{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:06:48Z","timestamp":1790068008494,"version":"4.0.1"},"reference-count":36,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"unspecified","delay-in-days":264,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prim Health Care Res Dev"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Large-scale quality improvement programmes (QIPs) have diverse factors that may influence their success and can undergo rapid changes throughout their lifecycle. The COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST) programme has recently been implemented in primary care practices in the UK. The CONQUEST programme aims to identify patients with already diagnosed and undiagnosed COPD at high risk of COPD-related adverse outcomes and optimize their management. CONQUEST has been successful in identifying COPD patients who may represent an outsized opportunity to improve patient outcomes and healthcare utilization, whilst focusing on relatively few patients per primary care practice. This paper reviews the steps involved in implementing CONQUEST in the UK, focussing on the challenges encountered, the solutions used to overcome these challenges barriers, and the lessons learned for the implementation of QIPs more widely. Key lessons from this process include that QIPs need to be designed with the flexibility to adapt to multiple and different local contexts, that early monitoring of data across the lifecycle of a QIP allows efficient detection of issues and troubleshooting, and that planning for allocation of limited resources to a QIP is essential for real-world implementation. The problems and solutions described here are applicable to QIPs in a wide variety of high-risk diseases and different healthcare settings.<\/jats:p>","DOI":"10.1017\/s1463423626101480","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:47:55Z","timestamp":1790066875000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Implementing quality improvement for patients with high-risk chronic disease: lessons from the CONQUEST UK COPD programme"],"prefix":"10.1017","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2009-4406","authenticated-orcid":false,"given":"David M.G.","family":"Halpin","sequence":"first","affiliation":[{"name":"University of Exeter"},{"name":"Observational and Pragmatic Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Gatenby","sequence":"additional","affiliation":[{"name":"Optimum Patient Care Global"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1573-6245","authenticated-orcid":false,"given":"Katherine","family":"Hickman","sequence":"additional","affiliation":[{"name":"RCP London: Royal College of Physicians"},{"name":"Low Moor Medical Practice"},{"name":"West Yorkshire ICB"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7246-6040","authenticated-orcid":false,"given":"John","family":"Hurst","sequence":"additional","affiliation":[{"name":"University College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3892-3113","authenticated-orcid":false,"given":"Amy","family":"Couper","sequence":"additional","affiliation":[{"name":"Observational and Pragmatic Research Institute"},{"name":"Optimum Patient Care Global"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7591-8129","authenticated-orcid":false,"given":"Andrew P.","family":"Dickens","sequence":"additional","affiliation":[{"name":"Observational and Pragmatic Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Evans","sequence":"additional","affiliation":[{"name":"Observational and Pragmatic Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Adan Coronado","sequence":"additional","affiliation":[{"name":"Optimum Patient Care Global"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4644-9845","authenticated-orcid":false,"given":"Rachel","family":"Pullen","sequence":"additional","affiliation":[{"name":"Observational and Pragmatic Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5855-2754","authenticated-orcid":false,"given":"Lu\u00eds","family":"Alves","sequence":"additional","affiliation":[{"name":"University of Porto: Universidade Do Porto"},{"name":"Laboratory for Integrative and Translational Research in Population Health (ITR)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Bafadhel","sequence":"additional","affiliation":[{"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0333-3308","authenticated-orcid":false,"given":"Victoria","family":"Carter","sequence":"additional","affiliation":[{"name":"Optimum Patient Care Global"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6876-0258","authenticated-orcid":false,"given":"Michael","family":"Crooks","sequence":"additional","affiliation":[{"name":"University of Hull"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9850-9520","authenticated-orcid":false,"given":"Marc","family":"Miravitlles","sequence":"additional","affiliation":[{"name":"Vall d\u2019Hebron Institut de Recerca"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamsin","family":"Morris","sequence":"additional","affiliation":[{"name":"AstraZeneca UK Limited"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0949-0101","authenticated-orcid":false,"given":"Hana","family":"M\u00fcllerov\u00e1","sequence":"additional","affiliation":[{"name":"AstraZeneca UK Limited"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukesh","family":"Singh","sequence":"additional","affiliation":[{"name":"Keele University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0149-4869","authenticated-orcid":false,"given":"Jennifer K.","family":"Quint","sequence":"additional","affiliation":[{"name":"Imperial College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave","family":"Singh","sequence":"additional","affiliation":[{"name":"Manchester University NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"NIHR Southampton BRC