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Primary Cares: A Performance Improvement (PI) Activity Designed to Improve the Diagnosis and Management of COPD and Asthma

sponsorship and support statements
Sponsorship and Support Statements

This activity is being co-sponsored by The American College of Allergy, Asthma & Immunology (ACAAI) in cooperation with The Peer•Point Medical Education Institute, LLC.

This activity is supported by an independent educational grant from AstraZeneca LP.

accreditation statements
Accreditation Statements

Physician Accreditation

The American College of Allergy, Asthma & Immunology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Physician Credit Designation

The American College of Allergy, Asthma & Immunology designates this PI CME activity for a maximum of 20 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing AccreditationThe Peer•Point Medical Education Institute, LLC, is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Nursing Credit Designation

This program is accredited for 15 contact hours and contains

0.2 hours of pharmacology (Rx) content.

faculty
Faculty

Sheldon Spector, MD

(Activity Faculty Chair)

Director

California Allergy and Asthma Medical Group

Los Angeles, California

Leonard M. Fromer, MD

Assistant Clinical Professor of Family Medicine

UCLA School of Medicine

Los Angeles, California

Board Member, TransforMED, LLC

Leawood, Kansas

faculty speaker
Faculty Speaker

Sheldon Spector, MD

Dr. Spector has been a consultant for, served on the advisory boards for, served as a speaker, and received research grants from AstraZeneca, Genentech, Schering-Plough, Sepracor, Abbott, sanofi-aventis, Merck, Johnson & Johnson, Novartis, Skypharma, and Medpointe Healthcare Inc.

Received research grants from, Amgen, Boehringer-Ingelheim, CTI Inc, Eli-Lilly, Glaxo Smith-Kline, Ig Pro, Karmel Sonics, Ono Pharma, Perrigo/TKL, and Sepracor.

learning objectives
Learning Objectives

Upon completion of this PI activity, participants should be able to demonstrate the following knowledge, competence, and performance-based objectives:

  • Utilize the diagnostic benefits of offering office-based/hospital-based spirometric evaluations for their at-risk patients (knowledge, competence)
  • Demonstrate understanding of spirometric performance/ interpretation skills and other techniques to enhance diagnosis and management of asthma and COPD (knowledge, competence)
  • Use spirometric results to distinguish between those patients with asthma vs. COPD and provide appropriate first-line therapy(s) for each condition (performance)
  • Improve the long-term care of their patients with COPD or asthma by assessing symptoms and assuring therapies are making an objective difference (competence, performance).
gaps in diagnosing copd
Gaps in Diagnosing COPD
  • PCPs provide care for some aspect of COPD in 80%of Americans
  • Most experts advocate for PCPs to include spirometry into their office procedures
  • Only 1/3 of newly diagnosed COPD patients had undergone spirometry
  • 50% of asthmatics have never undergone spirometry

Mannino DM, et al. Chest. 2002;121(5 Suppl):121S-126S.; Yawn BP, Wollan PC. Int J Chron Obstruct Pulmon Dis. 2008;3(2):311-317.; Moore PL. Am J Med. 2007;120(8 Suppl 1):S23-S27.; Chavannes N, et al. Respir Med. 2004;98(11):1124-1130.; Han MK, et al. Chest. 2007;132(2):403-409.; Chapman KR, et al. Eur Respir J. 2008;31(2):320-325.

gaps in diagnosing copd8
Gaps in Diagnosing COPD
  • 13.6 million Americans have been diagnosed with COPD. This means that another 15 million patients that actually have COPD have been misdiagnosed or underdiagnosed
  • This translates to nearly 50% of Americans with COPD are not given the correct diagnosis
  • National Institute of Health report: currently COPD is the 4th leading cause of death in the United States, and expected to be the 3rd leading cause of death by 2020

