Pulmonary function outcomes for assessing cystic fibrosis care

Area of Science:

• Pulmonary Medicine
• Clinical Quality Measurement
• Epidemiology

Background:

• Assessing cystic fibrosis (CF) patient quality of care necessitates selecting appropriate outcome measures.
• Pulmonary function outcomes are critical indicators that may reflect clinical practice patterns in CF care.

Purpose of the Study:

• To systematically evaluate pulmonary function outcomes as potential measures of clinical practice patterns in cystic fibrosis care.
• To assess the association between CF care site rankings and practice patterns, including follow-up pulmonary function.

Main Methods:

• Utilized data from the Epidemiologic Study of Cystic Fibrosis.
• Evaluated six pulmonary function outcome variables: best FVC, FEV(1), FEF(25-75) in 2002, and the rate of decline for each from 2000-2002.
• Ranked CF care sites based on these outcome measures and analyzed associations with practice patterns and follow-up pulmonary function.

Main Results:

• CF care sites in the top quartile demonstrated more frequent patient monitoring, treatment of exacerbations, and utilization of chronic therapies and oral corticosteroids.
• The rate of pulmonary function decline in follow-up was not significantly predicted by the initial site ranking.

Conclusions:

• Different pulmonary function outcome measures show slight variations in their association with clinical practice patterns.
• Annual FEV(1) is identified as a robust and effective measure, comparable to other outcomes for assessing CF care quality.
• Current site rankings offer only moderate predictive value for future performance rankings.