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Spirometry Utilization After Hospitalization for Patients With Chronic Obstructive Pulmonary Disease Exacerbations

Department of Hospital Medicine, Kaiser Permanente Medical Group, Inc, natutie{at}lycos.com

Ann Kodani, DO

Department of Internal Medicine, The Permanente Medical Group, Inc, Santa Clara, California

Dahlia Hilario, MD

Pikeville Medical Center, Pikeville, Kentucky

Sipho M. Munyaradzi, BSc Hons, MS

Medical Decision Support Department, Community Medical Center-Sierra

Michael W. Peterson, MD

Department of Internal Medicine, University of California, San Francisco Fresno Medical Education Program

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the US population. An area of improvement hinges on early detection and proper monitoring. Spirometry is an important interventional tool; its underuse among hospitalized patients with COPD could affect quality of care. This study evaluates spirometry use at the Community Medical Center—Sierra in hospitalized patients with COPD. A retrospective medical record review from January 1, 2000, to March 15, 2002, assesses 1507 inpatients with COPD. The effects are analyzed of age, sex, race/ ethnicity, diagnosis, insurance status, disposition, and admitting service on spirometry use by physicians are analyzed. A questionnaire is used to evaluate the knowledge, attitudes, and behaviors of residents toward spirometry ordering. Baseline characteristics are similar between study groups. Only 3% of 1476 study patients have spirometry performed within the recommended time frame, and only 12.2% have at least 1 spirometry performed. Patients having a primary diagnosis of COPD have a greater likelihood of having spirometry performed (20.3% vs 11.1%, P < .001), as do patients who are discharged to home (13.4% vs 5.9%, P = .001). No significant effects are noted for sex, race/ethnicity, insurance status, or admitting service. The house staff surveys reveal that most do not know the indications for (72.0%) or how to order (46.0%) spirometry. Spirometry is underused among physicians who treat hospitalized patients with COPD. Future educational efforts aimed at improving physicians' ordering and use of spirometry are needed to address this disparity. (Am J Med Qual 2009;24:61-66)

Key Words: Keywords: spirometry utilization • COPD • hospitalized

American Journal of Medical Quality, Vol. 24, No. 1, 61-66 (2009)
DOI: 10.1177/1062860608326417


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