Chronic Obstructive Pulmonary Disease (COPD) Fact Sheet. (Available at www.lungusa.org/lung-disease/copd/resources/facts-figures/COPD-Fact-Sheet.html#note_12. Accessed December 6, 2010); Mannino DM, et al. Respir Care. 2002;47(10):1184-1199.; Barr RG, et al.Am J Med. 2005;118(12):1415.

gaps in diagnosing copd9
Gaps in Diagnosing COPD
  • Underdiagnosis and misdiagnosis of COPD are missed opportunities to intervene early and change disease trajectory
  • Early treatment improves lung function, health-related QoL, exacerbations, and early mortality
  • In one large survey, 850/1000 PCPs believed COPD was “self-inflicted”
    • 1/3 felt that there was nothing that could be done for those that continued to smoke

Radin A, Cote C. Am J Med. 2008;121(7 Suppl):S3-12.; Decramer M, et al. Lancet. 2009; 374: 1171-1178.; Jones R, Ostrem A. Prim Care Respir J. 2010; Nov 19. [Epub ahead of print]; Zanconato S. Pediatrics. 2005;116(6):e792-e797.

gaps in diagnosing copd10
Gaps in Diagnosing COPD
  • Lack of training and awareness of spirometry guidelines for both asthma and COPD
  • Providers reluctance on owning a spirometer because of perceived lack of validity
  • COPD patients often present with/for other medical conditions making recognition difficult. Patients fail to report symptoms and providers fail to make inquires
  • Spirometry reversibility assessments should be considered a primary diagnostic measure

Barr RG, et al. Am J Med. 2005;118(12):1415.; Schermer TR, et al. Thorax. 2003;58(10):861-866.; Mortimer KM, et al. Chest. 2003;123(6):1899-1907.; Yawn BP, Wollan PC. Int J Chron Obstruct Pulmon Dis. 2008;3(2):311-317.; Ben SH, et al. Pulm Pharmacol Ther. 2008;21(5):767-773.

differentiating asthma from copd12
Differentiating Asthma From COPD

National Heart, Lung and Blood Institute. National Asthma Education and Prevention Program. (available at http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. Accessed December 6, 2010.); Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

differentiating asthma from copd13
Differentiating Asthma From COPD

Asthma

COPD

Allergens

CigaretteSmoke

Alveolar macrophage

Epithelial

Cells

Epithelial

Cells

Mast

Cell

CD4+ Cell(Th2)

CD8+ cell (Tc1)

Neutrophilis

Eosinophils

Bronchoconstriction andairway hyperresponsiveness

Small airway fibrosis and

alveolar destruction

Eotaxin, IL-4, IL-5, IL-13

TNF- α, IL-8, IL-1β, IL-6

Not Fully Reversible

Airflow Limitation

Reversible

IL = interleukin; TNF = tumor necrosis factor.

Adapted from Global Initiative for Chronic Obstructive Lung Disease. (http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989.Accessed December 6, 2010.)

differentiating asthma from copd14
Differentiating Asthma From COPD

*In patients with persistent asthma.†In patients with COPD of at least moderate severity.

National Heart, Lung and Blood Institute. National Asthma Education and Prevention Program. (available at http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. Accessed December 6, 2010.)

Global Initiative for Chronic Obstructive Lung Disease (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010).

differentiating asthma from copd15
Differentiating Asthma From COPD

Asthma

COPD

Inflammation

Airway Smooth Muscle

Basement Membrane

Fibrosis

Alveolar Disruption

Adapted with permission from Barnes PJ. Nature Rev Immunol. 2008;8:183-192.

inflammation in copd
Inflammation in COPD

100

80

60

Airways With Measurable Cells (%)

40

20

0

Neutrophils

Macrophages

Eosinophils

CD4+ cells

CD8+ cells

Normal FEV1, FEV1/FVC

FEV1 30% to <80%, FEV1/FVC <0.70

FEV1 ≥80%, FEV1/FVC <0.70

FEV1 <30%, FEV1/FVC <0.70

Adapted from Hogg JC et al. N Engl J Med. 2004;350:2645-2653.

