Reducing socioeconomic inequalities in COPD care in the hospital outpatient setting: A nationwide initiative
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Reducing socioeconomic inequalities in COPD care in the hospital outpatient setting : A nationwide initiative. / Tøttenborg, Sandra S.; Lange, Peter; Thomsen, Reimar W.; Nielsen, Henrik; Johnsen, Søren P.
I: Respiratory Medicine, Bind 125, 04.2017, s. 19-23.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Reducing socioeconomic inequalities in COPD care in the hospital outpatient setting
T2 - A nationwide initiative
AU - Tøttenborg, Sandra S.
AU - Lange, Peter
AU - Thomsen, Reimar W.
AU - Nielsen, Henrik
AU - Johnsen, Søren P.
PY - 2017/4
Y1 - 2017/4
N2 - Objective: Socioeconomic differences in quality of care have been suggested to contribute to inequality in clinical prognosis of COPD. We examined socioeconomic differences in the quality of COPD outpatient care and the potential of a systematic quality improvement initiative in reducing potential socioeconomic differences.Methods: A mandatory national quality improvement initiative has since 2008 monitored the quality of COPD care at all national pulmonary specialized outpatient clinics in Denmark using six evidence-based process performance measures. We followed patients aged ≥30 years with a first-ever outpatient contact for COPD during 2008–2012 (N = 23,741). Adjusted year-specific relative risks (RR) of fulfilling all relevant process performance measures was compared according to ethnicity, education, income, employment, and cohabitation using Poisson regression.Results: Quality of care improved following the implementation of the clinical improvement initiative with 11% of COPD patients receiving optimal care in 2008 compared to 57% in 2012. Substantial socioeconomic differences were observed the first year: immigrants (RR 0.41, 95% CI 0.21–0.82), the unemployed (RR 0.37, 95% CI 0.18–0.74), disability pensioners (RR 0.63, 95% CI 0.46–0.87) and patients living alone (RR 0.80, 95% CI 0.60–0.97) were less likely to receive all relevant care processes, whereas those with highest education (RR 1.22, 95% CI 0.92–1.63) were more likely to receive these processes. These differences were eliminated during the study period.Conclusion: A systematic quality improvement initiative including regular audits, knowledge sharing, and detailed disease-specific recommendations for care improvement may increase the overall quality of care and considerably modify the substantial socioeconomic inequalities in COPD management.
AB - Objective: Socioeconomic differences in quality of care have been suggested to contribute to inequality in clinical prognosis of COPD. We examined socioeconomic differences in the quality of COPD outpatient care and the potential of a systematic quality improvement initiative in reducing potential socioeconomic differences.Methods: A mandatory national quality improvement initiative has since 2008 monitored the quality of COPD care at all national pulmonary specialized outpatient clinics in Denmark using six evidence-based process performance measures. We followed patients aged ≥30 years with a first-ever outpatient contact for COPD during 2008–2012 (N = 23,741). Adjusted year-specific relative risks (RR) of fulfilling all relevant process performance measures was compared according to ethnicity, education, income, employment, and cohabitation using Poisson regression.Results: Quality of care improved following the implementation of the clinical improvement initiative with 11% of COPD patients receiving optimal care in 2008 compared to 57% in 2012. Substantial socioeconomic differences were observed the first year: immigrants (RR 0.41, 95% CI 0.21–0.82), the unemployed (RR 0.37, 95% CI 0.18–0.74), disability pensioners (RR 0.63, 95% CI 0.46–0.87) and patients living alone (RR 0.80, 95% CI 0.60–0.97) were less likely to receive all relevant care processes, whereas those with highest education (RR 1.22, 95% CI 0.92–1.63) were more likely to receive these processes. These differences were eliminated during the study period.Conclusion: A systematic quality improvement initiative including regular audits, knowledge sharing, and detailed disease-specific recommendations for care improvement may increase the overall quality of care and considerably modify the substantial socioeconomic inequalities in COPD management.
KW - COPD
KW - Quality of care
KW - Process performance indicators
KW - COPD care standardization
KW - Socioeconomic inequality
KW - COPD management
U2 - 10.1016/j.rmed.2017.02.016
DO - 10.1016/j.rmed.2017.02.016
M3 - Journal article
C2 - 28340857
VL - 125
SP - 19
EP - 23
JO - Respiratory Medicine
JF - Respiratory Medicine
SN - 0954-6111
ER -
ID: 185241264