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Spirometry Use in Chronic Obstructive Pulmonary Disease: A Performance Measure in a Primary Care Setting - A Quality Improvement Project FREE TO VIEW

Karan Chugh, MD; Karthikeyan Venkatachalam, MD; Roman Barazza, MD; Ziad Kanaan, MD; Anurag Mehrotra, MD; Joseph Skoney, MD
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Wayne State University School of Medicine/Crittenton Hospital, Rochester, MI

Chest. 2013;144(4_MeetingAbstracts):529A. doi:10.1378/chest.1703641
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SESSION TITLE: Clinical Improvement Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: According to the Healthcare Effectiveness Data and Information Set (HEDI) measures, spirometry for chronic obstructive pulmonary disease (COPD) diagnosis is a quality measure in a primary care setting. Only one third of patients with newly diagnosed COPD have undergone spirometry as part of their diagnosis. We hypothesized that implementation of prospective spirometry testing orders concordant with physician education about spirometry utilization would improve quality of care in COPD patients in a primary care setting.

METHODS: This study was conducted at a primary care practice of 20 physicians between 2011 and 2012. Prospective spirometry testing orders were placed on 544 patients with COPD diagnosis identified using the electronic health record (EMR). Monthly physician education about new HEDIS measures regarding spirometry testing in COPD diagnosis was conducted. A survey among physicians about awareness of HEDIS measures, compliance following initial EMR orders, and reason behind underutilization of spirometry testing was done.

RESULTS: Spirometry testing for COPD diagnosis almost doubled following implementation of prospective EMR orders along with physician education (44 tests in 2011 vs. 85 in 2012, p<0.05). Only 40% of surveyed physicians were aware of the HEDIS measures and considered implementing them on newly diagnosed COPD patients. Most physicians were compliant with spirometry ordering following initial implementation of spirometry testing. Underutilization of spirometry was attributed to referral to pulmonologists to perform the testing.

CONCLUSIONS: Based on our findings, spirometry testing for COPD diagnosis could be successfully implemented in primary care setting with good results.

CLINICAL IMPLICATIONS: The use of HEIDIS measures could lead to early COPD diagnosis and stratification among high-risk patients in a primary care setting. This warrants study in larger cohorts as this could improve the overall care of COPD patients.

DISCLOSURE: The following authors have nothing to disclose: Karan Chugh, Karthikeyan Venkatachalam, Roman Barazza, Ziad Kanaan, Anurag Mehrotra, Joseph Skoney

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