why perform spirometry
Why Perform Spirometry?
  • Measure airflow obstruction to help make a definitive diagnosis of COPD
  • Confirm presence of airway obstruction
  • Assess severity of airflow obstruction in COPD
  • Detect airflow obstruction in smokers who may have fewor no symptoms
  • Monitor disease progression in COPD
  • Assess one aspect of response to therapy
  • Assess prognosis (FEV1) in COPD
  • Perform pre-operative assessment

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

why perform spirometry cont
Why Perform Spirometry?(cont.)
  • Make a diagnosis and assess severity in a range of other respiratory conditions
  • Distinguish between obstruction and restriction as causes of breathlessness
  • Screen workforces in occupational environments
  • Assess fitness to dive
  • Perform pre-employment screening in certain professions

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

types of spirometers
Types of Spirometers
  • Bellows spirometers:
    • Measure volume
  • Electronic desk top spirometers:
    • Measure flow and volume
    • Real-time display
  • Small hand-held spirometers:
    • Inexpensive and quick to use
    • No print out

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

spirometric measurements
Spirometric Measurements

Inspiratory reserve

volume

Inspiratory

capacity

Total

lung

capacity

Tidal volume

Expiratory reserve

volume

Vital

capacity

Residual volume

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

lung volume capacity
Lung Volume Capacity

VOLUMES

CAPABILITIES

IRV

TLC

IC

Volume

VC

VT

ERV

FRC

RV

Time

Middleton's Allergy: Principles and Practice, 7th ed. Volume 2, Chapter 42, pp732. 2008

lung volume in various patients
Lung Volume in Various Patients

FRC

VC

VC

VC

FRC

FRC

VC

FRC

RV

Asthma

Middleton's Allergy: Principles and Practice, 7th ed. Volume 2, Chapter 42, pp732. 2008

copd measurements
COPD Measurements
  • FEV1―Forced expiratory volume in one second:
    • The volume of air expired in the first second of the blow
  • FVC ―Forced vital capacity:
    • The total volume of air that can be forcibly exhaled in one breath
  • FEV1/FVC ratio:
    • The fraction of air exhaled in the first second relative to the total volume exhaled

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

normal trace showing fev 1 and fvc
Normal Trace Showing FEV1 and FVC

FVC

5

4

FEV1 = 4L

FVC = 5L

FEV1/FVC = 0.8

Volume, liters

3

2

1

1

2

3

4

5

6

1

Time, sec

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

spirogram patterns
Spirogram Patterns
  • Normal
  • Obstructive
  • Restrictive

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

flow volume curves as seen in normal patients with obstructive and restrictive disease
Flow Volume Curves As Seen In Normal Patients With Obstructive And Restrictive Disease

8

Normal

6

Flow, L/sec

4

Obstructive

Restrictive

2

8

6

4

2

0

Volume, L

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

faculty speaker28
Faculty Speaker

Leonard M. Fromer, MD

Dr. Fromer has served as a consultant and speaker for BohringerIngelheim.

feasibility of performing spirometry in pcp practices
Feasibility of Performing Spirometry in PCP Practices
  • Critical triad:
    • Workflow
    • Improving the patient care process
    • Return on Investment
      • You will receive compensation for performing spirometry as it is indicated by evidence based guidelines

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

application of the chronic care model to copd
Application of the Chronic Care Model to COPD
  • Clinical decision support:
    • COPD guidelines
  • Self-management Support:
    • Education, plans, support, motivational interviewing, OARS technique
  • Delivery System Design:
    • Integrated team approach, integrated and team based collaborative care approach
  • Community Resources:
    • Rehab, clubs, support groups
  • Healthcare Organizations (HCO):
    • Partnerships with durable medical equipment (DME) suppliers and insurers
  • Clinical Information Systems:
    • Registries, tracking disease management

Braman SS, Lee DW. Curr Opin Pulm Med. 2010;16(2):83-88.

copd signs and symptoms
COPD: Signs and Symptoms

IL = interleukin; TNF = tumor necrosis factor.

