Spirometry documentation gaps and reporting delays in a COPD reporting system: implications for surveillance data quality

Chronic obstructive pulmonary disease (COPD) reporting systems can support public health surveillance and quality improvement, but their value depends on complete diagnostic documentation and timely data entry.

We conducted a retrospective cross-sectional analysis of records from the COPD case-reporting module of the Chongqing municipal chronic disease monitoring platform, provided by the Chongqing Center for Disease Control and Prevention, with clinical visit dates in 2024. Records from persons younger than 40 years were excluded. Acute exacerbation of COPD (AECOPD) was classified from explicit diagnostic text indicating acute exacerbation. Spirometry documentation was defined as diagnostic-basis documentation of pulmonary function testing or a recorded pre- or post-bronchodilator FEV₁/FVC value. Reporting delay was calculated from the clinical visit date to the system-recorded entry timestamp; >7 days was prespecified as an operational quality threshold rather than a statutory reporting deadline, with >14- and >30-day thresholds examined in sensitivity analyses.

Among 1,076 included records, median age was 73.2 years (IQR 68.1-80.3), and 829 (77.0%) records were for males. AECOPD was explicitly recorded in 357 (33.2%) records. Any spirometry documentation was present in 195 (18.1%) records, diagnostic-basis spirometry in 167 (15.5%), and post-bronchodilator FEV₁/FVC in 133 (12.4%). Older age was associated with higher odds of absent spirometry documentation (OR 1.03 per year, 95% CI 1.01-1.04), whereas municipal-hospital records had lower odds than county/district-hospital records (OR 0.52, 95% CI 0.33-0.82). Median reporting delay was 19 days (IQR 9-32.5), and 851 (79.1%) records were entered >7 days after the visit.

Gaps in spirometry documentation and delays in reporting-system entry were common. These findings identify actionable data-quality targets for COPD surveillance systems, particularly structured spirometry-status fields, explicit reasons for unavailable testing, and routine timeliness monitoring. Because the study evaluated submitted records from a single municipal reporting system, the findings should not be interpreted as estimates of clinical spirometry utilization or population-level case capture and should be validated in other reporting settings.