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Chronic obstructive pulmonary disease in adults [QS10]

Measuring the use of this guidance

Statement: 1

People aged over 35 years who present with a risk factor and one or more symptoms of chronic obstructive pulmonary disease (COPD) have post‑bronchodilator spirometry. 2011, updated 2016.

Quality standard measure: Proportion of people aged over 35 years presenting with a risk factor and one or more symptoms of COPD who have post‑bronchodilator spirometry.
What was measured: COPD002: The percentage of patients with COPD (diagnosed on or after 1 April 2011) in whom the diagnosis has been confirmed by post bronchodilator spirometry between 3 months before and 12 months after entering on to the register.
Data collection end: March 2014
90.7%
Number that met the criteria: 236107 / 260193
Data collection end: March 2016
81%
Data collection end: March 2017
81%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Statement: 2

People with chronic obstructive pulmonary disease (COPD) who are prescribed an inhaler have their inhaler technique assessed when starting treatment and then regularly during treatment.

Quality standard measure: Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed at their annual review.
What was measured: The proportion of people who have COPD and are using inhaler therapy received an inhaler technique check.
Data collection end: March 2015
91.3%
Area covered: Wales
Source: Royal College of Physicians. National COPD Audit Programme: primary care


Statement: 4

People with stable chronic obstructive pulmonary disease (COPD) and exercise limitation due to breathlessness are referred to a pulmonary rehabilitation programme. 2011, updated 2016

Quality standard measure: Evidence of local arrangements and written clinical protocols to ensure that people with stable COPD and exercise limitation due to breathlessness are referred to a pulmonary rehabilitation programme.
What was measured: The proportion of pulmonary rehabilitation programmes that accept patients with COPD who report significant exercise limitation and report MRC grade 3.
Data collection end: April 2015
96%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

Quality standard measure: Evidence of local arrangements and written clinical protocols to ensure that people with stable COPD and exercise limitation due to breathlessness are referred to a pulmonary rehabilitation programme.
What was measured: The proportion of pulmonary rehabilitation programmes that accept patients with COPD who report significant exercise limitation and report MRC grade 4.
Data collection end: April 2015
97%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

Quality standard measure: Evidence of local arrangements and written clinical protocols to ensure that people with stable COPD and exercise limitation due to breathlessness are referred to a pulmonary rehabilitation programme.
What was measured: The proportion of pulmonary rehabilitation programmes that accept patients with COPD who report significant exercise limitation and report MRC grade 5.
Data collection end: April 2015
81%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

Quality standard measure: Evidence of local arrangements and written clinical protocols to ensure that people with stable COPD and exercise limitation due to breathlessness are referred to a pulmonary rehabilitation programme.
What was measured: Proportion of pulmonary rehabilitation programmes that included the incremental shuttle walk test exercise outcome assessment.
Data collection end: April 2015
67%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

Quality standard measure: Evidence of local arrangements and written clinical protocols to ensure that people with stable COPD and exercise limitation due to breathlessness are referred to a pulmonary rehabilitation programme.
What was measured: Proportion of pulmonary rehabilitation programmes that included the 6-minute walk test exercise outcome assessment.
Data collection end: April 2015
69%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

Quality standard measure: Evidence of local arrangements and written clinical protocols to ensure that people with stable COPD and exercise limitation due to breathlessness are referred to a pulmonary rehabilitation programme.
What was measured: Proportion of pulmonary rehabilitation programmes that keep a database of programme information including patient outcomes, attendance and completion rates.
Data collection end: April 2015
96%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

Quality standard measure: Proportion of attendances of people with stable COPD and exercise limitation due to breathlessness that result in the person completing a pulmonary rehabilitation programme.
What was measured: Proportion of attendances of people with stable COPD and exercise limitation due to breathlessness that result in the person completing a pulmonary rehabilitation programme.
Data collection end: April 2015
71%
Number that met the criteria: 4456 / 6319
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation

Quality standard measure: Proportion of attendances of people with stable COPD and exercise limitation due to breathlessness that result in the person completing a pulmonary rehabilitation programme.
What was measured: The proportion of people on COPD registers in Wales with a severity of breathlessness that would indicate suitability for referral for pulmonary rehabilitation have ever been referred to the service.
Data collection end: March 2015
34.5%
Area covered: Wales
Source: Royal College of Physicians. National COPD Audit Programme: primary care


Statement: 5

People admitted to hospital for an acute exacerbation of chronic obstructive pulmonary disease (COPD) start a pulmonary rehabilitation programme within 4 weeks of discharge. 2011, updated 2016

