title: Spirometry utilization after hospitalization for patients with chronic obstructive pulmonary disease exacerbations.
abstract: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the US population. An area of improvement hinges on early detection and proper monitoring. Spirometry is an important interventional tool; its underuse among hospitalized patients with COPD could affect quality of care. This study evaluates spirometry use at the Community Medical Center-Sierra in hospitalized patients with COPD. A retrospective medical record review from January 1, 2000, to March 15, 2002, assesses 1507 inpatients with COPD. The effects are analyzed of age, sex, race/ethnicity, diagnosis, insurance status, disposition, and admitting service on spirometry use by physicians are analyzed. A questionnaire is used to evaluate the knowledge, attitudes, and behaviors of residents toward spirometry ordering. Baseline characteristics are similar between study groups. Only 3% of 1476 study patients have spirometry performed within the recommended time frame, and only 12.2% have at least 1 spirometry performed. Patients having a primary diagnosis of COPD have a greater likelihood of having spirometry performed (20.3% vs 11.1%, P < .001), as do patients who are discharged to home (13.4% vs 5.9%, P = .001). No significant effects are noted for sex, race/ethnicity, insurance status, or admitting service. The house staff surveys reveal that most do not know the indications for (72.0%) or how to order (46.0%) spirometry. Spirometry is underused among physicians who treat hospitalized patients with COPD. Future educational efforts aimed at improving physicians' ordering and use of spirometry are needed to address this disparity.
authors.affiliation: Department of Hospital Medicine, Kaiser Permanente Medical Group, Inc., Fresno, CA 93720, USA. natutie@lycos.com
authors.forename: Natalia B
authors.initials: NB
authors.lastname: Volkova
authors.forename: Ann
authors.initials: A
authors.lastname: Kodani
authors.forename: Dahlia
authors.initials: D
authors.lastname: Hilario
authors.forename: Sipho M
authors.initials: SM
authors.lastname: Munyaradzi
authors.forename: Michael W
authors.initials: MW
authors.lastname: Peterson
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012189:Retrospective Studies; D013147:Spirometry; D011795:Surveys and Questionnaires; D014481:United States