Development of disease-specific quality indicators for Danish chiropractic patients with low back pain.

OBJECTIVE: The purpose of this study is to develop disease-specific quality indicators for Danish chiropractic patients with low back pain (LBP) as an initial effort to include chiropractors in the Danish Health Care Quality Programme. METHODS: A cross-disciplinary Indicator Group consisting of researchers and clinicians prioritized 9 evidence-based quality indicators and quality performance standards in a systematic consensus process. A feasibility study involving 20 chiropractors in 8 chiropractic clinics and 206 LBP patients was undertaken. Afterward, an audit meeting was held where participating clinicians could voice their opinion and share experiences. After the test and audit, the Indicator Group reconvened and decided on the final set of indicators. RESULTS: The following quality indicators were chosen: case history, test for discogenic back pain, neurology, radiology, classification, exercise therapy, outcome assessment, and reevaluation. Only the outcome assessment indicators met the standards set by the Indicator Group. Based on the feedback supplied at the audit meeting and after evaluating the test results, the Indicator Group decided to reduce the standards but keep all indicators. CONCLUSIONS: This study showed that it is possible to describe quality indicators for the assessment and treatment of LBP patients, to identify the patient population, and to collect data. The participating clinics did not meet the original quality standards set by the Indicator Group. Reasons for this may include unrealistically high thresholds set by the Indicator Group and the somewhat complex or compound structure of some of the indicators. The Indicator Group and the test clinics recommend future nationwide implementation of the developed quality indicators.

Validity and underrecording of diagnosis of COPD in the Danish National Patient Registry.

INTRODUCTION: We examined the positive predictive value of diagnoses of acute exacerbation of chronic obstructive pulmonary disease (COPD) in the Danish National Patient Registry. We also examined the negative predictive value of acute pneumonia or respiratory failure discharge diagnoses for absence of underlying COPD. METHODS: We identified all patients aged 30 years or older with acute hospital admission in Denmark from January 1st to December 31st 2008. Physicians at 34 Danish hospitals retrieved and reviewed medical records for 1581 patients with a discharge diagnosis of COPD, and for 1546 patients with a discharge diagnosis of either pneumonia or respiratory failure but no COPD diagnosis. Presence of COPD was assessed based on medical history, clinical symptoms and findings, and spirometry results. RESULTS: The overall positive predictive value for COPD was 92% (95% confidence interval [CI] = 91-93%). Among patients coded with pneumonia or respiratory failure but not COPD, 19% (95% CI = 17-21%) had COPD, corresponding to a negative predictive value for COPD of 81% (95% CI = 79-83%). CONCLUSIONS: The positive predictive value of acute COPD discharge diagnoses in the Danish National Patient Registry is high. At the same time, there is a substantial underrecording of COPD during hospitalizations with other acute respiratory disorders like pneumonia and respiratory failure.

Sex-related differences in quality of care and short-term mortality among patients with acute stroke in Denmark: a nationwide follow-up study.

BACKGROUND AND PURPOSE: Sex may predict level of care and successive outcome among patients with stroke. We examined fulfillment of quality of care criteria according to sex and possible impact of any sex-related differences on short-term mortality in a population-based nationwide follow-up study in Denmark. METHODS: We identified 29 549 patients admitted with stroke between January 2003 and October 2005 in the Danish National Indicator Project. Data on 30- and 90-day mortality were obtained from The Civil Registration System. We compared proportions of patients receiving adequate care between sexes, as measured by admission to a specialized stroke unit, administration of antiplatelet or anticoagulant therapy, examination with CT/MRI scan, and assessment by a physiotherapist, an occupational therapist, and of nutritional risk. Further, we computed 30- and 90-day mortality rate ratios (MRR), adjusted for patient characteristics, fulfillment of quality of care criteria, and department. RESULTS: The proportion of patients who received adequate care was either slightly lower or similar among women when compared to men. The relative risks (RR) of receiving specific components of care ranged from 0.84 (95% confidence interval [CI]:0.74 to 0.96) to 1.01 (95% CI:0.96 to 1.06) when comparing sexes. The adjusted mortality rate ratios were lower among women and adjustment for fulfillment of quality of care criteria had only marginal impact. CONCLUSIONS: There appear not to be any substantial sex-related differences in acute hospital care among patients with stroke in Denmark. The lower female short-term mortality is therefore most likely explained by other factors.