{ "abstract": "Background\n\nIntegrated COPD management has improved outcomes for patients with diagnosed COPD. The CONQUEST Quality Improvement Program aims to improve the diagnosis and management for patients with potential and diagnosed modifiable high-risk (MHR) COPD, defined as those with a history of exacerbations and opportunities for treatment optimization.Methods\n\nUtilizing the CONQUEST registry and Optimum Patient Care (OPC) Research Database, this observational cohort analysis assessed changes in quality indicator attainment over 12 months among potentially undiagnosed, newly diagnosed and already diagnosed patients with MHR COPD in exposed and matched usual care (UC) general practices. In exposed practices, newly diagnosed and already diagnosed patients were restricted to those receiving OPC-led CONQUEST clinics. Outcomes were compared using difference-in-difference generalized linear models with overlap propensity weighting.Findings\n\nFrom 168 UK practices, we identified 113,574 potentially undiagnosed (59,706 exposed, 53,868 UC), 2787 newly diagnosed (1448 exposed of which 252 attended OPC clinics, 1339 UC) and 38,054 already diagnosed (21,670 exposed of which 392 attended OPC clinics, 16,384 UC). Potentially undiagnosed patients in exposed practices were more likely to subsequently receive a spirometry-confirmed COPD diagnosis (1.0% vs 0.6%; adjusted ratios-of-risk-ratios [ARRR]:1.55, 95% CI: 1.19-2.01) compared to UC. Initiation or step-up to guideline-appropriate inhaled therapy was more likely among OPC-supported patients in exposed practices for newly diagnosed (96.4% vs 55.7%; ARRR: 1.71, 95% CI: 1.41-2.06) and already diagnosed (91.6% vs 39.8%; ARRR: 1.94, 95% CI: 1.77-2.1212) versus unsupported UC.Interpretation\n\nCONQUEST is associated with measurable improvements in quality indicator attainment aligned with guideline-recommended identification and management of COPD, including higher rates of spirometry-confirmed COPD diagnosis and treatment optimization. Future randomized trials will evaluate if this translates into improved outcomes including reduced exacerbations and hospitalizations.", "abstract_shown": true, "affiliations": [ "Modality Partnership, Horley, Surrey, UK.", "Optimum Patient Care, Cambridge, UK.", "Observational and Pragmatic Research Institute, Singapore, Singapore.", "Optimum Patient Care Global, Cambridge, UK.", "EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal.", "Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.", "King's Centre for Lung Health, School of Immunology and Microbial Science, Faculty of Life Sciences and Medicine, King's College London, London, UK.", "Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.", "Key Laboratory of Respiratory Disease of Shenzhen, Shenzhen Institute of Respiratory Disease, Shenzhen People's Hospital (Second Affiliated Hospital of Jinan University, First Affiliated Hospital of South University of Science and Technology of China), Shenzhen, Guangdong, People's Republic of China.", "Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.", "Hull University Teaching Hospitals NHS Trust, Hull, UK.", "Hull York Medical School, University of Hull, Hull, UK.", "Clinical Sciences, Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, UK.", "East of England Community Health & Care NHS Trust, Norwich, UK.", "Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.", "Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.", "Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.", "NorthWest EHealth, Salford, UK.", "Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK.", "Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK.", "University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK.", "NRAP, Care Quality Improvement Department (CQID), RCP, London, UK.", "Low Moor Medical Practice, Bradford, UK.", "UCL Respiratory, University College London, London, UK.", "Global Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.", "New York-Presbyterian Weill Cornell Medical Center, New York, NY, USA.", "Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.", "Respiratory & Immunology, Medical and Payer Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.", "Medical and Scientific Affairs, AstraZeneca, London, UK.", "Department of Respiratory Medicine, Nara Medical University, Nara, Japan.", "Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden.", "School of Public Health, Imperial College London, London, UK.", "Platinum Medical Centre, Chermside, QLD, Australia.", "Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK.", "Horse Fair Practice Group, Keele University Medical School Teaching Practice, Rugeley, UK.", "Staffordshire & Stoke-on-Trent ICB, Stafford, UK.", "Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany.", "Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA.", "NIHR Southampton BRC Southampton, Southampton, UK.", "Faculty of Medicine, University of Southampton, Southampton, UK." ], "article_type": "research article", "arxiv": null, "author_total": 41, "authors": [ { "affs": [ 0 ], "name": "Elango Vijaykumar", "orcid": "0009-0002-8996-5791" }, { "affs": [ 1 ], "name": "James Gatenby", "orcid": "0009-0005-5937-3949" }, { "affs": [ 2 ], "name": "Alexander Evans" }, { "affs": [ 2 ], "name": "William Henley", "orcid": "0000-0001-6273-2619" }, { "affs": [ 1 ], "name": "Neva Eleangovan" }, { "affs": [ 2, 3 ], "name": "Amy Couper", "orcid": "0000-0002-3892-3113" }, { "affs": [ 2, 3 ], "name": "Margee Kerr" }, { "affs": [ 1 ], "name": "Cono Ariti", "orcid": "0000-0001-7615-0935" }, { "affs": [ 2 ], "name": "John Busby", "orcid": "0000-0003-4831-7464" }, { "affs": [ 4, 5 ], "name": "Luis Alves", "orcid": "0000-0001-5855-2754" }, { "affs": [ 6 ], "name": "Mona Bafadhel", "orcid": "0000-0002-9993-2478" }, { "affs": [ 7 ], "name": "Mohit Bhutani", "orcid": "0000-0002-1911-4169" }, { "affs": [ 1 ], "name": "Victoria Carter", "orcid": "0000-0002-0333-3308" }, { "affs": [ 8 ], "name": "Rongchang Chen", "orcid": "0009-0003-3377-1872" }, { "affs": [ 9 ], "name": "James Chalmers", "orcid": "0000-0001-5514-7868" }, { "affs": [ 10, 11 ], "name": "Michael G Crooks", "orcid": "0000-0001-6876-0258" }, { "affs": [ 12 ], "name": "Graham Devereux" }, { "affs": [ 1 ], "name": "Andrew P Dickens", "orcid": "0000-0002-7591-8129" }, { "affs": [ 13 ], "name": "Daryl Freeman", "orcid": "0000-0003-2056-2716" }, { "affs": [ 14, 15, 16 ], "name": "Chris P Gale", "orcid": "0000-0003-4732-382X" }, { "affs": [ 17, 18, 19 ], "name": "John Martin Gibson", "orcid": "0000-0002-1331-1524" }, { "affs": [ 20 ], "name": "David Halpin", "orcid": "0000-0003-2009-4406" }, { "affs": [ 21, 22 ], "name": "Katherine Hickman", "orcid": "0009-0004-1573-6245" }, { "affs": [ 23 ], "name": "John R Hurst", "orcid": "0000-0002-7246-6040" }, { "affs": [ 24 ], "name": "Jonathan Marshall" }, { "affs": [ 25 ], "name": "Fernando J Martinez" }, { "affs": [ 26 ], "name": "Marc Miravitlles", "orcid": "0000-0002-9850-9520" }, { "affs": [ 27 ], "name": "Hana Mullerova", "orcid": "0000-0002-0949-0101" }, { "affs": [ 28 ], "name": "Tamsin Morris", "orcid": "0000-0003-4475-5483" }, { "affs": [ 29 ], "name": "Shigeo Muro", "orcid": "0000-0001-7452-9191" }, { "affs": [ 30 ], "name": "Jonatan Natman" }, { "affs": [ 31 ], "name": "Jennifer K Quint", "orcid": "0000-0003-0149-4869" }, { "affs": [ 32 ], "name": "Anita Sharma", "orcid": "0000-0002-3926-7947" }, { "affs": [ 33 ], "name": "Dave Singh", "orcid": "0000-0001-8918-7075" }, { "affs": [ 34, 35 ], "name": "Mukesh Singh" }, { "affs": [ 36 ], "name": "Daiana Stolz", "orcid": "0000-0003-0099-882X" }, { "affs": [ 2 ], "name": "Rachel Pullen", "orcid": "0000-0002-4644-9845" }, { "affs": [ 37 ], "name": "Della Varghese" }, { "affs": [ 38, 39 ], "name": "Tom M Wilkinson", "orcid": "0000-0003-1771-3851" }, { "name": "Tonya Winders", "orcid": "0000-0001-7689-6438" }, { "affs": [ 2, 3 ], "name": "David Price", "orcid": "0000-0002-9728-9992" } ], "bibtex": "https://research.draconitic.com/paper/frj7wz7rkhjhv.bib", "cited_by": 0, "doi": "10.2147/por.s601059", "fulltext_url": "https://europepmc.org/articles/PMC13695919", "id": "frj7wz7rkhjhv", "issns": [ "1179-7266" ], "landing_url": "https://europepmc.org/article/MED/42928880", "language": "eng", "licence": "CC-BY-NC", "licence_label": "CC BY-NC", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2740|Chronic Obstructive Pulmonary Disease (COPD) Research" ] ], "openalex": "W7223005186", "pdf_url": "https://europepmc.org/articles/PMC13695919?pdf=render", "pmcid": "PMC13695919", "pmid": "42928880", "published": "2026-10-21", "publisher": null, "ris": "https://research.draconitic.com/paper/frj7wz7rkhjhv.ris", "sources": [ { "first_seen": "2026-10-30T12:21:18Z", "native_id": "MED:42928880", "source": "europepmc", "url": "https://europepmc.org/article/MED/42928880" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2740|Chronic Obstructive Pulmonary Disease (COPD) Research", "subfield": "general" } ], "title": "CONQUEST-ADVANCE: Achieving proDuctiVe implementAtioN of CONQUEST Quality Standards in COPD Care.", "title_text": "CONQUEST-ADVANCE: Achieving proDuctiVe implementAtioN of CONQUEST Quality Standards in COPD Care.", "type": "peer-reviewed", "updated_at": "2026-10-30T12:21:18Z", "url": "https://research.draconitic.com/paper/frj7wz7rkhjhv", "venue": "Pragmatic and observational research", "versions": [] }