Clinical Audit of COPD Patients Requiring Hospital Admissions in Spain: AUDIPOC Study

PLOS ONE, Dec 2019

Backgrounds AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive pulmonary disease (ECOPD), assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients’ characteristics, and adherence to guidelines. Methodology/Principal Findings An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible) were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0–35%). Among discharged patients, 37% required readmission (0–62%) and 6.5% died (0–35%). The overall mortality rate was 11.6% (0–50%). Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (<50%) addressed guidance on healthy life-styles. Conclusions/Significance The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement.

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Clinical Audit of COPD Patients Requiring Hospital Admissions in Spain: AUDIPOC Study

et al. (2012) Clinical Audit of COPD Patients Requiring Hospital Admissions in Spain: AUDIPOC Study. PLoS ONE 7(7): e42156. doi:10.1371/journal.pone.0042156 Clinical Audit of COPD Patients Requiring Hospital Admissions in Spain: AUDIPOC Study Francisco Pozo-Rodrguez 0 Jose Luis Lo pez-Campos 0 Carlos J. A lvarez-Martnez 0 Ady Castro- 0 Acosta 0 Ramo n Agu ero 0 Javier Hueto 0 Jesu s Herna ndez-Herna ndez 0 Manuel Barro n 0 Victor Abraira 0 Anabel Forte 0 Juan Miguel Sanchez Nieto 0 Encarnacio n Lopez-Gabaldo n 0 Borja G. Coso 0 Alvar Agust 0 on behalf of the AUDIPOC Study Group" 0 Joan A. Cayla`, Public Health Agency of Barcelona, Spain 0 1 Instituto de Investigacio n, Hospital 12 de Octubre , Madrid Spain , 2 Centre for Biomedical Research on Respiratory Diseases (CIBERES). Instituto de Salud Carlos III , Madrid , Spain , 3 Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Roc o , Seville , Spain , 4 Hospital Universitario Marque s de Valdecilla , Santander , Spain , 5 Complejo Hospitalario de Navarra , Pamplona , Spain , 6 Hospital Nuestra Sra. de Sonsoles, A vila, Spain, 7 Complejo Hospitalario San Milla n , Logron o, Spain, 8 Hospital Universitario Ramo n y Cajal, IRYCIS, Madrid , Spain , 9 Centre for Biomedical Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III , Madrid , Spain , 10 Department of Statistics and Operational Research, Universidad de Castello n , Castello n, Spain , 11 Hospital Universitario Morales Meseguer , Murcia , Spain , 12 Hospital Virgen de la Salud , Toledo , Spain , 13 Hospital Universitario Son Espases , Balearic Island , Spain , 14 Instituto del To rax, Hospital Cl`nic , Barcelona , Spain Backgrounds: AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive pulmonary disease (ECOPD), assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients' characteristics, and adherence to guidelines. Methodology/Principal Findings: An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible) were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0-35%). Among discharged patients, 37% required readmission (0-62%) and 6.5% died (0-35%). The overall mortality rate was 11.6% (050%). Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (,50%) addressed guidance on healthy life-styles. Conclusions/Significance: The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement. - Funding: This work was supported by Fondo de Investigacio n Sanitaria (FIS), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovacio n (PI 08/90129, PI 90486, PI08/90578, PI 07/90503, PI 08/90251, PI 07/90516, PI 08/90529, PI 07/90309, PI 08/90457, PI 08/90129, PI 07/90721, PI 08/90550, PI08/90447, PI07/90403, PI 08/90486), Spanish Respiratory Society (SEPAR) and CIBER de Enfermedades Respiratorias (CIBERES). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. " Membership of the AUDIPOC Study Group is provided in the Acknowledgments. The existence of variations in clinical practice and clinical appropriateness has been recognized for decades [1]. Two methods, both developed in the late 1980s, of exploring and dealing with these variations are Evidence-Based Medicine and Clinical Audits [2,3]. These approaches are of particular relevance for the development of evidence-based clinical practice guidelines and the generation of real-life information that may eventually feed-back to the further refinement of guidelines [4]. Chronic Obstructive Pulmonary Disease (COPD) is a major health problem of increasing incidence. COPD is currently th (...truncated)


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Francisco Pozo-Rodríguez, Jose Luis López-Campos, Carlos J. Álvarez-Martínez, Ady Castro-Acosta, Ramón Agüero, Javier Hueto, Jesús Hernández-Hernández, Manuel Barrón, Victor Abraira, Anabel Forte, Juan Miguel Sanchez Nieto, Encarnación Lopez-Gabaldón, Borja G. Cosío, Alvar Agustí, on behalf of the AUDIPOC Study Group. Clinical Audit of COPD Patients Requiring Hospital Admissions in Spain: AUDIPOC Study, PLOS ONE, 2012, Volume 7, Issue 7, DOI: 10.1371/journal.pone.0042156