Table 3 List of quality of care indicators with relevant expected change after intervention

Prevalence indicator

1

COPD prevalence

N. COPD patients (identified with a registration of ICD-CM-9: 496* or 491.2*) [numerator]/ total inhabitants of GPs participating to the study [denominator]

None

No change is expected in prevalence of COPD. The increase in newly occurring cases plus identification of false negative cases due to training on COPD diagnosis should be balanced by the death of the most severe cases and removal of false positive cases from the archives after the re-evaluation of previous diagnosis from GPs’.

Diagnostic process indicators

2

% of COPD patients with at least one spirometry test registered lifetime

N. COPD patients with at least one spirometry test registered lifetime [numerator]/ total COPD patients [denominator]

Increase

In agreement with GOLD guidelines spirometry test is required in the COPD diagnosis, Therefore, an increase in this data registration, especially in smokers, is expected.

3

% COPD patients, smokers or ex smokers, with at least one spirometry test registered lifetime

N. COPD patients, smokers or ex smokers, with at least one spirometry test registered lifetime [numerator]/ total COPD patients, smokers or ex smokers [denominator]

Increase

4

% COPD patients with at least one spirometry test registered in the last year

N. COPD patients with at least one spirometry test registered in the last 365 days [numerator]/ total COPD patients [denominator]

Increase

5

Mean number of spirometry registrations by COPD patients in the last two years

N. spirometry registrations in the last two years [numerator]/ total COPD patients with at least one spirometry registration in the last two years [denominator]

Increase

Preventive measures indicators

6

% COPD patients with BMI registration lifetime

N. COPD patients with BMI registration [numerator]/total COPD patients [denominator]

Increase

Overweight and obesity may modify the clinical overview of COPD, as well as comorbidities. Therefore, a careful registration and an increase of BMI data are expected.

7

% COPD patients with smoking registration lifetime

N. COPD patients with smoking registration [numerator]/total COPD patients [denominator]

Increase

Tobacco smoke is the main risk factor for COPD. Therefore, a careful registration and an increase of smoking data are expected.

8

% COPD patients with influenza vaccination registration in the last year

N. COPD patients with influenza vaccination registration in the last year [numerator]/total COPD patients [denominator]

Increase

In COPD patients, influenza vaccination can reduce serious illness and it should be offered in line with local guidelines. Therefore, a careful registration and an increase of influenza vaccination data are expected.

9

% COPD patients with pneumococcal vaccination registration in the last 4 years

N. COPD patients with pneumococcal vaccination registration in the last 4 years [numerator]/total COPD patients [denominator]

Increase

GOLD guidelines recommend pneumococcal vaccination for COPD patients older than 64 years and those younger than 65 with and with predicted FEV₁ < 40%. Therefore, a careful registration and an increase of pneumococcal vaccination data are expected.

Therapeutic process indicators

10

% COPD patients with prescriptions for drugs targeting obstructive airway diseases in the last year

N. COPD patients with ≥1 prescription for drugs targeting obstructive airway diseases in the last year/ total COPD patients [denominator]

Increase

When COPD diagnosis is confirmed, all patients should be treated chronically or as needed on the basis on GOLD staging. Therefore, an increase of prescriptions of drugs targeting obstructive airway is expected.

11

% COPD patients with at least one alone ICS prescription (without any ICS + LABA and/ or LAMA prescription) in the last year

N. COPD patients with ≥1 ICS prescription as monotherapy (i.e., no LABA and/or LAMA prescription) in the last year [numerator] /total COPD patients [denominator]

Decrease

In COPD treatment, use of ICS is recommended only in combination with bronchodilators. Therefore, a decrease of ICS prescription as monotherapy is expected.

12

Occasional use (only 1 prescription) of long-acting bronchodilators in the last year

N. COPD patients with only 1 prescription of long-acting bronchodilators plus ICS or less (LABA and/or LAMA and/or LABA/LAMA + ICS) in the last year [numerator]/ total COPD patients [denominator]

Decrease

Long-acting bronchodilators have to be used chronically. Therefore, a decrease of occasional use of long acting bronchodilators is expected.

13

% COPD patients in treatment with leukotriene receptor antagonists in the last year

N. COPD patients with ≥1 prescription of leukotriene receptor antagonists in the last year [numerator]/ total COPD patients [denominator]

Decrease

Leukotriene receptor antagonists are not approved for COPD treatment A decrease of prescriptions of leukotriene receptor antagonists is expected.

14

% COPD patients with low adherence to LABA and/or LAMA therapy (±ICS)

N. COPD patients with <8 packages of LABA and/or LAMA (±ICS) in the last year [numerator]/ total COPD patients in treatment with LABA and/or LAMA (±ICS) [denominator]

Decrease

Long acting bronchodilators are indicated for COPD patients as chronic treatment. Therefore, a decrease of patients with low adherence to LABA and/or LAMA (±ICS) therapy is expected.

15

% COPD patients with prolonged term therapy with ICS in monotherapy

N. COPD patients with >5 packages of ICS (alone, without any ICS + LABA and/ or LAMA prescription) prescribed in the last year [numerator]/ total COPD patients in treatment with ICS (alone, without any ICS + LABA and/ or LAMA prescription)[denominator]

Decrease

Long term therapy with inhaled corticosteroid is associated with an increased risk of adverse effects (i.e. pneumonia, fractures). Therefore, a decrease of patients with prolonged term therapy with ICS is expected.