Adapted from Global Initiative for Chronic Obstructive Lung Disease. (http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989.Accessed December 6, 2010.)

spirometry in asthma and copd
Spirometry in Asthma and COPD

National Heart, Lung and Blood Institute. National Asthma Education and Prevention Program. (available at http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. Accessed December 6, 2010); Fuhlbrigge AL et al. J Allergy Clin Immunol. 2001;107:61-67.; Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

diseases associated with airflow obstruction
Diseases Associated With Airflow Obstruction
  • COPD
  • Asthma
  • Bronchiectasis
  • Cystic Fibrosis
  • Lung cancer (greater risk in COPD)
  • Obliterative Bronchiolitis
spirometric findings used for differentiation
Spirometric Findings Used for Differentiation

Sciurba FC. Chest. 2004;126:117S-124S.

hyperinflation is a hallmark of copd
Increases FRC (EELV)

Decreases IC

Increases volume at which tidal breathing occurs

Worsens with exercise and reduces exercise tolerance (dynamic hyperinflation)

Hyperinflation is a Hallmark of COPD

Total LungCapacity(TLC)

IC

Tidal

Ventilation

FRC/

EELV

No Bronchodilator

With Bronchodilator

HealthyPatients

PatientsWith COPD

Patients With COPD During Exercise

IC = inspiratory capacity; FRC = functional residual capacity; EELV = end expiratory lung volume.

Adapted from Sutherland ER et al. N Engl J Med. 2004;350:2689-2697.ODonnell DE et al. Am J Resp Crit Care Med. 2001;164:770-777.; Stubbing DG et al. J Appl Physiol. 1980;49:511-515.

spirometric diagnosis of copd
Spirometric Diagnosis of COPD
  • COPD is confirmed by post–bronchodilator FEV1/FVC < 0.7
  • Post-bronchodilator FEV1/FVC
    • Measured 15 minutes after 400µg albuterol or equivalent

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

staging copd
Staging COPD
  • Stage I: Mild COPD (FEV1/FVC<0.70; FEV1>80% predicted)
    • Chronic Cough and sputum production may be present
  • Stage II: Moderate COPD (FEV1/FVC<0.70; FEV1<80% predicted)
    • Exertional dyspnea, cough/sputum may be present
  • Stage III: Severe COPD (FEV1/FVC <0.70; FEV1<50% predicted)
    • Dyspnea, fatigue, impacts quality of life (QoL)
  • Stage IV: Very Severe COPD (FEV1/FVC<0.70; FEV1<30% predicted or FEV1<50% with chronic respiratory failure)

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

bronchodilator responsiveness

Bronchodilator Responsiveness

0.8

0.7

0.6

0.5

Mean Δ FEV1 (SE)

0.4

0.3

0.2

0.1

0

5*

105*

855*

1855*

Patients With Asthma Ipratropium (anticholinergic)

Patients With COPD Ipratropium (anticholinergic)

Patients With COPD Albuterol (β2-Agonist)

Patients With Asthma Albuterol (β2-Agonist)

SE = standard error.*5 µg dose taken initially. Additional doses of 100 µg, 750 µg, and 1000 µg taken at 20, 40, and 60 min, respectively, for a cumulative dose of 1855 µg at 60 min.†Increasing log doses.

