Study objectives: Information on current
practices of COPD diagnosis and treatment is needed to identify
opportunities for improving care. This study describes the clinical
characteristics and diagnostic evaluations of COPD patients in a health
maintenance organization (HMO) and a university-affiliated county
medical center (UMC).
survey performed in a 174,484-member regional HMO and in The University
of New Mexico Hospitals and Clinics (UNMH).
Two hundred COPD patients from each system randomly selected from
administrative databases based on discharge diagnoses.
Results: COPD patients in the UMC, compared to those in the
HMO, were younger (mean age, 59.3 vs 66.9 years, respectively),
were more likely to be using home oxygen (33% vs 20%, respectively),
and had fewer chronic medical conditions (mean number of conditions,
3.1 vs 3.7, respectively) (p < 0.01 for all differences).
Approximately half of the COPD patients in both groups continued to
smoke cigarettes during the study year. Only 38% of patients in the
HMO and 42% in the UNMH system had spirometry results documented in
their medical records.
Conclusions: The demographic
and clinical characteristics of the COPD patients in these two
health-care systems were very different, but smoking status and
utilization of diagnostic tests were similar. The diagnosis of COPD in
most patients was based only on a history of chronic respiratory
symptoms and smoking; spirometry often was not used to confirm the
diagnosis. An increased emphasis on smoking cessation and more
effective utilization of spirometry are needed to improve the
management of COPD in these health-care