diagnosed patients at high-risk are not being assessed or treated promptly. There is substantial scope to improve the assessment and treatment optimisation of these patients.Funding: This study is conducted by the Observational & Pragmatic Research International Ltd and was co-funded by Optimum Patient Care and AstraZeneca. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.",

keywords = "COPD, Diagnosis, Spirometry, Exacerbations, Treatment, Pulmonary rehabilitation",

author = "Halpin, {David M.G.} and Dickens, {Andrew P} and Derek Skinner and Murray, {Ruth B} and Mukesh Singh and Katherine Hickman and Victoria Carter and Amy Couper and Alexander Evans and Rachel Pullen and Shruti Menon and Tamsin Morris and Hana Muellerova and Mona Bafadhel and James Chalmers and Graham Devereux and Martin Gibson and Hurst, {John R.} and Rupert Jones and Konstantinos Kostikas and Jennifer Quint and Dave Singh and {van Melle}, Marije and Wilkinson, {Tom M.A.} and David Price",

note = "Funding: This study is conducted by the Observational & Pragmatic Research International Ltd and was co-funded by Optimum Patient Care and AstraZeneca. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution. Acknowledgments We acknowledge Jonathan Marshall, Clementine Nordon, Mehul Patel, Michael Pollack, and Yang Xu, of AstraZeneca, for their contributions to the development and review of the protocol, and Kathleen Heil, of AstraZeneca, for project management support. We would also like to acknowledge Ms Shilpa Suresh (MSc) and Ms Andrea Lim (BSc) of the Observational and Pragmatic Research Institute (OPRI), Singapore, for editorial and formatting assistance which supported the development of this publication. ",

year = "2023",

month = jun,

day = "1",

doi = "10.1016/j.lanepe.2023.100619",

language = "English",

volume = "29",

journal = "The Lancet Regional Health - Europe",

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TY - JOUR

T1 - Identification of key opportunities for optimising the management of high-risk COPD patients in the UK using the CONQUEST Quality Standards

T2 - an observational longitudinal study

AU - Halpin, David M.G.

AU - Dickens, Andrew P

AU - Skinner, Derek

AU - Murray, Ruth B

AU - Singh, Mukesh

AU - Hickman, Katherine

AU - Carter, Victoria

AU - Couper, Amy

AU - Evans, Alexander

AU - Pullen, Rachel

AU - Menon, Shruti

AU - Morris, Tamsin

AU - Muellerova, Hana

AU - Bafadhel, Mona

AU - Chalmers, James

AU - Devereux, Graham

AU - Gibson, Martin

AU - Hurst, John R.

AU - Jones, Rupert

AU - Kostikas, Konstantinos

AU - Quint, Jennifer

AU - Singh, Dave

AU - van Melle, Marije

AU - Wilkinson, Tom M.A.

AU - Price, David

N1 - Funding: This study is conducted by the Observational & Pragmatic Research International Ltd and was co-funded by Optimum Patient Care and AstraZeneca. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution. Acknowledgments We acknowledge Jonathan Marshall, Clementine Nordon, Mehul Patel, Michael Pollack, and Yang Xu, of AstraZeneca, for their contributions to the development and review of the protocol, and Kathleen Heil, of AstraZeneca, for project management support. We would also like to acknowledge Ms Shilpa Suresh (MSc) and Ms Andrea Lim (BSc) of the Observational and Pragmatic Research Institute (OPRI), Singapore, for editorial and formatting assistance which supported the development of this publication.

PY - 2023/6/1

Y1 - 2023/6/1

N2 - Background: This study compared management of high-risk COPD patients in the UK to national and international management recommendations and quality standards, including the Collaboration on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). The primary comparison was in 2019, but trends from 2000 to 2019 were also examined.Methods: Patients identified in the Optimum Patient Care Research Database were categorised as newly diagnosed (≤12 months after diagnosis), already diagnosed, and potential COPD (smokers having exacerbation-like events). High-risk patients had a history of ≥2 moderate or ≥1 severe exacerbations in the previous 12 months.Findings: For diagnosed patients, the median time between diagnosis and first meeting the high-risk criteria was 617 days (Q1-Q3: 3246). The use of spirometry for diagnosis increased dramatically after 2004 before plateauing and falling in recent years. In 2019, 41% (95% CI 39-44%; n=550/1343) of newlydiagnosed patients had no record of spirometry in the previous year, and 45% (95% CI 43-48%;n=352/783) had no record of a COPD medication review within 6 months of treatment initiation or change. In 2019, 39% (n=6,893/17,858) of already diagnosed patients had no consideration of exacerbation rates, 46% (95% CI 45-47%; n=4,942/10,725) were not offered or referred for pulmonaryrehabilitation, and 41% (95% CI 40-42%; n=3,026/7,361) had not had a COPD review within 6 weeks of respiratory hospitalization.Interpretation: Opportunities for early diagnosis of COPD patients at high risk of exacerbation are being missed. Newly and already diagnosed patients at high-risk are not being assessed or treated promptly. There is substantial scope to improve the assessment and treatment optimisation of these patients.Funding: This study is conducted by the Observational & Pragmatic Research International Ltd and was co-funded by Optimum Patient Care and AstraZeneca. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.

AB - Background: This study compared management of high-risk COPD patients in the UK to national and international management recommendations and quality standards, including the Collaboration on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). The primary comparison was in 2019, but trends from 2000 to 2019 were also examined.Methods: Patients identified in the Optimum Patient Care Research Database were categorised as newly diagnosed (≤12 months after diagnosis), already diagnosed, and potential COPD (smokers having exacerbation-like events). High-risk patients had a history of ≥2 moderate or ≥1 severe exacerbations in the previous 12 months.Findings: For diagnosed patients, the median time between diagnosis and first meeting the high-risk criteria was 617 days (Q1-Q3: 3246). The use of spirometry for diagnosis increased dramatically after 2004 before plateauing and falling in recent years. In 2019, 41% (95% CI 39-44%; n=550/1343) of newlydiagnosed patients had no record of spirometry in the previous year, and 45% (95% CI 43-48%;n=352/783) had no record of a COPD medication review within 6 months of treatment initiation or change. In 2019, 39% (n=6,893/17,858) of already diagnosed patients had no consideration of exacerbation rates, 46% (95% CI 45-47%; n=4,942/10,725) were not offered or referred for pulmonaryrehabilitation, and 41% (95% CI 40-42%; n=3,026/7,361) had not had a COPD review within 6 weeks of respiratory hospitalization.Interpretation: Opportunities for early diagnosis of COPD patients at high risk of exacerbation are being missed. Newly and already diagnosed patients at high-risk are not being assessed or treated promptly. There is substantial scope to improve the assessment and treatment optimisation of these patients.Funding: This study is conducted by the Observational & Pragmatic Research International Ltd and was co-funded by Optimum Patient Care and AstraZeneca. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.

KW - COPD

KW - Diagnosis

KW - Spirometry

KW - Exacerbations

KW - Treatment

KW - Pulmonary rehabilitation

U2 - 10.1016/j.lanepe.2023.100619

DO - 10.1016/j.lanepe.2023.100619

M3 - Article

C2 - 37131493

SN - 2666-7762

VL - 29

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 100619

ER -

Identification of key opportunities for optimising the management of high-risk COPD patients in the UK using the CONQUEST Quality Standards: an observational longitudinal study

Abstract

Bibliographical note

Keywords

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