Health Care Guideline Diagnosis And Management Of Chronic Obstructive .
Health Care GuidelineDiagnosis and Management ofChronic Obstructive Pulmonary Disease (COPD)ICSI has endorsed with qualifications the Veteran’s Affairs/Department of Defense (VA/DoD) ClinicalPractice Guideline for the Management of Chronic Obstructive Pulmonary Disease. Using the ICSIendorsement process, this document has been reviewed by the ICSI COPD work group: Anderson B,Brown H, Bruhl E, Bryant K, Burres H, Conner K, Kaderabek D, Kerestes G, Kuehn M, Lim K, MrosakK, Raikar S, Rickbeil T, Westman K.Access this guideline through the link below:VA/DoD Clinical Practice GuidelinesThe Veteran’s Affairs and Department of Defense are not sponsors of, affiliated with or endorsers of ICSIor the ICSI COPD work group. The VA/DoD has not reviewed ICSI’s processes for endorsement ofguidelines. The following ICSI endorsement and conclusions are solely the consensus of the ICSI COPDwork group using the ICSI Endorsement Process.Please note, the previous ICSI Diagnosis and Management of Chronic Obstructive Pulmonary Disease(COPD) guideline from March 2013 is being retired.www.icsi.orgCopyright 2016 by Institute for Clinical Systems Improvement
Health Care Guideline:Diagnosis and Management of Chronic ObstructivePulmonary Disease (COPD)Text in blue in this documentindicates a link to another part ofthe document or website.Tenth EditionJanuary 2016Work Group LeaderBlair Anderson, MDPulmonology, HealthPartnersMedical Group and RegionsHospitalWork Group MembersAllina HealthGeorge Kerestes, MDFamily MedicineKathryn Westman, RN, MS,APRNAdult MedicineCentraCare Health SystemTiffany Rickbeil, MDInternal MedicineEssentia HealthHeather Brown, APRN, CNPFamily MedicineFairview Health ServicesHeidi Burres, PharmD, BCACPPharmacyHealthEast Care SystemMichelle Kuehn, RRTRespiratory CareTable of ContentsEvidence Grading. 2Qualifications Table for COPD. 3-12Quality Improvement Support. 13-29Aims and Measures. 14-15Measurement Specifications. 16-26Implementation Recommendations. 27Implementation Tools and Resources. 27Implementation Tools and Resources Table. 28-29Supporting Evidence. 30-38References. 31-32ICSI Shared Decision-Making Model. 33-38Disclosure of Potential Conflicts of Interest. 39-41Document History and Development. 42-43Document History. 42ICSI Document Development and Revision Process. 43HealthPartners MedicalGroup and Regions HospitalShama Raikar, MDInternal MedicineMayo ClinicElliot Bruhl, MD, FAAFPFamily MedicineKimberly Bryant, APRN, CNPFamily MedicineDawn Kaderabek, APRN, CNPFamily MedicineKaiser Lim, MDPulmonary and Critical CareMedicineNorth Memorial Health CareKristen Conner, MSN, CNPNursing and HealthEducationPark Nicollet Health ServicesKristelle Mrosak, BAH, RRTRespiratory CareICSI StaffJeyn Monkman, MA, BSN,NE-BCProject Manager/Health CareConsultantwww.icsi.orgCopyright 2016 by Institute for Clinical Systems Improvement1
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Evidence GradingLiterature SearchThe VA/DoD literature search covered the time period from January 1, 2005 to February 2014. ICSI replicated this search to include January 2014 – February 2015.Additional articles were provided by work group members and discussed by the work group prior to inclusion.GRADE MethodologyFollowing a review of several evidence rating and recommendation writing systems, ICSI has made a decisionto transition to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.GRADE has advantages over other systems including the current system used by ICSI. Advantages include: developed by a widely representative group of international guideline developers; explicit and comprehensive criteria for downgrading and upgrading quality of evidence ratings; clear separation between quality of evidence and strength of recommendations that includes atransparent process of moving from evidence evaluation to recommendations; clear, pragmatic interpretations of strong versus weak recommendations for clinicians, patients andpolicy-makers; explicit acknowledgement of values and preferences; and explicit evaluation of the importance of outcomes of alternative management strategies.The VA/DoD document was developed using the GRADE methodology to evaluate the overall quality ofthe body of evidence (page 8 of Va/DoD guideline).Return to Table of Contentswww.icsi.orgInstitute for Clinical Systems Improvement2
