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The Quality of Obstructive Lung Disease Care for Adults in the United States as Measured by Adherence to Recommended Processes^*

^* From the Center for Health Research (Dr. Mularski), Kaiser Permanente Northwest, Portland, OR; VA Greater Los Angeles Healthcare System (Dr. Asch), Los Angeles, CA; RAND Health (Drs. McGlynn, Adams, and Setodji, and Ms. Keesey), Los Angeles, CA; Center for Practice Management and Outcomes Research (Dr. Kerr), VA Ann Arbor Healthcare System, Ann Arbor, MI; and Department of Medicine (Dr. Shrank), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

Correspondence to: Richard A. Mularski, MD, MSHS, FCCP, The Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate, WIN 1060, Portland, OR 97227; e-mail: Richard.Mularski{at}kpchr.org

Abstract

Background: The extent to which patients with obstructive lung disease receive recommended processes of care is largely unknown. We assessed the quality of care delivered to a national sample of the US population.

Methods: We extracted medical records for 2 prior years from consenting participants in a random telephone survey in 12 communities and measured the quality of care provided with 45 explicit, process-based quality indicators for asthma and COPD developed using the modified Delphi expert panel methodology. Multivariate logistic regression evaluated effects of patient demographics, insurance, and other characteristics on the quality of health care.

Results: We identified 2,394 care events among 260 asthma participants and 1,664 events among 169 COPD participants. Overall, participants received 55.2% of recommended care for obstructive lung disease. Asthma patients received 53.5% of recommended care; routine management was better (66.9%) than exacerbation care (47.8%). COPD patients received 58.0% of recommended care but received better exacerbation care (60.4%) than routine care (46.1%). Variation was seen in mode of care with considerable deficits in documenting recommended aspects of medical history (41.4%) and use of diagnostic studies (40.1%). Modeling demonstrated modest variation between racial groups, geographic areas, insurance types, and other characteristics.

Conclusions: Americans with obstructive lung disease received only 55% of recommended care. The deficits and variability in the quality of care for obstructive lung disease present ample opportunity for quality improvement. Future endeavors should assess reasons for low adherence to recommended processes of care and assess barriers in delivery of care.

Key Words: asthma • pulmonary disease, chronic obstructive • quality indicators, health care • quality of health care • therapeutics, standards

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