Impact of the CAPTURE Chronic Obstructive Pulmonary Disease Screening Tool in U.S. Primary Care: A Cluster-Randomized Trial.

Objectives: We sought to assess the impact of receiving screening scores for clinical and patient outcomes using the COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) tool.

目标：我们旨在评估使用初级保健中识别未诊断呼吸系统疾病和急性加重风险的COPD评估（CAPTURE）工具接收筛查分数对临床和患者结果的影响。

Methods: This cluster-randomized trial included 49 usual-care (COPD education only) and 51 intervention (COPD and CAPTURE education plus screening scores) primary care practices.

方法：这项群组随机试验包括49个常规护理（仅COPD教育）和51个干预（COPD和CAPTURE教育加筛查评分）的初级保健实践。

Twelve-month medical record and patient survey outcome data were collected from patients with elevated screening scores or study spirometric abnormalities.

从筛查评分升高或研究中存在肺功能异常的患者那里收集了12个月的病历和患者调查结果数据。

Measurements and Main Results: Among 387 CAPTURE screen-positive (CAPTURE+) patients, no significant difference was noted between usual-care and intervention practices in the primary composite outcomes of 1) spirometry referral/completion, or 2) new COPD diagnosis, or 3) newly prescribed inhaled long-acting respiratory medication, or 4) referral to a respiratory specialist, or 5) pulmonary rehabilitation referral/completion; 45.9% versus 41.9%, respectively (absolute difference, 4.0%; 95% confidence interval, -6.9, 15.0; P = 0.47).

测量和主要结果：在387名CAPTURE筛查阳性（CAPTURE+）患者中，常规护理和干预实践在主要综合结果方面没有显著差异，这些结果包括1）肺功能检测的转诊/完成，或2）新的慢阻肺诊断，或3）新开具吸入长效呼吸系统药物处方，或4）转诊至呼吸专科，或5）肺康复的转诊/完成；分别为45.9%和41.9%（绝对差异，4.0%；95%置信区间，-6.9, 15.0；P = 0.47）。

Only spirometry referral/completion was higher in the intervention group (absolute difference, 10.4%; 95% confidence interval, 0.1, 20.7; P = 0.0465).

只有肺功能检测的转诊/完成在干预组中更高（绝对差异，10.4%；95%置信区间，0.1, 20.7；P = 0.0465）。

No differences were noted for secondary outcomes, composite components, change in COPD Assessment Test scores, rates of respiratory illnesses, or hospitalizations.

未观察到次要结果、复合成分、慢性阻塞性肺疾病评估测试评分变化、呼吸道疾病发生率或住院率的差异。

For the 1,028 CAPTURE screen-negative (CAPTURE-) patients, composite primary and all secondary outcomes were similar in the two arms.

对于1,028名CAPTURE筛查阴性（CAPTURE-）患者，两组的复合主要结果和所有次要结果相似。

In secondary and post hoc analyses evaluating the potential impact of the pandemic, intervention group differences in clinician and patient outcomes were noted for CAPTURE+ and CAPTURE- patients in the prepandemic period that diminished during the pandemic.

在对疫情潜在影响进行的次要和事后分析中，注意到在疫情前的CAPTURE+和CAPTURE-患者中，干预组在临床医生和患者结果上的差异在疫情期间有所减少。

Conclusions: Within these U.S. primary care practices, COPD and CAPTURE education plus receipt of CAPTURE screening scores did not change clinician COPD assessment or care or patient outcomes for CAPTURE+ patients.

结论：在美国的初级保健实践中，COPD和CAPTURE教育以及接受CAPTURE筛查评分并未改变临床医生对COPD的评估或治疗，或CAPTURE+患者的患者结果。

However, in the prepandemic period, CAPTURE+ patients were more likely to undergo spirometry referral completion, whereas for CAPTURE- patients, clinicians were significantly less likely to assess for COPD, suggesting that the intervention resulted in a more appropriate use of healthcare resources.

然而，在大流行前时期，CAPTURE+患者更有可能完成肺功能检查的转诊，而对于CAPTURE-患者，临床医生显著较少评估慢性阻塞性肺病（COPD），这表明该干预措施导致了对卫生资源的更合理使用。

Clinical trial registered with www.clinicaltrials.gov (NCT03581227).

临床试验已在www.clinicaltrials.gov注册（NCT03581227）。