Today, the Observational & Pragmatic Research Institute (OPRI) and affiliate organization Optimum Patient Care (OPC) announced the results of the latest observational study for the Collaboration on Quality Improvement Initiative for Achieving Excellence in Standards of Chronic Obstructive Pulmonology Disease (COPD) care (CONQUEST program), that is being delivered in collaboration with respiratory experts and AstraZeneca.
Focused on the management of patients with high-risk* COPD in the United States (US), the CONQUEST program’s opportunity analysis highlighted areas to enhance patient care, spanning from the point of diagnosis through to maximizing therapy and patient assessment.
Accessing US electronic medical records, provided by the DARTNet Institute, for ~1 million patients, OPRI evaluated 9-years of COPD management practices against national, international and CONQUEST Quality Standards, from 2011 through 2019.
Top 3 Areas of Opportunity in US Primary Care
1. Earlier opportunities to enhance identification of those at high-risk of respiratory flare-ups and other exacerbation events
In 2019, 12.8% of patients newly diagnosed with COPD were high-risk, and almost 1 in 3 of these patients had 3 or more exacerbations (acute chest infections or similar events) in the 12-months before diagnosis.
Among these newly diagnosed patients, there was scope to conduct systematic COPD review (including symptom assessment) in 42.7% of patients, 12 months either side of their diagnosis.
2. Opportunities to increase diagnostic & risk assessments in patients with high-risk COPD
Nearly all (98%) patients with high-risk COPD had no evidence of cardiovascular (CV) risk assessment, which is particularly important given the growing body of evidence surrounding the associations between COPD exacerbation events and CV events.
Moreover, large opportunities to conduct diagnostic assessments persist in patients with high-risk COPD. Approximately 80% were without record of diagnostic assessment by lung function testing, despite it being a critical component of diagnostic criteria.
3. Opportunities to optimize pharmacological intervention for patients with high-risk COPD
Treatment could be optimized for over 50% of patients with high-risk COPD who, in 2019, were on no inhaled therapy, with an additional 12% of patients receiving relievers only and ~9% on monotherapies.
Per current Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations, many, if not all, of these high-risk patients would benefit from initiating or stepping up their treatment.
‘‘Collectively, our findings underscore the long-term opportunities for enhancements in COPD management in US primary care’’, shared Professor David Price, ‘‘but they also call for improvements in the consistency of coding of data in electronic medical records’’. OPRI’s founder later added that ‘‘CONQUEST will tackle these areas by working with physicians to not only ensure they have access to accurate information but to also provide clinical decision support at the point of care.’’
Recognizing this scope for improved high-risk COPD management presents opportunities to affect patient outcomes in US primary care. While this study did not include data from the pandemic, the scope for change has likely expanded further since then, given the significant and persistent impacts of COVID-19 on how care is being delivered.
Dr Barry Make, Steering Committee member, and Pulmonologist at National Jewish Health, also shared that ‘‘given the extent of both under- and misdiagnosis of COPD in the United States, these results highlight the significance of a program like CONQUEST that drive the implementation of earlier, comprehensive disease assessment, that includes monitoring risk of future adverse respiratory and cardiovascular events.’’
To view the full results of CONQUEST’s US Opportunity Analysis study and the scope for change, read the paper here.
*Patients at high-risk were identified as those who had experienced ≥2 moderate or ≥1 severe (requiring hospitalization) exacerbations, or probable exacerbations (for patients with suspected but undiagnosed COPD) in the previous 24 months, with one of these events occurring in the last 12 months.
COPD exacerbations are a large healthcare burden in COPD, and carry considerable consequences, including lung function decline, cardiac events, and steroid-related side effects.
CONQUEST is a collaborative, interventional COPD registry that drives long-term, targeted, patient-centred changes in COPD management. The promotion of expert and guideline-led care aims to reduce exacerbation frequency and improve health care outcomes. It comprises an integrated quality improvement program focusing on patients (diagnosed and undiagnosed) at a modifiable and higher risk of COPD exacerbations. CONQUEST is underpinned by four evidence-based Quality Standards developed by 11 experts internationally recognized in their field. CONQUEST is co-funded by AstraZeneca and OPC.
Approximately 16 million people have COPD in the US alone. COPD is a group of progressive lung diseases, of which the most common are emphysema and chronic bronchitis. Common COPD symptoms include frequent coughing or wheezing, excess mucus production, shortness of breath and trouble taking a deep breath. While there is no cure for COPD, treatment can help ease symptoms, lower the chance of complications, and generally improve health related quality of life.