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Geographic Variation of Spirometry Use in Newly Diagnosed COPD

¹ Center for Management of Complex Chronic Care, Hines VA Hospital, Hines, IL ² Center for Management of Complex Chronic Care, Jesse Brown VA Hospital, Chicago, IL ³ Institute for Healthcare Studies and the Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL ⁴Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL ⁵American Board of Medical Specialties, Evanston, IL

joo{at}uic.edu

Abstract

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

MethodsWe identified patients within the Veteran Health Administration who were 42 years or older with a new diagnosis of COPD between July 2003 and June 2004. The date of 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. Veterans Integrated Service Networks (VISN) was used as the geographic unit for comparison.

ResultsOf the 93,724 patients included, 36.7% had spirometry performed during the study period. Using the largest VISN as the referent, there was more than a three-fold difference in the adjusted odds ratios(AOR) for spirometry use between the regions with the lowest use (AOR =0.52, 95% CI, 0.48-0.57) and highest use (AOR=1.61, 95% CI, 1.46-1.78).

ConclusionsOverall, the use of spirometry for newly diagnosed COPD was low using the new HEDIS^® spirometry measure with significant regional variation of more than a three-fold difference between the regions with the lowest and highest rates of spirometry use.

Key Words: Chronic obstructive pulmonary disease • Spirometry • Diagnosis • Quality of health care • Process assessment (health care) • Health care delivery • Health services research