Adapted from Higgins BG et al.Eur Resp J. 1991;4:415-420.

airflow obstruction in copd is partially reversible

-30

-25

-20

-15

-10

-5

0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

85

90

95

100

Airflow Obstruction inCOPD is Partially Reversible

15

Degree of Reversibility

*

10

*65.6% showed a ≥15% increase in FEV1

Patients, %

5

0

Change in FEV1 %

Adapted with permission from Tashkin DP et al. Eur Resp J. 2008;31:742-750.

bronchodilator reversibility testing
Bronchodilator Reversibility Testing
  • Provides the best achievable FEV1(and FVC)
  • Helps to differentiate COPD from asthma

Must be interpreted with clinical history - neither asthma nor COPD are diagnosed by spirometry alone

  • Can be done on first visit if no diagnosis has been made
  • Best done as a planned procedure: pre- and post-bronchodilator tests require a minimum of 15 minutes
  • Short-acting bronchodilators need to be withheld for four to six hours prior to test

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

bronchodilator reversibility testing42
BronchodilatorReversibility Testing

Preparation Stage of Testing

  • Tests should be performed when patients are clinically stable and free from respiratory infection
  • Patients should not have taken:
    • Inhaled short-acting bronchodilators in the previous six hours
    • Long-acting bronchodilator in the previous 12 hours
    • Sustained-release theophylline in the previous 24 hours

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

bronchodilator reversibility testing43
Bronchodilator Reversibility Testing

Spirometry Stage of Testing

  • FEV1 should be measured (minimum three, within 5% or 150 ml) before a bronchodilator is given
  • The bronchodilator should be given by metered dose inhaler through a spacer device or by nebulizer to be certain it has been inhaled
  • The bronchodilator dose should be selected to be high on the dose/response curve

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

bronchodilator reversibility testing44
Bronchodilator Reversibility Testing
  • Some guidelines suggest nebulised bronchodilators can be given but the doses are not standardised. “There is no consensus on the drug, dose or mode of administering a bronchodilator in the laboratory.” Ref: ATS/ERS Task Force: Interpretive strategies for Lung Function Tests. ERJ 2005;26:948
  • **Usually 8 puffs of 20 µg
bronchodilator reversibility testing45
BronchodilatorReversibility Testing

Results Stage of Testing

  • An increase in FEV1 that is both greater than 200 ml and 12% above the pre-bronchodilator FEV1 (baseline value) is considered significant
  • It is usually helpful to report the absolute change (in ml) as well as the percentage change from baseline to set the improvement in a clinical context

Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989. Accessed December 6, 2010.)

benefits of smoking cessation on fev 1
Benefits of Smoking Cessation on FEV1

Never smokedor not susceptibleto smoke

75

Smoked

regularly and susceptible toits effects

50

FEV1 (% of value at age 25)

Stopped at 45

Disability

25

Stopped at 65

Death

*

*

0

25

50

75

100

Age (years)

Adapted from Fletcher C et al. Br Med J. 1977;1:1645-1648.

stepwise approach for managing copd
Stepwise Approach for Managing COPD

I

II

III

IV

  • FEV1/FVC <0.70
  • FEV1 <30% predicted orFEV1 <50% predicted plus chronic respiratory failure
  • FEV1/FVC <0.70
  • 30% ≤FEV1 <50% predicted
  • FEV1/FVC <0.70
  • 50% ≤FEV1 <80% predicted
  • FEV1/FVC <0.70
  • FEV1≥80% predicted

Active reduction of risk factor(s); influenza, pneumococcal,

and other vaccinations as needed

Add short-acting bronchodilator (when needed)

Add regular treatment with one or more long-acting bronchodilators (when needed); Add pulmonary rehabilitation

Add inhaled glucocorticosteroids if repeated exacerbations

Add long-term oxygenif chronic respiratory failure;Consider surgery

Adapted from Global Initiative for Chronic Obstructive Lung Disease. (available at http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=1&intId=2003.Accessed December 6, 2010.)

