Chen Xiao Rui Catherine, Fu Sau Nga, Leung Wing Kit, Ng Sze Wing Catherine, Kwan Wing Yan Wendy, Wong Tseng Kwong, Chan Pang Fai, Wong Man Ying Michelle, Ko Wai Kit Welchie, Liang Jun, Hui Ming Tung Eric, Li Yim Chu, Luk Wan, Chao V K David
Department of Family Medicine and General Out Patient Clinics, Kowloon Central Cluster, Hospital Authority, Hong Kong.
Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong.
Int J Chron Obstruct Pulmon Dis. 2021 Jun 23;16:1901-1911. doi: 10.2147/COPD.S304527. eCollection 2021.
To enhance the quality of COPD management in primary care via a two-phase clinical audit in Hong Kong.
COPD patients aged 40 or above and had attended any of the 73 public primary care clinics under the Hospital Authority of Hong Kong (HAHK) for follow up (FU) during the audit period were included. Performance of six evidence-based audit criteria on COPD care was reviewed in phase 1 from 1st April 2017 to 31st March 2018. Service gaps were identified and a series of quality improvement strategies were executed in the one-year implementation phase. The outcome of the service enhancement was assessed in phase 2 from 1st April 2019 to 31st March 2020. Student's -test and the chi-square test were used to examine the statistically significant differences between the two phases.
Totally 10,385 COPD cases were identified in phase 1, the majority were male (87.7%) and the mean age was 75.3±9.9 years. Among the 3102 active smokers, 1788 (57.6%) were referred to receive the smoking cessation counselling and 1578 (50.9%) actually attended it. A total of 4866 cases (46.9%) received seasonal influenza vaccine (SIV) and 4227 cases (40.7%) received pneumococcal vaccine (PCV). A total of 1983 patients (19.1%) had spirometry test done before and 1327 patients (12.8%) had history of hospital admission due to acute exacerbation of COPD (AECOPD). After the proactive implementation phase, performance on all criteria was significantly improved in phase 2, with a marked increase in the SIV and PCV uptake rate and spirometry performance rate. Most importantly, a significant reduction in AECOPD rate leading to hospital admission had been achieved (9.6%, <0.00001).
COPD care at all public primary care clinics of HAHK had been significantly improved for all audit criteria via the systematic team approach, which, in turn, reduced the hospital admission rate and helped relieve the burden of the health care system.
通过香港的两阶段临床审计提高基层医疗中慢性阻塞性肺疾病（COPD）的管理质量。
纳入年龄在40岁及以上、在审计期间曾到香港医院管理局（HAHK）下属73家公立基层医疗诊所中的任何一家进行随访（FU）的COPD患者。在2017年4月1日至2018年3月31日的第一阶段，对COPD护理的六项循证审计标准的执行情况进行审查。识别服务差距，并在为期一年的实施阶段执行一系列质量改进策略。在2019年4月1日至2020年3月31日的第二阶段评估服务改进的结果。使用学生t检验和卡方检验来检验两个阶段之间的统计学显著差异。
第一阶段共识别出10385例COPD病例，大多数为男性（87.7%），平均年龄为75.3±9.9岁。在3102名现吸烟者中，1788人（57.6%）被转介接受戒烟咨询，1578人（50.9%）实际参加了咨询。共有4866例（46.9%）接受了季节性流感疫苗（SIV）接种，4227例（40.7%）接受了肺炎球菌疫苗（PCV）接种。共有1983例患者（19.1%）进行了肺功能测定，1327例患者（12.8%）有因慢性阻塞性肺疾病急性加重（AECOPD）住院的病史。在积极的实施阶段之后，第二阶段所有标准的执行情况均有显著改善，SIV和PCV接种率以及肺功能测定执行率显著提高。最重要的是，因AECOPD导致住院的比率显著降低（9.6%，<0.00001）。
通过系统的团队方法，HAHK所有公立基层医疗诊所的COPD护理在所有审计标准方面均有显著改善，这反过来降低了住院率，并有助于减轻医疗保健系统的负担。
