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Obstructive Lung Diseases |

Patient Centered Medical Home and the Spirometric Diagnosis of Chronic Obstructive Pulmonary Disease Over Time

Yu-Ching Yeh, MD; Nikunj Bhatt, MD
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Walter Reed National Military Medical Center, Kensington, MD


Chest. 2015;148(4_MeetingAbstracts):699A. doi:10.1378/chest.2269891
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Abstract

SESSION TITLE: COPD Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: In 2004 a joint American Thoracic Society (ATS) and European Respiratory Society (ERS) task force endorsed the use of spirometry to diagnose chronic obstructive pulmonary disease (COPD). Subsequent studies revealed low compliance rates with these guidelines among primary care providers. The Patient-Centered Medical Home (PCMH) utilizes an interdisciplinary, comprehensive and continuous care framework to address compliance with best practices. Walter Reed National Military Medical Center (WRNMMC) launched the PCMH model beginning in 2009. Our objective was to assess whether the PCMH model maintained adherence to guidelines regarding COPD diagnosis with spirometry between March 2010 and March 2015.

METHODS: Five outpatient PCMH clinics at WRNMMC were selected at random and pooled. Patients who received a new diagnosis of COPD (based on ICD9 codes) between March 2010 and March 2015 were analyzed to see if spirometry was also conducted in accordance with the ATS/ERS best practices. Year-to-year trends were observed in each clinic.

RESULTS: A total of 98 patients received a new diagnosis of COPD by a primary care physician during the time period studied. A spirometry diagnosis of COPD peaked in 2011 at 100%, but declined every year thereafter. Compliance reached its lowest point over the last year observed (March 2014 - March 2015), where only 71% of patients diagnosed with COPD underwent spirometry.

CONCLUSIONS: Compliance with the ATS/ERS guidelines was highest immediately after PCMH’s introduction. Early enthusiasm for the implementation of guideline-based practices in the medical home may have accounted for the high adherence rates early on. However, adherence to the spirometric diagnosis of COPD declined shortly after launching the PCMH and trended towards national rates.

CLINICAL IMPLICATIONS: Further studies are warranted to identify the role of PCMHs and COPD guideline-based practices. Barriers should be explored to explain poor adherence over time. The year-to-year declining trend of obtaining spirometry to diagnose COPD suggests interventions may be needed to re-invigorate COPD guidelines practices within medical homes. Like all homes, maintenance is often required.

DISCLOSURE: The following authors have nothing to disclose: Yu-Ching Yeh, Nikunj Bhatt

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