Once again, there were many interesting presentations to be heard at this year’s Trend Days Health in Lucerne. It was all about benchmarking in healthcare: useful, not useful? And what does benchmarking look like in practice? PD Dr. med. Claudia Steurer-Stey, Zurich, introduced the participants to the concept of QualiCCare in the field of COPD and thus brought an example from current practice on the subject of benchmarking.
QualiCCare is a national project that aims to improve patient care in Switzerland by implementing so-called best practice standards in the prevention and care of chronic diseases. The concept was initially defined for two diseases, type 2 diabetes mellitus and COPD. Several credos apply in the planning and implementation of QualiCCare: Acting in close coordination (1), Think Big (2), Implementing “best practices” (3) and Focusing on patients (4). Above all, the implementation of “best practices” has a high priority.
International benchmarks for COPD therapy in Switzerland
“Switzerland can still improve significantly in the care and treatment of COPD patients, as international comparisons show,” said Dr. Steurer-Stey of the Institute of Family Medicine at the University of Zurich. While Switzerland has a rate of 56% of correct COPD diagnoses, Spain, as “best in class”, is much better with 89%. There is also room for improvement in the effectiveness of smoking cessation counseling in Switzerland compared to Canada (45 vs. 60% nonsmokers). In the field of pharmacotherapy, Denmark tops the list of best performers. Here, 73% of all COPD patients in the GOLD I stage are without inhaled corticosteroids; in Switzerland, the figure is more than 10% lower.
The “best practice” interventions are expected to have a direct effect on the disease burden of COPD and other diseases: “Correct implementation of the measures also makes the treatment and care of COPD patients more cost-effective: implementing the vision of QualiCCare Quality and Benefit is important and correct,” is Dr. Steurer-Stey’s assessment. For example, smoking cessation, drug therapy, influenza vaccination, self-management support, and pulmonary rehabilitation could prevent approximately 11,000 hospitalizations over the next decade and improve the quality of life of those affected.
At the Institute of Family Practice of the University of Zurich, there is a cantonal project for the evaluation of measures on the one hand CAROL (Care in obstructive lung disease), a large-scale prospective randomized trial that hypothesized that “participation in the COPD quality intervention improves adherence with good practice standards”; second, the PILOT project in collaboration with the GD of the Canton of Zurich, a retrospective analysis of documentation of good practice quality indicators. Initial evaluations and results show that there is a large variance both between hospitals and primary care providers (despite the fact that the two patient populations do not differ fundamentally) and between the individual indicators reviewed. Guidance on exacerbation management, a written action plan for patients, and offering pulmonary rehabilitation were particularly poorly documented. Comparing the documented performance measures in the canton of Zurich with ratios from facilities where the “Living well with COPD” program is applied, improvements of up to 90% are possible in some cases, Dr. Steurer-Stey summarizes: “With targeted disease-specific interventions and better integration of care, both horizontally and vertically, we can achieve a great deal. However, it is important to learn from the past and from collected data for the future, and to ensure that the right measures and incentives for beneficial care are also supported by health policy.”
Source: Trendtage Gesundheit, March 27, 2014, Lucerne.
HAUSARZT PRAXIS 2014; 9(4): 33-34