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Qualifications Table for COPDSource: VA/DoD Clinical Practice Guideline For the Management of Chronic Obstructive Pulmonary DiseaseThe ICSI Chronic Obstructive Pulmonary Disease Work Group endorsed with qualifications the followingrecommendations.RecommendationStrength ofRecommendationDiagnosis and Assessment of COPDAgreewithoutQualification#1 – We recommend thatspirometry, demonstratingairflow obstruction (postbronchodilator forcedexpiratory volume in onesecond/forced vital capacity[FEV1/FVC] 70%, with ageadjustment for more elderlyindividuals), be used toconfirm all initial diagnoses ofchronic obstructive pulmonarydisease (COPD).Strong ForNo#2 – We have norecommendations regardingthe utilization of existingclinical classification systemsat this time.Not ApplicableYesWeak For#4 – We recommend offeringprevention and risk reductionefforts including smokingcessation and vaccination.Modified from the 2007 CPGwithout an updated systematicreview of the evidence.*Strong For#3 – We suggest classificationof patients with COPD intotwo groups:a. Patients who experiencefrequentexacerbation (two ormore/year, definedas prescription ofcorticosteroids,prescription of antibiotics,hospitalization oremergency department[ED] visit); andb. Patients without frequentexacerbations.Return to Table of ContentsInstitute for Clinical Systems ImprovementQualification StatementLiterature (New)Search SupportCare needs to be exercisedwhen interpreting spirometryin the elderly as thepercentages of patients withFEV1/FVC 0.7 rises withage so that about ½ ofsubjects age 75‐85 have adecreased FEV1/ FVC ratio(Chest 2000;117:326S‐31S).In a study of asymptomaticnever‐smokers 70 years ofage, 35% had FEV1/FVC 0.7.Hardie, 2002;Petty, 2000#2 dovetails into #3, seebelowGoossens, 2014YesAgreeGupta, 2014;Hsu, 2013Resources:mMRC (ModifiedMedical ResearchCouncil dyspneascale)YesAgreeResource: CDCVaccination linkUSPSTF – forcurrent ACIPrecommendationson s/index.html.This link goes offsite. Click to readthe external linkdisclaimer.www.icsi.org3
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Qualifications Table for COPDRecommendationStrength ofRecommendation#5 – We recommend investigatingadditional comorbid diagnosesparticularly in patients whoexperience frequent exacerbations(two or more/year, defined asprescription of corticosteroids,prescription of antibiotics,hospitalization, or ED visit) usingsimple tests and decision rules(cardiac ischemia [troponin,electrocardiogram], congestive heartfailure [B-typenatriuretic peptide(BNP), pro-BNP], pulmonaryembolism [D-dimer plus clinicaldecision rule] and gastroesophagealreflux).Strong For#7 – We suggest that patientspresenting with early onset COPDor a family history of early onsetCOPD be tested for alpha-1antitrypsin (AAT) deficiency.Modified from the 2007 CPGwithout an updated systematicreview of the atementLiterature (New)Search SupportAgreeNeshemura, 2014;Shapira-Rootman, 2014Holmedahl, 2014#6 We suggest that patients withCOPD and signs or symptoms of asleep disorder have a diagnosticsleep evaluation.Modified from the 2007 CPGwithout an updated systematicreview of the evidence.*Weak ForYesAgreeWeak ForYesAgree#8 – We recommend that patientswith AAT deficiency be referred toa pulmonologist for managementof treatment.Modified from the 2007 CPGwithout an updated systematicreview of the evidence.*Strong ForYesAgreeReturn to Table of Contentswww.icsi.orgInstitute for Clinical Systems Improvement4
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Qualifications Table for COPDRecommendationStrength ofRecommendationAgreewithoutQualification#9 – We recommendprescribing inhaled short-actingbeta 2-agonists (SABAs) topatients with confirmed COPDfor rescue therapy as needed.Modified from the 2007 CPGwithout an updated systematicreview of the evidence.