Diagnosis of COPD in hospitalised patients.
OBJECTIVE
To examine the quality of COPD diagnosis in hospitalised patients.


METHODS
Retrospective multicentre cross-sectional audit review of the clinical histories of patients discharged with a diagnosis of COPD. The diagnosis of COPD was considered correct (DxC) in cases where the combination of a bronchial obstruction (FEV1/FVC<70%) and smoking (>10 packets/year) could be documented. In the rest of the cases the diagnosis was considered deficient (DxD). A DxC in at least 60% of patients was required to be considered an acceptable quality health care diagnosis. Demographic data such as, smoking, spirometry, the specialist who discharged the patient (P: Pneumologist; MS: Medical Specialty; CS: Surgical Specialty), and health care level (hospital complexity; low (H1), intermediate (H2) and high (H3)).


RESULTS
A total of 840 cases were analysed (718 males, 122 females); mean age (SD) 73 (10), from 10 hospitals (3 H1, 4 H2, 3 H3). A DxD was obtained in 597 (71.1%), due to either lack of spirometry (538, 64%) or smoking criteria (319, 38%), (P<0.001). Only two of the ten hospitals complied with the criteria of an acceptable quality health care diagnosis. Significant differences (P<0.0001) were seen on comparing DxC and DxD by health care level (DxC: 56.2% in H1, 29.9% in H2, 20.9% in H3), and by specialist (DxC: 47.6% en P, 24.6% in SP, 17.4% in MS). A multivariate analysis associated DxC with the male sex, H1 and pneumology reports.


CONCLUSIONS
1. The quality health care for the diagnosis of COPD is deficient. 2. The lack of spirometry is the most common cause of DxD.
Pellicer Císcar
Concha
C
Unidad de Neumología, Hospital Francesc de Borja, Gandía, Valencia, España. pellicer_con@gva.es
Soler Cataluña
Juan José
JJ
Andreu Rodríguez
Ada Luz
AL
Bueso Fabra
Josefa
J
D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000150:complications; D001982:Bronchial Diseases / Q000150:complications; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008485:Medical Audit; D008511:Medicine; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011787:Quality of Health Care; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D013030:Spain / Q000453:epidemiology; D013147:Spirometry / Q000706:statistics & numerical data