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In the absence of documented indicators&#44; Neumomadrid developed a Respiratory Disease Quality Guideline<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> that was endorsed by the Spanish Society of Quality in Healthcare&#44; the aim of which is to measure indicators for analyzing our ability to determine the real situation of respiratory care quality in our community&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We report a retrospective&#44; cross-sectional study of 13 indicators from this guideline<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> selected by the members of each Neumomadrid working group under the supervision of the Quality Group&#46; These indicators were considered representative and reproducible for each of the diseases that form the underlying structure of the Guideline &#40;<a class="elsevierStyleCrossRef" href="#sec0010">Table 1&#44; Annex&#44; supplementary material</a>&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The Quality Group developed a data collection form&#44; that&#44; together with the corresponding guidelines&#44; was distributed to all heads of department who had previously been invited to participate&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Recruitment took place between October 15 and November 15&#44; 2017&#44; and the number of participants reflected the degree of complexity of each hospital&#46; Fourteen of the 23 hospitals with a respiratory medicine department participated and provided data on certain indicators&#44; representing a total of 4&#46;7 million inhabitants&#59; 4 hospitals provided data on 12 of the 13 indicators&#59; and 3 collected data on all 13&#44; representing a population of 2&#46;5 million inhabitants&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The results reflect measures from the total number of participating hospitals&#44; reported by relative frequencies &#40;&#37;&#41; and the degree of participation for each of the indicators&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The 13 selected indicators were broken down as follows&#58; 1 referred to structure &#40;nursing&#41;&#44; 4 to processes &#40;fiberoptic bronchoscopy&#44; pleura&#44; sleep-NIMV&#44; and lung cancer&#41;&#44; and 8 to outcomes &#91;cystic fibrosis &#40;CF&#41;&#44; pulmonary thromboembolism &#40;PTE&#41;&#44; pediatrics&#44; diffuse interstitial pulmonary disease &#40;IPD&#41;&#44; chronic obstructive pulmonary disease&#44; asthma&#44; infections&#44; and smoking&#93;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Analysis of the data &#40;<a class="elsevierStyleCrossRef" href="#sec0010">Table 1&#44; Annex&#44; supplementary material</a>&#41; showed favorable results&#44; with the target reference value<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> being achieved for 41&#37; of the indicators&#58; lung cancer&#44; nursing&#44; pediatrics&#44; IPD&#44; and smoking&#46; Of the remaining 59&#37;&#44; 3 indicators &#40;fiberoptic bronchoscopy&#44; COPD and asthma&#41;&#44; showed a deviation from the reference value of &#60;5&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> whereas the other 4 &#40;sleep-NIMV&#44; CF&#44; infections&#44; and pleura&#41;&#44; showed a deviation of more than 35&#37; from the reference value&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> Data on PTE could not be obtained&#44; since it was only reported in 3 of the hospitals due to difficulty in obtaining this information from the Admissions Department&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">When the degree of participation of the different hospitals was assessed&#44; we found a rate of 47&#37; for the COPD indicator&#44; followed by asthma with 43&#37;&#44; cancer and nursing with 39&#37;&#44; fiberoptic bronchoscopy&#44; infections&#44; tobacco&#44; sleep-NIMV with 34&#37;&#44; and 30&#37; for pediatrics&#44; IPD&#44; and pleura&#46; The CF indicator was recorded in 3 hospitals&#44; 60&#37; of which were CF units in the Community of Madrid&#46; Although the participation of all hospitals would have been desirable&#44; the catchment area that these centers represent allows the intervention to be analyzed in a large proportion of the population&#44; since the number of more common cases&#44; such as COPD or asthma&#44; would be as high as 4&#46;7 million inhabitants&#44; and in less common areas&#44; such as pediatrics&#44; IPD and pleura&#44; the population would be up to 2&#46;5 million&#46; Notwithstanding&#44; the outcomes may have been more relevant if the participation of all hospitals had been achieved&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In view of the need to measure quality and establish areas for improvement in our specialty&#44; we aimed to evaluate 13 indicators selected from the Neumomadrid guideline&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> and found that the established standard for quality<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> was achieved for 41&#37; of our indicators&#44; while significant areas for improvement were detected in the remaining 59&#37;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Many advances have been made since the first publications on the evaluation of quality appeared&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> and interest among clinicians in improving quality and participating in clinical management under the aegis of regulations and guidelines is growing&#44; underlining the need for specific indicators in each specialist area&#46; The RECALAR study&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> recently published by SEPAR&#44; depicts the resources and the organizational structure of the pulmonology specialty in the Spanish National Health System&#46; This document draws attention to the lack of standards and indicators specifically applicable to respiratory medicine&#44; with the exception of some indicators for a few highly specialized processes&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">7&#44;11&#44;12</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The problem with published respiratory indicators lies in the fact that they tend to be excessive for a few organizations and virtually non-existent for others&#44; wording is ambiguous&#44; and they are unreproducible and impracticable&#46; They are also difficult to determine because they are not part of the measurement systems used in our hospitals and healthcare structures&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The Neumomadrid project arose to address these shortcomings and to assess the quality of our specialty&#46; This document forms the basis<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> for measuring the selected indicators&#44; and will be regularly updated&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion&#44; quality of care needs to be backed up by measurable indicators&#46; In the absence of homogeneous studies in our specialty&#44; Neumomadrid has developed the first guideline for quality indicators&#44; and has measured 13 of these indicators&#46; This study was conducted on around 40&#37; of the Community of Madrid&#44; and found that 41&#37; of the indicators exceed the reference value<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> but that there is room for improvement in the remaining 59&#37;&#44; including computer systems&#44; which&#44; if available&#44; could facilitate the participation of a greater number of centers&#46;</p></span>"
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