Article Text

  1. D. Hilario1,
  2. A. Kodani1,
  3. N. B. Volkova1,
  4. M. W. Peterson1,
  5. S. M. Munyaradzi2
  1. 1Department of Medicine, UCSF Fresno Medical Education Program, Fresno, CA
  2. 2Medical Decision Support Department, Community Medical Centers-Sierra Community Health Center, Fresno, CA


Background Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the US population. One area of improvement hinges on early detection and proper monitoring. Pulmonary function testing is an important interventional tool; thus, its underutilization among hospitalized COPD patients could affect the quality of care.

Objective To evaluate the pulmonary function test (PFT) utilization of primary care providers at the Community Medical Centers in hospitalized COPD patients.

Methods We conducted a retrospective chart review of hospitalized COPD patients from January 1, 2000 to March 15, 2002, on 1,507 inpatients. We analyzed the effect of age, gender, race, diagnosis, insurance type, disposition, and admitting service on PFT utilization by physicians. A questionnaire was used to evaluate the knowledge, attitudes, and behaviors of the residents toward PFT ordering.

Results Baseline characteristics were similar between study groups. Only 3% of the 1,476 study patients had PFTs in the recommended time frame, and only 12.2% had at least one PFT. Patients with a primary diagnosis of COPD had more PFTs completed (34.4% vs 11.1%; p = .0005). PFT testing varied between services (p = .003), although the number of patients was different. Patient insurance groups corresponded with differences in PFT utilization (p = .004). No significant differences were found with gender, ethnicity, or disposition. The housestaff survey forms revealed that the majority did not know the indications of (72%) or how to appropriately order (46%) PFTs.

Conclusions PFT is underutilized among physicians who treat hospitalized COPD patients. Future educational efforts aimed in improving physicians' ordering and utilization reviews are needed to address this disparity.

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