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Spirometry utilization for COPD: How do we measure up?

MeiLan Han, M.D^*; Min Gayles Kim, MPH; Russell Mardon, Ph.D^**; Phil Renner, M.B.A.; Sean Sullivan, PharmD; Gregory B. Diette, M.D., M.H.S. and Fernando J. Martinez, M.D., M.S^*

^*Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI University of Washington, Seattle, WA Johns Hopkins University, Baltimore, MD; National Committee for Quality Assurance, Washington, DC ^**Westat,Rockville, MD (formerly with NCQA)

mrking{at}umich.edu

Abstract

BackgroundCOPD is a significant cause of morbidity and mortality. Guidelines recommend the confirmation of a COPD diagnosis with spirometry. Limited evidence exists, however, documenting the frequency of spirometry use in clinical practice.

MethodsThe National Committee for Quality Assurance recruited five health plans to determine the proportion of patients 40 years and older with a new diagnosis of COPD who had received spirometry during the interval starting 720 days prior to diagnosis and ending 180 days post-diagnosis. Patients were identified via ICD-9 diagnostic codes for encounters during the period July 1, 2002 through June 30, 2003. For each patient, the participating plans provided patient demographic and claims data from administrative data systems.

ResultsParticipating health plans covered 1,597,749 members with a total of 5,039 eligible COPD patients identified. Patients in the 40-64 age range had the highest percentage of new COPD diagnoses. Women were also slightly more likely to receive spirometry (33.5% versus 29.4%, p=0.001). Approximately 32% of patients with a new diagnosis of COPD had undergone spirometry in the specified interval. Spirometry frequency was lowest in older patients, with the lowest frequency in those 75 years and older.

ConclusionsOur study suggests that approximately 32% of a broad range of patients with a new COPD diagnosis had undergone spirometry within the previous two years to six months following diagnosis. In addition spirometric testing appeared to decrease with increasing age. As opposed to previous reports, women were not less likely to have had spirometry. This study shows that spirometry is infrequently used in clinical practice for diagnosis of COPD and suggests opportunities for practice improvement.

Key Words: Chronic obstructive pulmonary disease • lung function • gender • insurance

Related Editorial

Spirometry for COPD Is Both Underutilized and Overutilized

Paul Enright and Philip Quanjer
Chest 2007 132: 368-370. [Full Text] [PDF]

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				M. J. Joo, T. A. Lee, and K. B. Weiss Geographic Variation of Spirometry Use in Newly Diagnosed COPD Chest, July 1, 2008; 134(1): 38 - 45. [Abstract] [Full Text] [PDF]

				M. Lusuardi, D. Orlandini, M. K. Han, and F. J. Martinez Underutilization of Spirometry for the Diagnosis of COPD Chest, January 1, 2008; 133(1): 313 - 314. [Full Text] [PDF]

				P. Enright and P. Quanjer Spirometry for COPD Is Both Underutilized and Overutilized Chest, August 1, 2007; 132(2): 368 - 370. [Full Text] [PDF]