Evaluation of the effectiveness of an algorithm to predict COPD exacerbations in primary care: an interrupted time series analysis

OBJECTIVE: To evaluate the impact of the Clinical Exacerbation Score for Health Search (CEX-HScore) on the frequency of registered chronic obstructive pulmonary disease (COPD) exacerbations and referrals to specialists in Italian primary care using an interrupted time series (ITS) analysis. METHODS: Using data from an Italian federated network of general practitioners (GPs), we conducted an ITS analysis on GP-level (aggregated) indicators to assess changes in registration of moderate-to-severe COPD exacerbations and pulmonologist referrals before (up to January 2023) and after (up to June 2024) the implementation of CEX-HScore as a decision support system in GPs software. RESULTS: The launch of the CEX-HScore on 1 January 2024 did not yield statistically significant increases in indicators quantifying monthly referral rates or coded exacerbations in the general COPD population. Instead, among incident COPD cases, a significant increase of 45% per month (P < .001) in the proportion of coded exacerbations out of total exacerbations was observed postintervention. CONCLUSION: These findings suggest that the implementation of CEX-HScore may enhance the coding accuracy of COPD exacerbations in newly diagnosed patients. Further data points are needed to robustly evaluate its long-term effectiveness on broader clinical outcomes.