Chest
Original ResearchAirway DiseasesGeographic Variation of Spirometry Use in Newly Diagnosed COPD*
Section snippets
Methods and Materials
We evaluated the 2006 HEDIS COPD spirometry performance measure by applying the definitions and parameters to a VA population.6 Using a retrospective cohort design, VA administrative data were used to identify patients with a diagnosis of COPD (International Classification of Diseases, ninth revision, codes 491.x, 492.x, and 496) between July 1, 2003, and June 30, 2004. The date of diagnosis was defined as the index date. To be included, patients must have been ≥42 years of age by December 31,
Results
There were 93,724 patients with newly diagnosed COPD identified who were for inclusion in the analysis. A total of 34,393 patients (36.7%) had undergone spirometry during a period starting from 760 days prior to the index date to 180 days after the index date. Of this cohort, 96.8% were men and 68.3% were > 60 years of age. Table 1 shows the patient characteristics stratified by whether spirometry had been performed and the adjusted odds ratios (AORs) between spirometry use and covariates.
The
Discussion
Using the 2006 HEDIS spirometry performance measure for a new diagnosis of COPD, our analysis revealed an overall low performance at 36.7% with more than a threefold difference between the VISNs with the lowest and the highest likelihoods of patients having undergone spirometry after controlling for patient characteristics and health-care utilization.
Our sensitivity analysis using only the CPT codes for spirometry showed more than a fourfold difference in the AORs between the VISNs with the
Acknowledgment
The authors thank Zachary Christman, PhD candidate (Clark University Graduate School of Geography), for his contribution in creating the US VISN color-coded map.
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2017, American Journal of Preventive MedicineCitation Excerpt :In other similar studies, factors that increased the chances of pulmonary function testing in patients with a new diagnosis of COPD included asthma or another lung disease,7 use of a short-acting β-agonist or other respiratory medication,7,8 any pulmonary clinic visits,7,8 and having a pulmonologist as the primary physician.9 Conversely, older age and non-respiratory comorbidities were associated with lower chances of pulmonary function testing.7–10 Yet, in this study, the majority of patients (81%) who screened positive for increased risk of COPD received no RRCAs, perhaps because of the physician’s need to deal with other common comorbid conditions and limited time for each visit, requiring focus on only the reason for the visit.11
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This work was performed at the Hines VA hospital.
This research was supported by the Health Services Research and Development Service, Center for Management of Complex Chronic Care COE, Hines VA Hospital, Hines, IL. The funding agency did not participate in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
- 1
Dr. Weiss was the Director for the Management of Complex Chronic Care, Hines VA Hospital, Hines, IL, and the Institute for Healthcare Studies at Northwestern University Feinberg School of Medicine, Chicago, IL when this work was performed.