*Strong forYesAgreeWeak forYesAgree#11 – We recommend offeringlong-acting bronchodilators topatients with confirmed, stableCOPD who continue to haverespiratory symptoms (e.g.,dyspnea or cough).Strong forYesAgreeRoskell, 2014Weak forYesAgreeOba, 2015;Mathioudakis, 2014#13 – We recommend inhaledtiotropium as first-line therapyfor patients with confirmed,stable COPD who haverespiratory symptoms (e.g.,dyspnea or cough) and severeairflow obstruction (i.e., postbronchodilator FEV1 50%) ora history of COPDexacerbations.Strong ForYesAgreePharmacologic Therapy#10 – We suggest using spacersfor patients who have difficultyactuating and coordinating drugdelivery with metered-doseinhalers (MDIs).Modified from the 2007 CPGwithout an updated systematicreview of the evidence.*#12 – We suggest offering theinhaled long-actingantimuscarinic agent (LAMA)tiotropium as first-linemaintenance therapy in patientswith confirmed, stable COPDwho continue to haverespiratory symptoms (e.g.,dyspnea or cough).QualificationStatementLiterature (New)Search SupportReturn to Table of Contentswww.icsi.orgInstitute for Clinical Systems Improvement5
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Qualifications Table for COPDRecommendationStrength tion Statement#14 – For clinically stablepatients with a confirmeddiagnosis of COPD and whohave not had exacerbations onshort-acting antimuscarinicagents (SAMAs), we suggestcontinuing with this treatment,rather than switching to longacting bronchodilators.Modified from the 2007 CPGwithout an updated systematicreview of the evidence.*Weak For#15 – For patients treated with aSAMA who are started on aLAMA to improve patientoutcomes, we suggestdiscontinuing the SAMA.Modified from the 2007 CPGwithout an updated systematicreview of the evidence.*Weak ForYes#16 – We recommend againstoffering an inhaledcorticosteroid (ICS) insymptomatic patients withconfirmed, stable COPD as afirst-line monotherapy.Strong AgainstYesAgreeStrong AgainstYesAgree#18 – In patients withconfirmed, stable COPD whoare on inhaled LAMAs(tiotropium) or inhaled LABAsalone and have persistentdyspnea on monotherapy, werecommend combinationtherapy with both classes ofdrugs.Strong ForYesAgree#17 – We recommend againstthe use of inhaled long-actingbeta 2-agonists (LABAs)without an ICS in patients withCOPD who may haveconcomitant asthma.NoClinically stable patientscurrently using a SAMA(ipratropium) or those havingincreased exacerbationsshould be offered the first-linetherapy of LAMA. However,the short-acting agents dohave demonstrated clinicalbenefit and may be continuedif patient preference or costconsiderations make thisalternative therapy thepreferred agent for selectedpatients.Literature(New) ar,2014;Mattishent, 2014Return to Table of Contentswww.icsi.orgInstitute for Clinical Systems Improvement6
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Qualifications Table for COPDRecommendationStrength ofRecommendation#19 – In patients withconfirmed, stable COPD whoare on combination therapy withLAMAs (tiotropium) andLABAs and have persistentdyspnea or COPDexacerbations, we suggestadding ICS as a thirdmedication.Weak Lee, 2015;Bollmeier, 2014;Liu, 2014#20 – We suggest againstoffering roflumilast in patientswith confirmed, stable COPD inprimary care withoutconsultation with apulmonologist.Weak AgainstYesAgree#21 – We suggest againstoffering chronic macrolides inpatients with confirmed, stableCOPD in primary care withoutconsultation with apulmonologist.Weak AgainstYes#22 – We suggest againstoffering theophylline inpatients with confirmed, stableCOPD in primary care withoutconsultation with apulmonologist.Weak AgainstYesAgreeChronic macrolidetherapy is typicallyconsidered to involvedaily or alternate daymedication for sixmonths or more.Agree#23 – There is insufficientevidence to recommend for oragainst the use of Nacetylcysteine (NAC)preparations available in theU.S. in patients with confirmed,stable COPD who continue tohave respiratory symptoms (e.g.,dyspnea, cough).Not ApplicableYesAgreeWeak ForYesAgree#25 – We suggest using nonpharmacologic therapy as firstline therapy and using caution inprescribing hypnotic drugs forchronic insomnia in primarycare for patients with COPD,especially for those withhypercapnea or severe COPD.Weak ForYesAgree#24 – We suggest notwithholding cardio-selectivebeta-blockers in patients withconfirmed COPD who have acardiovascular indication forbeta-blockers.Return to Table of ContentsInstitute for Clinical Systems ImprovementLiterature (New)Search SupportMunoz-Esqueme,2014;Rennard, 2014Mathioudakis, 2014www.icsi.org7
