Do Patients Hospitalized With COPD Have Airflow Obstruction?

Area of Science:

• Pulmonary Medicine
• Health Services Research
• Diagnostic Accuracy

Background:

• Clinical guidelines mandate spirometry for Chronic Obstructive Pulmonary Disease (COPD) diagnosis.
• Administrative databases, using International Classification of Diseases, Ninth Revision, Clinical Modification codes, frequently identify COPD patients.
• COPD coding does not necessitate spirometry confirmation, potentially leading to diagnostic discrepancies.

Purpose of the Study:

• To evaluate the frequency of spirometric support for COPD discharge diagnoses within the Veterans Affairs (VA) health system.
• To assess the concordance between administrative COPD diagnoses and objective spirometric findings.

Main Methods:

• Retrospective review of hospitalized COPD patient records at a VA teaching hospital (2005-2015).
• Exclusion of rehospitalizations; focus on unique patient discharges with a principal COPD diagnosis.
• Assessment for presence and results of spirometric measurements, including evidence of airway obstruction.

Main Results:

• Of 826 included patients, 21% lacked spirometry, and 12% had invalid tests.
• Only 56% demonstrated spirometric evidence of airway obstruction.
• Older patients were more likely to have missing or failed spirometry; younger patients often had spirometry post-hospitalization.

Conclusions:

• Discharge diagnosis databases require cautious interpretation for healthcare outcomes and resource management.
• Enhanced efforts are crucial to ensure spirometry testing for suspected COPD cases.
• Improving spirometry utilization will increase the accuracy of COPD diagnoses.