Abstract
Background:
Dixie Regional Medical Center is a 245-bed hospital and one of 23 acute care hospitals of the Intermountain Healthcare Corporation. To improve CMS COPD Core Measures1, we instituted a Pulmonary Disease Navigator (PDN). In tracking PFT results in the medical record, we found inconsistency in the frequency of PFTs performed. We sought to determine baseline data of diagnostic and ongoing PFTs in COPD patients.
Methods:
Between May 2017-March 2018, 127 patients were identified as diagnosed at some time with COPD. Sixty-seven patients (53%) were admitted due to COPD exacerbation. Seventy-four of the 127 (58%) had a resulted PFT results viewable in their medical record.
Results:
Frequency of PFT results in the medical record are reported in Table 1.
Conclusions:
Controversy remains regarding the frequency for PFTs in the diagnosis and ongoing care for COPD patients. We identified patients who did not meet either GOLD guidelines (forced vital capacity FEV1/FVC < 0.70) or Lower Limits of Normal (LLN) criteria but who were given a COPD diagnosis complicating accurate identification of COPD patients. Our pulmonologist identified patients with normal spirometry but low DLCO and positive for emphysema. Current GOLD guidelines view smokers with preserved lung function but respiratory symptoms as having similar outcomes as COPD. One study suggested increased diagnosis accuracy by including an extensive history, physical examination spirometry, diffusion testing and the consensus of an expert panel2. The American Thoracic Society recommends a PFT when respiratory symptoms present; however, Mehta's suggestion that PFTs can be done before clinical symptoms are evident (especially in early smokers3, 4). More research will be required before conclusions can be accurately drawn.
1. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment Instruments/HospitalQualityInits/Measure-Methodology.html. 2. Mohamed Hoesein FA, Zanen P Sachs AP Verheij TJ, Lammers JW, Broekhuizen BD. Spirometric thresholds for diagnosing COPD: 0.70 or LLN, pre- or post-dilator values? COPD 2012;(4):338-343. 3. Mehta V, Desai N, Patel S. When pulmonary function test is available, should we wait for the COPD symptoms to develop? J Clin Diagnostic Res 2016;10(10):OE08-OE12. http: //doi. org/10.7860/JCDR/2016/21006.8705. 4. Han MK, Kim, MG, Mardon R, Renner P, Sullivan S, Diette GB and Martinez FJ. Spirometry utilization for COPD. Chest 2007;132(2):403-409.
*One patient had a PFT result but the date performed was unknown. View all access options for this article.Table One: Pulmonary Function Testing in COPD Patients
COPD Patients with PFT in Medical Recordn=74*
2 weeks-1 year# (%)
13 months-5 years# (%)
> 5 years -13 years# (%)
20 (16)
38 (30)
15 (12)
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