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* From the Epidemiology and Cancer Control Program (Drs. D.W. Mapel, V.M. Mapel, and Coultas, and Ms. Picchi), University of New Mexico Health Sciences Center, Albuquerque, NM; and the Southwest Center for Managed Care Research (Ms. Hurley, Dr. Frost, and Mr. Petersen), Lovelace Respiratory Research Institute, Albuquerque, NM.
Correspondence to: Douglas W. Mapel, MD, MPH, FCCP, Epidemiology and Cancer Control Program, The University of Mexico Health Sciences Center, 2325 Camino de Salud NE, Albuquerque, NM 87131-5306; e-mail: dmapel{at}salud.unm.edu
Study objectives: Information on current practices of COPD diagnosis and treatment is needed to identify opportunities for improving care. This study describes the clinical characteristics and diagnostic evaluations of COPD patients in a health maintenance organization (HMO) and a university-affiliated county medical center (UMC).
Design: Cross-sectional survey performed in a 174,484-member regional HMO and in The University of New Mexico Hospitals and Clinics (UNMH).
Patients: Two hundred COPD patients from each system randomly selected from administrative databases based on discharge diagnoses.
Results: COPD patients in the UMC, compared to those in the HMO, were younger (mean age, 59.3 vs 66.9 years, respectively), were more likely to be using home oxygen (33% vs 20%, respectively), and had fewer chronic medical conditions (mean number of conditions, 3.1 vs 3.7, respectively) (p < 0.01 for all differences). Approximately half of the COPD patients in both groups continued to smoke cigarettes during the study year. Only 38% of patients in the HMO and 42% in the UNMH system had spirometry results documented in their medical records.
Conclusions: The demographic and clinical characteristics of the COPD patients in these two health-care systems were very different, but smoking status and utilization of diagnostic tests were similar. The diagnosis of COPD in most patients was based only on a history of chronic respiratory symptoms and smoking; spirometry often was not used to confirm the diagnosis. An increased emphasis on smoking cessation and more effective utilization of spirometry are needed to improve the management of COPD in these health-care systems.
Key Words: comorbidity • diagnosis • managed-care programs • obstructive lung disease • respiratory function tests • smoking • utilization review
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