The COPD Patient Voice Being Heard in Quality Improvement

Patient-centeredness is now considered an essential element of high quality healthcare. By definition, in this approach, the patient is the focus of respectful care and guides decision making concerning his or her health. While quite a change from the earlier days of paternalism in medicine, the patient-centered care movement is now thriving. The inclusion of empathy and patient-centeredness in medical training and testing and the mandated establishment of influential organizations such as the Patient Centered Outcomes Research Institute (PCORI) are just two of the many clear signals that this new approach is an enduring one.

But there is still much work to be done, particularly in the area of outcomes measurement. In health disciplines, the success of initiatives and organizations is systematically assessed through the use of standard metrics. These are much like report cards; an agency or governing body determines the parameters on which the performance of all like entities will be measured. These organizations then methodically report their data to be compared to their counterparts. Such comparisons can be extremely important to hospitals and practitioners – they can determine the absence or presence of significant funding and can encourage or deter patients from using their services.

In COPD care delivery, there are 20 measures currently in use in the U.S. for outcomes measurement (see page one of results at link). These range from the more visible measures of the Hospital Readmissions Reduction Program (HRRP) on 30-day rehospitalizations to the National Committee on Quality Assurance’s measure on diagnosis via spirometry. Still other current measures assess smoking cessation efforts in COPD patients and referrals to pulmonary rehabilitation for those with moderate to severe COPD.

What do all of these have in common? They are all objective measures of success and reflect health care provider actions or impact. These objective measures are completely valid and essential to the demonstration of program effect. But in a patient-centered care environment, should we not also be asking patients themselves 1) what constitutes success from their vantage point and 2) if their health care providers have been successful in those efforts?

The National Quality Foundation (NQF), a non-profit devoted to quality improvement in healthcare, is working to that end. NQF runs the Measure Incubator, a project that nurtures quality measure development, particularly for those disease states for which inadequate quality measurement currently exists. Recently, MN Community Measurement (MNCM) announced that through the Measure Incubator, they will be developing a COPD patient-reported measure of physician practice outcomes. That is, this initiative will produce the first-ever COPD patient-centered outcomes measure intended for national use. Their first work group meeting took place last week.

NQF recognizes both the gap in current outcomes measurement for people with COPD as well as the need for quality improvement given the public health impact of these diseases. MNCM’s effort is timely and consistent with the basic tenets of NHLBI’s 2016 COPD Town Hall meeting. At the March event, patients were represented in each of the groups formed to tackle their six national goals; two of these six goals addressed quality improvement issues with an eye toward patient-centered program and process improvement at the local and national levels.

“Patient-centered care is prominently positioned on the political agenda, but our measures are not yet up to the challenge of ensuring that it is happening,” stated Drs. Ronald Epstein and Richard Street in a 2011 article. With these steps toward true COPD patient inclusion in the outcomes portion of the process, we are closer than ever to this changing.