Adherence to recommended processes of health care for obstructive lung disease is unknown. We measured the quality of care delivered to participants in a community-based sample of the U.S. population with asthma and chronic obstructive lung disease (COPD).
We performed a medical record review on randomly selected individuals from a pool of 20,158 from 12 communities representative of the national population in cities > 200,000. We requested medical records from all providers of consenting participants for the previous two years; 20 trained nurses abstracted performance on 45 indicators of obstructive lung disease quality derived from RAND’s Quality Assessment Tools System. Multivariate logistic regression evaluated effects of patient demographics, insurance, health status, and comorbidity on the quality of health care.
429 participants out of 6712 consenting respondents were eligible for quality evaluation for 3672 episodes of care in obstructive lung disease. Overall, participants received 53.5 % (95% C.I.) [50.0, 57.0] of recommended care for asthma (n=260) and 58.9 % [51.7, 64.4] of recommended care for COPD (n=169). We detected significant variation in the quality of care across the 12 sites (COPD scores highest 64 % in one community vs. low 48 %, p < 0.001). Logistic modeling identified few characteristics related to the quality of obstructive lung disease care provided to patients. In multivariate analysis, African Americans received better care than whites (adjusted scores 62% vs. 53% for asthma, p = 0.02; 67% vs. 56% for COPD, p < 0.01); lower income participants and those without insurance received lower quality of care.
Overall, Americans with asthma and COPD received < 57% of recommended care. There was wide variation across communities in the quality of care delivered.
Obstructive lung disease affects 8.5% of Americans and chronic lower respiratory disease ranks as the number four cause of death. The deficits in processes of care for asthma and COPD present ample opportunity for improvement in the health of Americans. Chest physicians should take the lead in quality improvement initiatives.
Richard Mularski, Grant monies (from sources other than industry) Supported by the Robert Wood Johnson Foundation; grants from AHRQ, NCI, NINR, CMS.