performance improvement cme pi cme
PerformanceImprovement-CME (PI-CME)
  • Necessity of PI-CME in COPD care:
    • COPD is a growing burden on the healthcare system in America
    • Outcomes for both male and female patients of all races with COPD are suboptimal
    • The quality of care is highly variable, many providers fail to meet the current standard
    • Increase awareness of updated GOLD guidelines designed to improve recognition and management of patients with COPD
this pi cme activity
This PI-CME Activity
  • Goals for participants:
    • Obtain a valuable, unbiased measurement of your current standard of care compared to the guidelines
    • Increase awareness of the need to detect and appropriately treat COPD
    • Improve comfort levels with managing patients with COPD
    • Improve compliance with evidence-based guidelines (GOLD)
this pi cme activity52
This PI-CME Activity
  • Metrics to be assessed (based on comparison to GOLD guidelines):
    • Identification of patient risk factors
      • Percentage of patients correctly identified as at-riskor COPD
    • Identification of patients correctly evaluated for COPD
      • Percentage of patients correctly given spirometry
this pi cme activity53
This PI-CME Activity
  • Identification of COPD patients requiring treatment:
    • Percentage of patients advised on lifestyle modification
      • Patients evaluated for smoking cessation
      • Patients evaluated for and advised on appropriateexercise regimen
this pi cme activity54
This PI-CME Activity
  • Identification of patients who are suitable for guideline-appropriate pharmacotherapy
    • Percentage of patients correctly selected for therapy
    • Comparison of rationales for therapy
  • Implementation of a guideline-approved therapy insuitable patients
    • Percentage of patients given GOLD orientedCOPD therapies
this pi cme activity55
This PI-CME Activity
  • Structure of this activity
    • Stages based on the AMA-approved structure for PI-CME
        • Stage A = Baseline Period
        • Stage B = Tools Implementation Period
        • Stage C = Closeout Period
    • Complete all three stages in order to receive credit
    • Practice data collected using 10 de-identified patients for Stages A and B (total of 20 individual patients)
this pi cme activity56
This PI-CME Activity
  • Patient inclusion criteria for this activity:
    • All patients > 35 years with a chief complaint of shortness of breath, wheezing or sputum production
    • No signs/symptoms of respiratory infection
    • AND patients with appropriate mental capabilities/capacities
  • All data collection forms and the clinical practice tools will be made available online as you reach each relevant stage
  • Fax numbers and email information can be found on each data collection form and this website homepage
this pi cme activity57
This PI-CME Activity
  • Stage A (Baseline Period)
    • Baseline performance measure using data acquired from de-identified patients
      • Fill out Patient Screening Log Questionnaire for 10 patients meeting the inclusion criteria using a retrospective chart pull
      • Fax or email completed questionnaires back to Peer·Point
      • Get promoted to Stage B
this pi cme activity58
This PI-CME Activity
  • Stage B (Tools Implementation Period)
    • Implement evidence-based tools to improve asthma/COPD management and re-measure practice
      • Utilize the supplied clinical tools with your patients
      • Fill out Patient Screening Log Questionnaire for 10 new patients in the inclusion criteria as they come to the office
      • Fax or e-mail completed questionnaires back to Peer·Point
      • Get promoted to Stage C
this pi cme activity59
This PI-CME Activity
  • Stage C (Closeout Period)
    • Complete the activity and receive your credit
      • Complete activity evaluation and post-test
      • Receive your credit
      • Receive a confidential individualized report followed by an aggregate report (all participants) at activity close
conclusions
Conclusions
  • COPD
    • Many gaps in diagnosis and management exist
    • Spirometry must be done in all patients suspected of having COPD and/or asthma
    • Utilizing GOLD recommendations may improve the prognosis
  • Implementation of this Performance Improvement initiative is important because:
    • It will address and improve deficits in the diagnosis and management of patients with COPD
    • It will help align your practice to current and future requirements for all primary care providers
    • The PI skills you learn in this initiative can be translated to

other aspects of your practice and other disease states

thank you
Thank You.

Peer·Point Site Coordinator Contact

Email: PIinfo@peerpt.com

Phone: 800-777-5790