Development of a Standard Set of Outcome Domains and Proposed Measures for Chronic Obstructive Pulmonary Disease in Primary Care Physical Therapy Practice in the Netherlands: a Modified RAND/UCLA Appropriateness Method

Abstract

Background

Standardization of measures in a common set opens the opportunity to learn from differences in treatment outcomes which can be used for improving the quality of care. Furthermore, a standard set can provide the basis for development of quality indicators and is therefore useful for quality improvement and public reporting purposes. The aim of this study was to develop a standard set of outcome domains and proposed measures for patients with COPD in Dutch primary care physical therapy practice, including a proposal to stratify patients in subgroups.

Material and methods

A consensus-driven modified RAND-UCLA appropriateness method was conducted with relevant stakeholders (patients, physical therapists, researchers, policy makers and health insurers) in Dutch primary physical therapy care in eight steps: (1) literature search, (2) first online survey, (3) patient interviews, (4) expert meeting, resulting in a concept standard set and methods to identify subgroups' (5) consensus meeting, (6) expert meeting (7) second online survey and (8) final approval of an advisory board resulting of the approved standard set.

Results

Five outcome domains were selected for COPD: physical capacity, muscle strength, physical activity, dyspnea and quality of life. A total of 21 measures were rated and discussed. Finally, eight measures were included, of which four mandatory measures: Characteristics of practices and physical therapists, Clinical COPD Questionnaire (CCQ) for quality of life, Global Perceived Effect (GPE) for experience, 6-mins Walk Test (6-MWT) for physical capacity; two conditional measures: Hand-Held Dynamometer (HHD) (with Microfet™) for Quadriceps strength, Medical Research Council Dyspnea (MRC) for monitoring dyspnea; and two exploratory measures: Accelerometry for physical activity, and the Assessment of Burden of COPD tool (ABC). To identify subgroups, a method described in the Dutch standard of care from the Lung Alliance was included.

Conclusion

This study described the development of a standard set of outcome domains and proposed measures for patients with COPD in primary care physical therapy. Each measure was accepted for relevance and feasibility by the involved stakeholders. The set is currently used in daily practice and tested on validity and reliability in a pilot for the development of quality indicators.

Keywords:

• COPD
• standard set
• outcome domains
• quality measures
• PROMs
• PREMs
• Delphi

Acknowledgments

We acknowledge the following stakeholders, experts and colleagues for their participation in our study:

Expert committee

Emmylou Beekman (EB), Ellen Toet (ET), Cor Zagers (CZ), Monica van der Lans (ML) and Nic van Paassen (NP).

Advisory board

The Royal Dutch Society for Physical Therapy (KNGF): Annemarie Trompert (AT). The Association for Quality in Physical Therapy (SKF): Marije de Leur (ML). The Lung Foundation Netherlands (Longfonds): Marie José Schrasser (MS). Health insurance company CZ Group: Hans Wattel (HW). Health insurance company de Friesland: Alida Wolters (AW).

Research members

Joan Luites (JL) and Juliette Cruijsberg (JC).

Abbreviations

COPD, chronic obstructive pulmonary disease; 6-MWT, 6-minute walk test; CCQ, clinical COPD questionnaire; HHD, hand-held dynamometer; GPE, global perceived effect, ABC-tool; assessment of burden of COPD tool; MRC, Medical Research Council Dyspnea; PREMs, patient-reported experience measures; PROMs, Patient-Reported Outcome Measures; G-I-N, Guidelines International Network; ICF, International Classification of Functioning; MCID, minimal clinically important difference; PEDro, Physical therapy Evidence Database; NGT, nominal group technique; HER, electronic health records; ZN, Zorgverzekeraars Nederland; GOLD, the global initiative for chronic obstructive lung disease.

Disclosure

Philip Jvan der Wees received a research grant from Dutch health insurer CZ. Jan HL Ypinga is an employee at CZ Health insurance company. The authors report no other conflicts of interest in this work.