Chest
Volume 132, Issue 2, August 2007, Pages 403-409
Journal home page for Chest

Original Research
Pulmonary Function Testing
Spirometry Utilization for COPD: How Do We Measure Up?

https://doi.org/10.1378/chest.06-2846Get rights and content

Background

COPD is a significant cause of morbidity and mortality. Guidelines recommend the confirmation of a COPD diagnosis with spirometry. Limited evidence exists, however, documenting the frequency of spirometry use in clinical practice.

Methods

The National Committee for Quality Assurance recruited five health plans to determine the proportion of patients ≥ 40 years old with a new diagnosis of COPD who had received spirometry during the interval starting 720 days prior to diagnosis and ending 180 days after diagnosis. Patients were identified via International Classification of Diseases, Ninth Revision diagnostic codes for encounters during the period July 1, 2002, through June 30, 2003. For each patient, the participating plans provided patient demographic and claims data from administrative data systems.

Results

Participating health plans covered 1,597,749 members with a total of 5,039 eligible COPD patients identified. Patients in the 40 to 64 age range had the highest percentage of new COPD diagnoses. Women were also slightly more likely to undergo spirometry (33.5% vs 29.4%, p = 0.001). Approximately 32% of patients with a new diagnosis of COPD had undergone spirometry in the specified interval. Spirometry frequency was lowest in older patients, with the lowest frequency in those ≥ 75 years old.

Conclusions

Our study suggests that approximately 32% of a broad range of patients with a new COPD diagnosis had undergone spirometry within the previous 2 years to 6 months following diagnosis. In addition, spirometric testing appeared to decrease with increasing age. As opposed to a prior report, women were not less likely to have undergone spirometry. This study shows that spirometry is infrequently used in clinical practice for diagnosis of COPD and suggests opportunities for practice improvement.

Section snippets

Materials and Methods

In the spring of 2004, the NCQA received expedited institutional review board approval to conduct a research study to investigate the feasibility of implementing a health plan performance measure to encourage use of spirometry testing during initial diagnosis and assessment for COPD. The research study did not involve human subjects, relying instead on retroactive review of existing patient-level data.

The NCQA recruited health plans to test the feasibility of a measure that would assess the

Results

In total, participating health plans covered 1,424,513 members who were commercially insured, 83,621 who received Medicaid, and 89,615 who received Medicare. A total of 5,039 eligible patients (3,559 commercial, 347 Medicaid, and 1,403 Medicare) with a new diagnosis of COPD during the study period were identified (Table 1). Sixty-five percent of patients were in the 40 to 64 year age range, and 53% were female. The age distributions within insurers show that as expected, the Medicare population

Discussion

Our study has several key findings, most notably that spirometry is uncommonly used for the diagnosis of COPD in managed care plans in the United States. In the participating health plans, the average rate of spirometry documentation in the 2 years prior to a new COPD diagnosis ranged from 26 to 38% between health plans. Importantly, altering the time of the negative diagnostic history had little effect on the overall utilization of spirometry. These data confirm those of another recent report8

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