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Qualifications Table for COPDRecommendationStrength ofRecommendation#26 – For patients with COPD andanxiety, we suggest consultationwith a psychiatrist and/or apulmonologist to choose a course ofanxiety treatment that reduces, asmuch as possible, the risk of usingsedatives/anxiolytics in thispopulation.Modified from the 2007 CPGwithout an updated systematicreview of the evidence.Weak ForOxygen mentLiterature (New)Search SupportNoFor patients withCOPD and anxiety,we suggestconsultation with aprimary carephysician,psychiatrist orpulmonologist tochoose a course ofanxiety treatment.Treating physiciansshould use caution inprescribingsedatives/anxiolyticsfor this population.Abascal-Bolado, 2015;Anxiety anddepression, combinedwith or separate fromfeelings of severeshortness of breath,should be assessed andconcurrently treated tooptimize health careutilization and increaseQOL for patients withCOPD.Blakemore, 2014Resource:6-Minute Walk Test#27 – We recommend providinglong-term oxygen therapy (LTOT)to patients with chronic stableresting severe hypoxemia (partialpressure of oxygen in arterial blood[PaO2] 55 mmHg and/orperipheral capillary oxygensaturation [SaO2] 88%) orchronic stable resting moderatehypoxemia (PaO2 of 56-59 mmHgor SaO2 88% and 90%) withsigns of tissue hypoxia (hematocrit 55%, pulmonary hypertension orcor pulmonale).Modified from the 2007 CPGwithout an updated systematicreview of the evidence.*Strong ForYesAgreeStrong ForYesAgree#29 – We suggest against routinelyoffering ambulatory LTOT forpatients with chronic stable isolatedexercise hypoxemia in the absenceof another clinical indication forsupplemental oxygen.Weak AgainstYesAgree#28 – We recommend that patientsdischarged home fromhospitalization with acutetransitional oxygen therapy areevaluated for the need for LTOTwithin 30-90 days after discharge.LTOT should not be discontinued ifpatients continue to meet the abovecriteria.Modified from the 2007 CPGwithout an updated systematicreview of the evidence.*Return to Table of ContentsInstitute for Clinical Systems ImprovementStoller, 2010Resource: 6-MinuteWalk Testwww.icsi.org8
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Qualifications Table for COPDRecommendationStrength ofRecommendation#30 – For patients withCOPD and hypoxemiaand/or borderline hypoxemia(SaO2 90%) who areplanning to travel by plane,we suggest a briefconsultation or an e-consultwith a pulmonologist.Modified from the 2007 CPGwithout an updatedsystematic review of theevidence.*Weak ForAgreewithoutQualificationNoQualification StatementAirline travel is safe for mostpatients with COPD. Hypoxemicpatients should be evaluatedclinically and a decision should bemade regarding oxygenrequirements. Patients with COPDreceiving continuous oxygen athome will require supplementationduring flight. Many airlines willallow the use of battery-operatedportable oxygen concentrators(POCs) on board during flight.POCs were first approved for useby the FAA in summer 2005.Literature(New) SearchSupportEach airline has its own policyregarding on-board oxygentransport and in-flight oxygenusage.Patients need to contact the airlinefor their current policies regardingoxygen. Patients should notify theoxygen supply company twoweeks in advance. Many airlines have their ownairline-specific medical formfor the clinician to fill out. POC rentals can be perday/week/month. Patients should always carrya copy of their oxygenprescription.#31 – When other causes ofnocturnal hypoxemia havebeen excluded, we suggestagainst routinely offeringLTOT for the treatment ofoutpatients with stable,confirmed COPD and isolatednocturnal hypoxemia.Weak AgainstYesAgree#32 – In the absence of othercontributors (e.g., sleepapnea), we suggest referral fora pulmonary consultation inpatients with stable, confirmedCOPD and hypercapnea.Weak ForYesAgreeStable HypercapneaReturn to Table of Contentswww.icsi.orgInstitute for Clinical Systems Improvement9
