A 21-Practice Evaluation of an Asthma and COPD Quality Improvement Program

To evaluate the Achieving Clinical Audits with Electronic Records (ACAER) program in supporting primary care providers in quality improvement initiatives across asthma and COPD.

This observational cohort study included individuals aged ≥12 years with documented diagnosis of asthma or COPD, receiving asthma or COPD therapy, at high risk of exacerbation and hospitalization. Data were derived from the intervention, linked patient questionnaires completed as part of practice evaluation and quality improvement, and routine primary care electronic medical records (EMR) within the Optimum Patient Care Research Database Australia (OPCRDA). Changes in exacerbation rates and maintenance treatment were evaluated.

7512 asthma and 6526 COPD patients were evaluated with EMR collection. A subset of 1327 asthma patients and 629 COPD patients were classified as active and high-risk. Patient questionnaires and evaluation reports were sent out between 29 October 2019 and 21 September 2021, the intervention period. For those at risk during the entire study period (2018-2023; N=1276), 48.4% and 59.3% of patients in the high-risk asthma and COPD populations, respectively, had maintenance therapy change in the first year post-intervention. Exacerbation rates fell after the intervention period in the high-risk asthma (74.8 to 32.4 per 1000 per month) and COPD (122.9 to 91.2 per 1000 per month) populations. High-risk asthma patients had increasing rates of exacerbations in the 2 years prior to the intervention period (linear trend: 2.79 exacerbations per 1000 per month [1.34, 4.24]; p=0.001), which declined and remained stable after the intervention (p=0.87; up to 2023). Exacerbation rates for high-risk COPD patients were stable pre-intervention (p=0.29). Post-intervention rates initially declined and then showed a marginal non-statistically significant increase (p=0.28).

Our findings support the potential for the ACAER asthma and COPD program to drive treatment change and improve long-term outcomes in high-risk patients in primary care settings.