Chest
Volume 134, Issue 1, July 2008, Pages 38-45
Journal home page for Chest

Original Research
Airway Diseases
Geographic Variation of Spirometry Use in Newly Diagnosed COPD*

https://doi.org/10.1378/chest.08-0013Get rights and content

Background

Studies indicate that not all physicians in clinical practice use spirometry routinely in the diagnosis of COPD. Understanding the patterns of spirometry use across geographic regions in patients with newly diagnosed COPD may help to identify the factors associated with the use of spirometry and to improve the quality of COPD care. The objective of this study was to characterize the regional variation in spirometry use for patients with newly diagnosed COPD using the Healthcare Effectiveness Data and Information Set (HEDIS) 2006 spirometry performance measure.

Methods

We identified patients within the Veteran Health Administration who were > 42 years of age who had received a new diagnosis of COPD between July 2003 and June 2004. The date of the COPD diagnosis was the index date. Spirometry use from 760 days prior to the index date to 180 days after the index date was identified. The Veterans Integrated Service Networks (VISNs) was used as the geographic unit for comparison.

Results

Of the 93,724 patients included in the study, 36.7% underwent spirometry during the study period. Using the largest VISN as the referent, there was more than a threefold difference in the adjusted odds ratios (AORs) for spirometry use between the regions with the lowest use (AOR, 0.52; 95% confidence interval [CI], 0.48 to 0.57) and the highest use (AOR, 1.61; 95% CI, 1.46 to 1.78).

Conclusions

Overall, the use of spirometry in patients with newly diagnosed COPD was low using the new HEDIS spirometry measure with a significant regional variation comprising a more than threefold difference between the regions with the lowest and highest rates of spirometry use.

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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    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).

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    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.

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