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Qualifications Table for COPDRecommendationStrength ofRecommendationAgreewithoutQualificationWeak ForYesAgreeWeak AgainstNoEnsure that the patient hassomeone to contact (phone,electronically, etc.) as well aswritten documentation of patienteducation that the patientparticipated in the creation of theplan.#35 – We suggest usingtelehealth for ongoingmonitoring and support of thecare of patients withconfirmed COPD.Weak ForYesAgreeLundell, 2015#36 – We recommend offeringpulmonary rehabilitation tostable patients with exerciselimitation despitepharmacologic treatment andto patients who have recentlybeen hospitalized for an acuteexacerbation.Strong ForYesAgreeJácome, 2014;Osterling, 2014#37 – We suggest offeringbreathing exercise (e.g.,pursed lip breathing,diaphragmatic breathing oryoga) to patients withdyspnea that limits physicalactivity.Weak ForYesAgreeBorge, 2014#38 – We suggest referral toa dietitian for medicalnutritional therapyrecommendations (such asoral calorie supplementation)to support patients withsevere COPD who aremalnourished (body massindex [BMI] 20 kg/m2).Weak ForYesAgreeSupport Self-Management#33 – We suggest supportedself-management for selectedhigh-risk patients with COPD.#34 – We suggest againstusing action plans alone in theabsence of supported selfmanagement.TelehealthPulmonary RehabilitationBreathing ExerciseNutrition ReferralQualification StatementLiterature(New) SearchSupportZwerinck, 2014Return to Table of Contentswww.icsi.orgInstitute for Clinical Systems Improvement10
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Qualifications Table for COPDRecommendationStrength ofRecommendationLung Volume Reduction Surgery and Lung Transplant#39 – We recommend that any patientconsidered for surgery for COPD (lungvolume reduction surgery [LVRS] andlung transplant) be first referred to apulmonologist for evaluation.Modified from the 2007 CPG withoutan updated systematic review of theevidence.*Strong For#40 – We recommend antibiotic usefor patients with COPD exacerbationswho have increased dyspnea andincreased sputum purulence (changein sputum color) or volume.#42 – For outpatients with acuteCOPD exacerbation who are treatedwith antibiotics, we recommend afive-day course of the ong ForYesAgreeWeak ForYesAgreeTypical secondgenerationcephalasporins includecefuroxime, cefaclorand cefprozil.Strong ForYesAgreeNot ApplicableYesAgreeManagement of Patients in Acute Exacerbation of COPD#41 – We suggest basing choice ofantibiotic on local resistance patternsand patient characteristics.a. First-line antibiotic choice mayinclude , second-generationcephalosporin, amoxicillin,amoxicillin/clavulanate andazithromycin.b. Despite the paucity of evidenceregarding the choice of antibiotics,we suggest reserving broaderspectrum antibiotics (e.g.,quinolones) for patients withspecific indications such as:i. Critically ill patients in theintensive care unit (ICU);ii. Patients with recent history ofresistance, treatment failure orantibiotic use; andiii. Patients with risk factors forhealth care-associated infections.#43 – There is insufficient evidence torecommend for or againstprocalcitonin-guided antibiotic use forpatients with acute COPDexacerbations.Agree withoutQualificationReturn to Table of ContentsInstitute for Clinical Systems ImprovementLiterature(New) SearchSupportwww.icsi.org11
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Qualifications Table for COPDRecommendationStrength ofRecommendationAgree withoutQualification#44 – For acute COPD exacerbations,we recommend a course of systemiccorticosteroids (oral preferred) of 30-40mg prednisone equivalent daily for 5-7days.Strong ForYes#45 – We suggest use of airwayclearance techniques utilizing positiveexpiratory pressure (PEP) devices forpatients with COPD exacerbationsand difficulty expectorating sputum.Weak ForYesAgreeStrong ForYesAgreeStrong ForYesAgreeManagement of Patients with COPD in the Hospital or Emergency Department#46 – We recommend the early use ofnon-invasive ventilation (NIV) inpatients with acute COPD exacerbationsto reduce intubation, mortality andlength of hospital stay.#47 – We recommend the use of NIV tosupport weaning from invasivemechanical ventilation and earlierextubation of intubated patients ) SearchSupportBajaj, 2015*For additional information please refer to the "Reconciling 2007 CPG Recommendations" section of the Va/DoD guideline(page 9).Return to Table of Contentswww.icsi.orgInstitute for Clinical Systems Improvement12
