title: Organizational structure for chronic heart failure and chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  In contrast to chronic heart failure (CHF), measures of quality of care for chronic obstructive pulmonary disease (COPD) are poor. Our objective was to examine differences in organizational structure available to support quality of care for patients with CHF and COPD.
  
  
  METHODS
  We performed 2 nationwide surveys exploring organizational structure for the management of CHF and COPD. We surveyed the chief of medicine and the chief of cardiology and pulmonary medicine at 120 Veterans Affairs facilities in the United States.
  
  
  METHODS
  Analogous questions about organizational structure that enhanced adherence to guideline-based care were compared between CHF and COPD surveys.
  
  
  RESULTS
  We found large and notable differences in the organizational structure for disease management, with systematically less attention given to COPD than CHF. These differences were evident in multiple processes of care. Key differences included fewer facilities: having COPD clinics than CHF clinics (12.7% vs 50.8%; P < .01), relating performance measures with COPD providers than CHF providers (17.1% vs 70%; P < .01), and having home monitoring programs for COPD than for CHF (50.5% vs 87.4%; P < .01).
  
  
  CONCLUSIONS
  Despite the growing burden of COPD, less organizational structure existed for COPD than CHF. Lack of organizational structure for COPD likely impedes an organization's abilities to encourage high-quality care and avoid recently implemented hospital readmission penalties. Our results suggest the need to develop a systematic approach for healthcare systems to provide essential organizational structure based on the burden of disease in the population.
authors.forename: Seppo T
authors.initials: ST
authors.lastname: Rinne
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Wong
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hebert
authors.forename: Paul
authors.initials: P
authors.lastname: Heidenreich
authors.forename: Lori A
authors.initials: LA
authors.lastname: Bastian
authors.affiliation: 1100 Olive Way, Ste 1400, Seattle, WA 98104-3801. E-mail: David.Au@va.gov.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
mesh_terms: D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration*; D019468:Disease Management; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D009937:Organizational Objectives; D010347:Patient Care Planning / Q000458:organization & administration*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011787:Quality of Health Care; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States