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Geographic Variation of Spirometry Use in Newly Diagnosed COPD^*

Min J. Joo, MD, MPH; Todd A. Lee, PharmD, PhD and Kevin B. Weiss, MD, MPH

^* From the Center for Management of Complex Chronic Care (Drs. Joo and Lee), Hines VA Hospital, Hines, IL; and the American Board of Medical Specialties (Dr. Weiss), Evanston, IL. 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.

Correspondence to: Min J. Joo, MD, MPH, 840 S Wood St, M/C 719, Chicago, IL 60612-7323; e-mail: joo{at}uic.edu

Abstract

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.

Key Words: COPD • diagnosis • health-care delivery • health services research • process assessment (health care) • quality of health care • spirometry

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