Utilization of pulmonary function tests by primary care internists in a community hospital

A quality assurance effort to evaluate the use of pulmonary function tests by primary care physicians. Specifically, to examine the patient's understanding of the test, the types of tests physicians order, and the appropriateness of the ordered tests for answering questions posed by physicians.

Concurrent chart review, clinical interviews, and patient interviews.

Community teaching hospital.

101 consecutive inpatients and outpatients, referred to the Pulmonary Function Laboratory over a consecutive 5-month period.

Interview of the patient by a pulmonary technician. Interview of the primary care physician by a pulmonary physician. Interview, where applicable, with the house staff. Final assessment by a pulmonary physician.

64% of the patients understood the purpose of the test and 49% of the patients felt there was some potential benefit to be derived from participating in the testing. Sixty-five percent of the physicians ordered specific tests on their patients. Seventy-two percent of physicians planned on using the data obtained from testing to formulate treatment decisions. Fifty percent of the interviewed physicians said they were using the results for decisions regarding further diagnostic evaluation and/or treatment. The reviewing pulmonary physician considered that 31% of the pulmonary function tests ordered were appropriate for the goals defined by the requesting physician. Sixty-eight percent of the ordered tests could have had some aspects of ordering improved, and 1% of the testing was unnecessary.

1) There is a need to increase patient understanding of the indications and potential benefits of participating in pulmonary function testing. 2) When physicians-in-training are involved in the process of requesting pulmonary function tests, greater staff-level supervision and involvement should be present. 3) There is a need to increase physician knowledge regarding the appropriate pulmonary function tests that should be requested for specific clinical questions and situations. 4) The requesting form for pulmonary function testing may serve to remind and educate the physician, while documenting the indications for the testing and the physician's efforts. 5) Quality assurance/utilization-review efforts can be combined with educational efforts that could result in a diminution of the deficiencies.