Quality standard measure: Evidence of local arrangements and written clinical protocols to ensure that people with COPD admitted to hospital for an acute exacerbation start a pulmonary rehabilitation programme within 4 weeks of discharge.
What was measured: Proportion of units with a pulmonary rehabilitation service available to patients discharged after exacerbation.
Data collection end: May 2014
92%
Number that met the criteria: 183 / 198
Data collection end: June 2017
94%
Number that met the criteria: 178 / 190
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: secondary care

Quality standard measure: Evidence of local arrangements and written clinical protocols to ensure that people with COPD admitted to hospital for an acute exacerbation start a pulmonary rehabilitation programme within 4 weeks of discharge.
What was measured: Proportion of units with a pulmonary rehabilitation service, available to patients who had an exacerbation, where it was available within 4 weeks of discharge.
Data collection end: May 2014
38%
Number that met the criteria: 70 / 183
Data collection end: June 2017
45%
Number that met the criteria: 80 / 178
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: secondary care

Quality standard measure: Evidence of local arrangements and written clinical protocols to ensure that people with COPD admitted to hospital for an acute exacerbation start a pulmonary rehabilitation programme within 4 weeks of discharge.
What was measured: Proportion of pulmonary rehabilitation programmes that offer pulmonary rehabilitation following hospitalisation for exacerbation of COPD.
Data collection end: April 2015
68%
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: pulmonary rehabilitation


Statement: 6

People receiving emergency oxygen for an acute exacerbation of chronic obstructive pulmonary disease (COPD) have their oxygen saturation levels maintained between 88% and 92%. 2011, updated 2016

Quality standard measure: Proportion of people receiving emergency oxygen for an acute exacerbation of COPD who have their oxygen saturation levels maintained between 88% and 92%.
What was measured: Proportion of people admitted with an acute exacerbation of COPD who were prescribed oxygen which was to a stipulated target range of 88-92%.
Data collection end: September 2017
85.1%
Number that met the criteria: 17733 / 29829
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: secondary care

Quality standard measure: Proportion of people receiving emergency oxygen for an acute exacerbation of COPD who have their oxygen saturation levels maintained between 88% and 92%.
What was measured: Proportion of patients whose oxygen prescription target range was 88% to 92%.
Data collection end: September 2018
85%
Number that met the criteria: 35336 / 41596
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: secondary care


Statement: 7

People with an acute exacerbation of chronic obstructive pulmonary disease (COPD) and persistent acidotic hypercapnic ventilatory failure that is not improving after 1 hour of optimal medical therapy have non‑invasive ventilation. 2011, updated 2016

Quality standard measure: Proportion of people with an exacerbation of COPD and persistent acidotic hypercapnic ventilatory failure that is not improving after 1 hour of optimal medical treatment who have non‑invasive ventilation.
What was measured: Patients given non-invasive ventilation within 3 hours of admission (for cases where both date and time are known).
Data collection end: May 2014
42.4%
Number that met the criteria: 505 / 1191
Data collection end: September 2017
40.3%
Number that met the criteria: 1191 / 2957
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: secondary care

Quality standard measure: Proportion of people with an exacerbation of COPD and persistent acidotic hypercapnic ventilatory failure that is not improving after 1 hour of optimal medical treatment who have non‑invasive ventilation.
What was measured: Patients given non-invasive ventilation within 2 hours of admission.
Data collection end: September 2018
21.2%
Number that met the criteria: 1546 / 7300
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: secondary care

Quality standard measure: Evidence of local arrangements to ensure that people with an acute exacerbation of COPD and persistent acidotic hypercapnic ventilatory failure that is not improving after 1 hour of optimal medical treatment have non‑invasive ventilation.
What was measured: Proportion of respiratory wards providing non-invasive ventilation (NIV).
Data collection end: May 2014
81%
Number that met the criteria: 160 / 198
Data collection end: June 2017
82%
Number that met the criteria: 156 / 190
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: secondary care

Quality standard measure: Evidence of local arrangements to ensure that people with an acute exacerbation of COPD and persistent acidotic hypercapnic ventilatory failure that is not improving after 1 hour of optimal medical treatment have non‑invasive ventilation.
What was measured: Proportion of units providing a training programme for staff providing non-invasive ventilation (NIV).
Data collection end: May 2014
90%
Number that met the criteria: 178 / 198
Data collection end: June 2017
92%
Number that met the criteria: 174 / 190
Area covered: England and Wales
Source: Royal College of Physicians. National COPD Audit Programme: secondary care



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