Does registration of performance indicators improve health outcomes in COPD

Background: Many countries have introduced financial incentives for healthcare providers to improve quality of care based on performance indicators. However, the association between these indicators and health outcomes has not been studied widely. Aim: To assess the association between the indicators of the COPD care process and improvement in health outcomes. Methods: This is a sub-study of the RECODE cluster randomised controlled trial, in which a disease management program for COPD patients was compared to usual care. From 38 Dutch GPs, we collected three-year prospective data on performance indicators and health outcomes (smoking status, level of physical activity, health-related quality-of-life (HRQoL)) of 913 COPD patients. Repeated measurement models were used to assess the association between indicator scores and annual changes in health outcomes after controlling for patient clustering, intervention and baseline scores. Results: The full set of indicators was completed for a minority of patients (year prior to trial=4%, year1=2%, year2=5%). However, the registration of indicators improved over time and improvements in indicator scores was higher in the intervention group, indicating improved quality of care. Indicators related to smoking (registered smoking status and stop-smoking advice) were not significantly associated with changed health outcomes. Indicators such as whether the inhalation technique was checked, spirometry test was performed, BMI and level of physical activity were recorded, were associated with a significant but not a clinically relevant improved HRQoL. Conclusion: This study showed that process indicators of the quality of COPD care are weakly associated with improved health outcomes.