Improving diagnostic accuracy of chronic obstructive pulmonary disease using spirometry test

1. Aim:To improving diagnostic accuracy of chronic obstructive pulmonary disease (COPD) using spirometry test in eight primary care clinics in the New Territories West Area of Hong Kong2. Context:Confirmation of diagnosis of COPD by spirometry was inadequately done in primary care. Clinic nurses and doctors were involved in practice-based and department-based meetings.3. Intervention:Decision Support:Doctors and nurses were updated about COPD management through educational seminar with respiratory physicians as guest speaker. A cue card placing in consultation room to guide COPD management.Nurses were empowered about the use of diagnostic spirometry by protocol. Reports had regular credentialing by doctors.Clinical Information System:A regularly updated registry for COPD patients was introduced. A reminder system to call those patients without spirometry by phone.Upgrading IT system for entry of spirometry results in designated page in electronic medical record. 4. Strategy for change:A clinical audit was initiated in 2015, starting with a pilot phase in which 2 clinics were involved. From 2017 onwards, eight clinics were involved. The deficiency of care was identified and presented in administrative meetings, where data was disseminated to all eight primary care clinics. Doctors in-charge of each clinic involved their clinic staff for implementation of change during bi-monthly clinic meeting.The proportion of records with proper documentation of spirometry results was used to measure the effect of change throughout the cycles.5. Effects of change:The percentage of COPD patients with spirometry test done improved from 18% (2017 to 2018) to 67% (2019 to 2020) (Please refer to Table 1 in the attached file). 6. Lessons learnt:Reminder system and simplifying the workflow of ordering spirometry were useful.If the computer systems of spirometry device and electronic record were compatible, the workflow could be even more streamlined.7. Messages for others:Involvement of all stakeholders including administrators, doctors, nurses and patients was essential for successful implementation of change. Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest None References and Clinical Trial Registry Information Not applicable