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Abstract: Poster Presentations |

INADEQUATE DOCUMENTATION OF SMOKING HISTORY IN HOSPITALIZED PATIENTS FOR ASTHMA WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (ICD-9 CODE 493.2) FREE TO VIEW

Jessica L. Wallace; Lori B. Arnold, PharmD; Justin B. Usery, PharmD; Christopher K. Finch, PharmD; Paul R. Deaton, MD; Timothy H. Self, PharmD
Author and Funding Information

University of Tennessee HSC, Memphis, TN


Chest


Chest. 2009;136(4_MeetingAbstracts):119S. doi:10.1378/chest.136.4_MeetingAbstracts.119S-b
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Abstract

PURPOSE:  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).

METHODS:  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.

RESULTS:  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.

CONCLUSION:  Documentation of smokeHx is insufficient in hospitalized “asthma with COPD” patients (ICD-9 code 493.22).

CLINICAL IMPLICATIONS:  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.

DISCLOSURE:  Jessica Wallace, No Financial Disclosure Information; No Product/Research Disclosure Information

Wednesday, November 4, 2009

12:45 PM - 2:00 PM


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