Quality Improvement Support:Diagnosis and Management of Chronic ObstructivePulmonary Disease (COPD)The Aims and Measures section is intended to provide protocol users with a menuof measures for multiple purposes that may include the following: population health improvement measures, quality improvement measures for delivery systems, measures from regulatory organizations such as Joint Commission, measures that are currently required for public reporting, measures that are part of Center for Medicare Services Clinician QualityReporting initiative, and other measures from local and national organizations aimed at measuringpopulation health and improvement of care delivery.This section provides resources, strategies and measurement for use in closingthe gap between current clinical practice and the recommendations set forth in theguideline.The subdivisions of this section are: Aims and Measures Implementation Recommendations Implementation Tools and Resources Implementation Tools and Resources TableCopyright 2016 by Institute for Clinical Systems Improvement13
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Aims and Measures1. Decrease the percentage of COPD patients who have exacerbation requiring emergency departmentevaluation or hospital admission.Measures for accomplishing this aim:a.Percentage of COPD patients seen in emergency department for COPD-related exacerbations inone month.b. Percentage of COPD patients who require hospital admission/readmission for COPD-related exacerbations in one month.c.Percentage of COPD patients with two or more hospitalizations over a 12-month period.2. Increase the use of spirometry testing in the diagnosis of patients with COPD.Measure for accomplishing this aim:a.Percentage of patients with a diagnosis of COPD who had spirometry testing to establish COPDdiagnosis.3. Increase the percentage of COPD patients who receive information on the tobacco cessation optionsand information on the risks of continued smoking.Measures for accomplishing this aim:a.Percentage of patients with COPD who are asked about smoking and smoking exposure at everyvisit with clinician.b. Percentage of patients with COPD who are smokers who have assessment of readiness to attemptsmoking cessation.c.Percentage of patients with COPD who are smokers who receive a smoking cessation intervention.d. Percentage of patients with COPD and smokers who quit smoking (100% quit-rate goal).4. Increase the percentage of patients with COPD who have appropriate therapy prescribed.Measure for accomplishing this aim:a.Percentage of patients with COPD who are prescribed appropriate therapy, including: appropriate vaccinations per CDC schedule long-term oxygen assessment and prescription for long-term home oxygen for those who arehypoxic and meet criteria short-acting bronchodilator (when needed) long-acting bronchodilator (when needed) corticosteroids (when needed)5. Increase the percentage of patients who have education and management skills with COPD.Measure for accomplishing this aim:a.Percentage of patients with moderate or severe COPD who have been referred to a pulmonaryrehabilitation or exercise program.Return to Table of ContentsInstitute for Clinical Systems Improvementwww.icsi.org14
Aims and MeasuresDiagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 20166. Increase the percentage of patients with moderate or severe COPD who have health directives in place.Measure for accomplishing this aim:a.Percentage of patients with moderate or severe COPD who have health care directives in place.Return to Table of Contentswww.icsi.orgInstitute for Clinical Systems Improvement15
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Aims and MeasuresMeasurement SpecificationsMeasure #1aPercentage of COPD patients seen in emergency room for COPD-related exacerbations in one month.Population DefinitionPatients 18 years and older with COPD diagnosis.Data of Interest# of patients seen in emergency room for COPD-related exacerbations# of patients with COPDNumerator/Denominator DefinitionsNumerator:Number of patients with COPD who are seen in emergency room for COPD-related exacerbations in one month.Denominator:Number of patients with COPD diagnosis.Method/Source of Data CollectionReview electronic medical records for all patients with COPD. Review records to determine whether theywere seen in the emergency room for COPD-related exacerbations.Time Frame Pertaining to Data CollectionMonthly.NotesThis is an outcome measure, and improvement is noted as a decrease in the rate.Return to Table of Contentswww.icsi.orgInstitute for Clinical Systems Improvement16
