Abstract
A model consisting of a motivated working group that identified the different stakeholders to convince them, through education, over the Global Lung Function Initiative reference values has appeared to be successful in implementing these in Belgiumhttp://ow.ly/Q21630kuE1N
Pulmonary function tests are pure physiological measurements. Spirometry allows the clinician to label lung diseases as either obstructive or restrictive, the latter requiring confirmation with static lung volume measurements. Transfer factor of the lung for carbon monoxide (TlCO) informs the clinician about the gas exchange properties of the respiratory system. A prerequisite to distinguish normal from abnormal data is the availability of accurate reference values as well as their lower and higher limits of normality. Choosing the correct set of reference values is crucial to discriminate health from disease in the individual and will influence any further medical processes. Indeed, results from one given subject may fall within the normal range using one equation while being abnormal using another [1–5]。The availability of accurate reference values is not only important in the diagnostic work-up and management of a single patient, it also leads to a better understanding of the global burden of lung disease, and allows a statistically correct estimation of the degree of impairment and disability in occupational medicine.
2005年美国胸部社会(ATS)/欧洲呼吸协会(ERS)关于美国受试者的肺功能标准188bet官网地址化的工作队,是血管测定的种族适当的国家健康和营养考试调查III参考方程。它不建议在欧洲使用任何特定的方程式,了解欧洲社区的钢铁和煤炭方程的许多缺点仍在那个大陆上[6]。ForTlCO, the ATS/ERS Task Force was unable to express any recommendation [6]。这促使许多临床医生,生理学家和研究人员建立了全球肺功能倡议(GLI)工作队,打算融合现有的数据来源,以创造更加强大和全球适用的参考方程。为此,他们利用了用于分析所有年龄段的肺功能数据的最新统计方法[7]。In 2012, this task force published the multiethnic “all-age” reference values for spirometry [8]。从那时起,这些已经受到主要欧洲,美国,亚洲和大洋洲和大洋洲呼吸道社会的认可。最近,GLI网络发布了参考值TlCOin Caucasians [4] and the same network is currently collecting data to establish reference equations for lung volumes.
Dissemination and publication of recommendations is often done by professional and national pulmonary societies, occasionally supported by industry, whereas their implementation is usually the responsibility of healthcare practitioners [9]。目前既不是临床研究合作,也不正式参与国家一级的GLI参考价值的传播和实施。此外,没有制定如何管理这一努力的策略。通过GLI参考价值的优势,2013年,比利时胸部社会的董事会批准了一个工作组,探讨了在比利时可以引入肺活量测量学的GLI参考价值,最终在2018年实现。来自第一次讨论,工作组承认,引入GLI参考值是一个复杂的过程,远远超出了从一组参考值到另一组的简单开关。它还认识到,过渡应优选在有限的时间框架内以全国范围的基础发生,以避免医疗保健提供者和不熟悉肺功能中使用的参考值的患者的混淆。GLI参考值的引入需要对新方程式的优点进行脉印教导,对每个测量的正常情况下限的概念和Z值的归因。此外,所涉及的所有利益攸关方也必须被识别,这些障碍可能会拖延或干扰成功的全国范围内引入GLI。
A master plan consisting of a three-stage approach was formulated and approved by the Belgian Thoracic Society board in 2013.
First, the pulmonologists were introduced to the GLI concept with posters during the 2014 winter meeting of the Belgian Thoracic Society. In addition, more detailed information on the “pros and cons” of GLI reference values were given to the majority of Belgian pulmonologists (n=500) during the 18 local focus groups meetings. These focus groups, consisting of 20–25 pulmonologists each, are instructed by the Belgian healthcare authorities to gather at least four times a year to discuss issues related to quality and cost-effectiveness of healthcare. The working group urged these focus groups to invite one of its members to present the GLI concept, its advantages and the need for a collective transition. The same channel was used to convince paediatricians with specific interest in pneumology. Just before final launch, an update was given at the 2017 Belgian Thoracic Society meeting.
其次,在2013年和2014年度延迟教授的2013年和2014年度国会会议期间向肺功能技术人员解释了GLI的概念。在几次区域会议上提供了有关更多技术方面的更新。
Third, from 2013 onwards, pulmonary function equipment manufacturers were contacted by members of the working group to prepare a collective transition. Technical barriers to upload the new reference values in older equipment and their financial repercussions were categorised, and estimations of the cost of updating the software were provided in all transparency. Eventually, all pulmonologists were regularly informed about the specific cost to update their equipment with the GLI reference values. This could vary between “completely free of charge”, in the case of recently purchased equipment, and the need to order a completely new unit for pulmonary function in case the equipment was outdated. Often, however, an update of the driver for a personal computer, or other software, was sufficient. Even more challenging was to work out solutions to integrate the GLI in the electronic health records of one of the university hospitals, which are connected to seven other regional hospitals.
In 2017, the introduction of the GLI concept in Belgium was postponed until the reference values forTlCObecame available, as it was estimated that the introduction of GLI for both values would be even more attractive to pulmonologists. Additionally, we developed and distributed a specific recommendation concerning the minimal requirements of a pulmonary function report (https://www.bvp-sbp.org). The pulmonologists were instructed to include absolute, median per cent predicted and Z-values on their report as well the source of the reference values. Starting in January 2018, the majority of pulmonologists were enthusiastic about the implementation and instructed for the transition. Since then, more and more hospitals have updated their software and implemented GLI as the standard reference in their protocol. Manufacturers told us that in rare cases, outdated equipment rendered installation of the update impossible, delaying it until the pulmonary function unit had been renewed in the upcoming year.
To the best of our knowledge, Belgium is the first country to have formally introduced the GLI reference values nationwide. It is expected that many other countries will follow. Different approaches going from a national survey (UK), to persistent debates of the pros and cons (France and Sweden), individual decisions whether to implement or not (the Netherlands and Spain), and university centres only (Germany, Italy and Lithuania) are currently seen. The “Belgian model” of a motivated working group that identified the different stakeholders to convince them through education for GLI appeared to be successful. A more challenging step is now to align primary care physicians with the new concepts of GLI.
Footnotes
利益冲突:大肠Derom无关盘lose concerning the submitted manuscript, but received financial support from AstraZeneca, Chiesi and Boehringer Ingeheim to attend ERS and ATS congresses, and participated in national advisory boards for AstraZeneca, Boehringer, GSK, Novartis and Chiesi.
兴趣冲突:W. Janssens报告在提交的工作之外获得GSK,Astrazeneca,Boehringer和Chiesi的赠款。
- ReceivedMay 26, 2018.
- AcceptedJune 10, 2018.
- Copyright ©ERS 2018