A project measuring whether care for patients with COPD (Chronic Obstructive Pulmonary Disease) could be improved by mutual peer review visits to respiratory units has shown that although the project brought benefits to both patients and health professionals, the effects were not as significant for the provision of COPD services as the continuing reorganisation and restructuring of the NHS.
COPD is a progressive, irreversible lung disease that kills around 30,000 people a year in the UK. More people in England and Wales die of COPD than of breast, colon or prostate cancer. Yet COPD is both preventable and treatable and early diagnosis and treatment can slow the progression of the illness.
NCROP (National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project) is an initiative of the Royal College of Physicians, the British Thoracic Society and the British Lung Foundation, and was established with a grant from the Health Foundation. The project paired teams of healthcare professionals, managers and patients in respiratory care from one hospital with another to work together on improving key services for COPD patients. The project first ran in 2007, and was repeated in 2010 to track long-term changes.
82 respiratory units took part in the 2010 project and were divided up into two groups – one group receiving a peer review visit from another respiratory team (intervention group), and a control group that did not receive a visit. Both sets responded to a survey on the quality of services, and completed change diaries, which were analysed for qualitative data.
The project revealed overall improvements in services since it began in 2007, but these were not notably different in the intervention groups:
- Increase in patient access to early discharge schemes
- Increase in the provision of ambulatory oxygen
- Increase in the availability of palliative care services
- Major service improvements since 2007 were more likely to relate to the four framework areas (pulmonary rehabilitation, early discharge schemes, oxygen services, non-invasive ventilation) in the intervention than the control group
Although the intervention groups had higher scores for quality of services, these were not significantly higher than the control groups, but the intervention groups noted many other benefits from the project. These included raising the profile of COPD; an opportunity to reflect on current practice; the benefit of national data; external validation as a negotiating tool; direct consequences of peer review recommendations; shared learning and experiences; linkages to other organisations specifically the PCOs; and improving morale due to recognition of achievement.
The NCROP Implementation Group concluded that it was disappointing that the intervention of peer review visits cannot be shown to have quantitative benefits to the quality of COPD services. However, the project took place against a background of dramatic shifts in the way the NHS is administered and more specifically how COPD care is provided. The constantly changing NHS environment limits the validity of the randomised controlled trial design model, so it is not surprising that a statistically significant change has not been demonstrated across all service areas.
Dame Helena Shovelton, Chief Executive of the British Lung Foundation, said:
The British Lung Foundation has been pleased to be part of this project which has driven up the quality of COPD services for patients. Although this change has not been shown to be a statistically significant across all services it does show that things are moving in the right direction. We look forward to continuing this work to ensure that the progress which has been made continues to improve health care services particularly in ensuring patients have increased access to early discharge schemes and palliative care services.