Utilization in COPD - Patient characteristics and diagnostic evaluation

Study objectives: Information on current practices of COPD diagnosis and tr eatment is needed to identify opportunities for improving care. This study describes the clinical characteristics and diagnostic evaluations of COPD p atients in a health maintenance organization (HMO) and a university-affilia ted county medical center (UMC). Design: Cross-sectional survey performed in a 174,484-member regional HMO a nd in The University of New Mexico Hospitals and Clinics (UNMH). Patients: Two hundred COPD patients from each system randomly selected from administrative databases based on discharge diagnoses. Results: COPD patients in the UMC, compared to those in the HMO, were young er (mean age, 59.3 vs 66.9 years, respectively), were more likely to be usi ng home oxygen (33% vs 20%, respectively), and had fewer chronic medical co nditions (mean number of conditions, 3.1 vs 3.7, respectively) (p < 0.01 fo r all differences). Approximately half of the COPD patients in both groups continued to smoke cigarettes during the study year. Only 38% of patients i n the HMO and 42% in the UNMH system had spirometry results documented in t heir medical records. Conclusions: The demographic and clinical characteristics of the COPD patie nts in these two health-care systems were very different, but smoking statu s and utilization of diagnostic tests were similar. The diagnosis of COPD i n most patients was based only on a history of chronic respiratory symptoms and smoking; spirometry often tvas not used to confirm the diagnosis, An i ncreased emphasis on smoking cessation and more effective utilization of sp irometry are needed to improve the management of COPD in these health-care systems.