Undocumented patient information is a barrier to providing quality care. Inadequate documentation has been reported in 2 major cardiovascular diseases, including lack of documentation of smoking history [smokeHx] (Cox JL et al, Am J Med 2003). Misdiagnosis of Chronic Obstructive Pulmonary Disease (COPD) and asthma is common (Tinkelman DG el al, J Asthma 2006), further heightening the need for documentation of smokeHx. Pack year history (PYH) is an important component of recent COPD diagnostic questionnaires (Price DB et al, Chest 2006).
We performed a retrospective electronic chart review of 108 admissions for 93 patients between January 7, 2006 and May 24, 2007 with an ICD-9 code 493.2, primary diagnosis of asthma with COPD. Inclusion criteria were ages > 40 and hospitalization for > 24 hours in an inner city, university-affiliated hospital.
Patients mean age was 62.8 years (age range 40–89) with 66.7% females, and 84.9% African Americans. Smoking was documented as “current” or “former” in 65.7% of admissions. Among current smokers, 36% did not have PYH documented. For patients with documentation, there was a mean 38.5 PYH. Among former smokers, 60% did not have a PYH documented. Former smokers with documentation had a mean 39.1 PYH. For 34.3% of admissions who were “nonsmokers,” there was no clear documentation that they had never smoked. Secondhand smoke exposure was not recorded in 96.3% of admissions. Age of onset of “asthma with COPD” was undocumented in 88.2% of patients.
Documentation of smokeHx is insufficient in hospitalized “asthma with COPD” patients (ICD-9 code 493.22).
Appropriate documentation of smokeHx, including PYH, as well as age of onset of “asthma with COPD” is needed to help ensure correct diagnosis and optimal management.
Jessica Wallace, No Financial Disclosure Information; No Product/Research Disclosure Information