Southampton"},{"name":"University of Southampton"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tonya","family":"Winders","sequence":"additional","affiliation":[{"name":"Global Allergy & Airways Patient Platform"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9728-9992","authenticated-orcid":false,"given":"David","family":"Price","sequence":"additional","affiliation":[{"name":"Observational and Pragmatic Research Institute"},{"name":"Optimum Patient Care Global"},{"id":[{"id":"https:\/\/ror.org\/016476m91","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Aberdeen"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"S1463423626101480_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2015.02.005"},{"key":"S1463423626101480_ref11","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02240-2023"},{"key":"S1463423626101480_ref19","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S253812"},{"key":"S1463423626101480_ref31","doi-asserted-by":"publisher","DOI":"10.1111\/ajr.12828"},{"key":"S1463423626101480_ref3","unstructured":"Buckingham, R , Lowe, D , Pursey, N , Roberts, CM and Stone, R (2008) \u201cReport 5 of The National Chronic Obstructive Pulmonary Disease Audit 2008: survey of COPD care within UK General Practices.\u201d The Royal College of Physicians of London, British Thoracic Society and British Lung Foundation. Available at https:\/\/archive-rcplondon.zedcloud.co.uk\/file\/1040\/download"},{"key":"S1463423626101480_ref15","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00208-2020"},{"key":"S1463423626101480_ref14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0909883"},{"key":"S1463423626101480_ref26","unstructured":"NHS England (2024a) \u201cNHS England\u00bb Community diagnostic centres,\u201d 9 February. Available at https:\/\/www.england.nhs.uk\/long-read\/community-diagnostic-centres\/ (accessed 5 June 2025)."},{"key":"S1463423626101480_ref17","doi-asserted-by":"publisher","DOI":"10.3399\/BJGPO.2025.0065"},{"key":"S1463423626101480_ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2024.07.150"},{"key":"S1463423626101480_ref29","unstructured":"Primary Care Respiratory Society (2023) PCRS Position Statement: Spirometry in primary care following the COVID-19 Pandemic. Available at https:\/\/www.pcrs-uk.org\/sites\/default\/files\/resource\/2023-10-23-Position-Statement-Spirometry-in-Primary-Care.pdf"},{"key":"S1463423626101480_ref28","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2021.20390"},{"key":"S1463423626101480_ref5","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-20-814"},{"key":"S1463423626101480_ref36","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k4388"},{"key":"S1463423626101480_ref21","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201711-2239OC"},{"key":"S1463423626101480_ref24","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp22X719213"},{"key":"S1463423626101480_ref32","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202209-1774OC"},{"key":"S1463423626101480_ref9","doi-asserted-by":"publisher","DOI":"10.2147\/POR.S396830"},{"key":"S1463423626101480_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(24)00038-9"},{"key":"S1463423626101480_ref6","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-10-92"},{"key":"S1463423626101480_ref18","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-0013"},{"key":"S1463423626101480_ref30","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S313498"},{"key":"S1463423626101480_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2019.07.003"},{"key":"S1463423626101480_ref13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.p2140"},{"key":"S1463423626101480_ref23","doi-asserted-by":"publisher","DOI":"10.1136\/thorax-2023-221211"},{"key":"S1463423626101480_ref34","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-017-0620-6"},{"key":"S1463423626101480_ref35","doi-asserted-by":"publisher","DOI":"10.1038\/npjpcrm.2014.35"},{"key":"S1463423626101480_ref22","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009993"},{"key":"S1463423626101480_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2017.04.013"},{"key":"S1463423626101480_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2023.100619"},{"key":"S1463423626101480_ref1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00239-2023"},{"key":"S1463423626101480_ref27","unstructured":"NHS England (2024b) NHS England\u00bb Population health management. Available at https:\/\/www.england.nhs.uk\/long-read\/population-health-management\/ (accessed 5 September 2024)."},{"key":"S1463423626101480_ref12","unstructured":"Healthwatch England (2024) A local diagnosis: Learning the lessons of Community Diagnostic Centres. Available at https:\/\/www.healthwatch.co.uk\/sites\/healthwatch.co.uk\/files\/20240828_A%20local%20diagnosis.pdf (accessed 5 September 2024)."},{"key":"S1463423626101480_ref2","doi-asserted-by":"publisher","DOI":"10.2147\/PROM.S296506"},{"key":"S1463423626101480_ref25","unstructured":"National Institute for Health and Care Excellence (2018) Chronic obstructive pulmonary disease in over 16s: diagnosis and management. Clinical guideline [NG115]."},{"key":"S1463423626101480_ref4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2011-000760"}],"container-title":["Primary Health Care Research &amp; Development"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1463423626101480","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:48:02Z","timestamp":1790066882000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1463423626101480\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":36,"alternative-id":["S1463423626101480"],"URL":"https:\/\/doi.org\/10.1017\/s1463423626101480","relation":{},"ISSN":["1463-4236","1477-1128"],"issn-type":[{"value":"1463-4236","type":"print"},{"value":"1477-1128","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e106"}}