Obstructive Lung Diseases |

Physician Compliance With Spirometry for Diagnosis of COPD in an Academic Outpatient Setting - A Quality Improvement Project FREE TO VIEW

Anup Singh*, MD; Leela Mathew, MD
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Unity Health System, Rochester, NY

Chest. 2012;142(4_MeetingAbstracts):669A. doi:10.1378/chest.1390457
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PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: To evaluate the utilization of spirometry or Pulmonary function tests (PFTs) for diagnosis and management of Chronic Obstructive Pulmonary Disease (COPD) in an academic outpatient Internal Medicine setting.

METHODS: We did a retrospective chart review on patients with the diagnosis of COPD (ICD code 496) at a resident run, faculty supervised academic setting. This is part of a quality improvement project in the residency program. Charts were reviewed for availability of spirometry/ PFT or Pulmonary consultation in 3 years. We analyzed the FEV1 and FEV1/FVC ratio to identify: (1) Accurate diagnosis (2) Severity of COPD. We stratified FEV1 to stage COPD per GOLD guidelines. Patients with incorrect diagnosis of COPD based on PFTs (normal, asthma, restrictive lung disease), were excluded.

RESULTS: One hundred nine patients with ICD code of 496, were reviewed. Thirty one were excluded per exclusion criteria. Nine out of 31 had incorrect diagnosis of COPD and rests were either deceased or not followed actively in clinic. A total 78 patients were included in the study. The records were reviewed for the presence of at least one set of PFTs for COPD diagnosis. Fifty (64.1%) out of 78 patients had least one set of PFTs in chart. Based on GOLD guidelines: Stage 1, Stage 2, Stage 3 and Stage 4 disease were identified in 14%, 48%, 32% and 6% of patients respectively.

CONCLUSIONS: Spirometry was done in 64.1% of patients with diagnosis of COPD in our academic clinic which exceeds the national average of 33%.

CLINICAL IMPLICATIONS: The American Thoracic Society recommends the use of PFTs/spirometry for the initial diagnosis and staging of COPD. In addition, the objective data of PFTs are often used to help with smoking cessation. Despite being an academic setting, our compliance in the utilization of PFTs for managment is suboptimal. Our recommendation is to educate the house staff and medical students about the important role of PFTs in the diagnosis and management of COPD, very common diagnostic entity.

DISCLOSURE: The following authors have nothing to disclose: Anup Singh, Leela Mathew

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Unity Health System, Rochester, NY




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