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Aims and MeasuresMeasure #1bPercentage of COPD patients who require hospital admission/readmission for COPD-related exacerbationsin one month.Population DefinitionPatients 18 years and older with COPD diagnosis.Data of Interest# of patients who were hospitalized for COPD-related exacerbations# of patients with COPDNumerator/Denominator DefinitionsNumerator:Number of patients with COPD who were hospitalized for COPD-related exacerbations inone month.Denominator:Number of patients with COPD diagnosis.Method/Source of Data CollectionReview electronic medical records for all patients with COPD. Review records to determine whether theywere hospitalized during the measurement period for COPD-related exacerbations.Time Frame Pertaining to Data CollectionMeasurement period could be weekly, monthly, quarterly or annual.NotesThis is an outcome measure, and improvement is noted as a decrease in the rate.Return to Table of Contentswww.icsi.orgInstitute for Clinical Systems Improvement17
Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD)Tenth Edition/January 2016Aims and MeasuresMeasure #1cPercentage of COPD patients with two or more hospitalizations over a 12-month period.Population DefinitionPatients 18 years and older with COPD diagnosis.Data of Interest# of patients who were hospitalized two or more times# of patients with COPDNumerator/Denominator DefinitionsNumerator:Number of patients with COPD who we
Chronic Obstructive Pulmonary Disease (COPD) ICSI has endorsed with qualifications the Veteran's Affairs/Department of Defense (VA/DoD) Clinical Practice Guideline for the Management of Chronic Obstructive Pulmonary Disease. Using the ICSI endorsement process, this document has been reviewed by the ICSI COPD work group: Anderson B,
copies may be provided to patients and the clinicians who manage their care, if the ICSI Health . Care Guideline is incorporated into the medical group's clinical guideline program. All other copyright rights in this ICSI Health Care Guideline are reserved by the Institute for Clinical . Systems Improvement.
titled Clinical Practice Guideline for Diagnosis and Treatment of Low Back Pain (2017 LBP CPG), includes objective, evidence-based information on the diagnosis and management of acute and chronic LBP. It is intended to assist healthcare providers in all aspects of patient care, including, but not limited to, diagnosis, treatment, and management.
Medical Treatment Guideline for Shoulder Diagnosis and Treatment -updated May 2018 I. Review Criteria for Shoulder Surgery A request may be appropriate for If the patient has AND the diagnosis is supported by these clinical findings: AND this has been done Surgical Procedure Diagnosis Subjective Objective Imaging Non-operative care
Section 1: Understand the diagnosis of Specific Learning Difficulties. 4. LCG 2017 . In this section, you will learn about diagnosis of Specific Learning Difficulties. You will . find out about the importance of gaining a diagnosis and gaining diagnosis as early as possible, and the impact of delayed or non-diagnosis. You will look at how diagnosis
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The Precede-Proceed model for health promotion planning and evaluation Phase 1 Social diagnosis Phase 2 Epidemiological diagnosis Phase 3 Behavioral and Environmental diagnosis Phase 4 Educational and Organizational diagnosis Phase 5 Administrative and Policy diagnosis Phase 6 Implementation Phase 7 Process Phase 8 Impact Phase 9 Outcome Health .
Primary Health Care Providers Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (office, inpatient, critical care, long-term care, home care, day care, etc.). Primary care is performed and
the evaluation, diagnosis, and treatment of pediatric ADHD; and the barriers that impede the implementation of such a resource. In response, this guideline is supported by 2 accompanying documents, available in the Supplemental Information: (1) a process of care algorithm (PoCA) for the diagnosis and treatment of children and adolescents with .
