Americans Treated Suboptimally for Obstructive Lung Disease

Americans with asthma and Chronic obstructive pulmonary disease (COPD) are getting suboptimal care, according to an analysis of health care delivery in communities with more than 200,000 people.

Indeed, the analysis found that patients with obstructive lung diseases - asthma and Chronic obstructive pulmonary disease - are getting only about 56% of recommended care, reported Richard Mularski, M.D., a pulmonologist at the Veterans Administration Greater Los Angeles Healthcare System.

“There are large shortfalls in the quality of obstructive lung disease care in the U.S.,” Dr. Mularski told a session today at CHEST 2005, the annual meeting of the American College of Chest Physicians. “We have some catching up to do.”

Dr. Mularski was reporting on a study he carried out with colleagues at Rand Health in Santa Monica, Calif. The researchers used data collected by the Community Tracking Survey, which analyzes healthcare delivery in population centers of more than 200,000 people, he said, using quality assessment tools developed by Rand.

Overall, the researchers were able to examine two-year medical records for 6,712 people, who had 4,058 episodes of medical care for obstructive lung disease, he said.

Chronic obstructive pulmonary disease (COPD) is a group of lung diseases involving limited airflow and varying degrees of air sac enlargement, airway inflammation, and lung tissue destruction. Emphysema and chronic bronchitis are the most common forms of COPD.

Causes, incidence, and risk factors

The leading cause of COPD is smoking, which can lead to the two most common forms of this disease, emphysema and chronic bronchitis.

Prolonged tobacco use causes lung inflammation and variable degrees of air sac (alveoli) destruction. This leads to inflamed and narrowed airways (chronic bronchitis) or permanently enlarged air sacs of the lung with reduced lung elasticity (emphysema). Between 15% and 20% of long-term smokers will develop COPD.

Asthma care was analyzed according to 25 indicators, of which nine covered routine care and 14 covered exacerbations; Chronic obstructive pulmonary disease was covered by 20 indicators, eight for routine care and 12 for exacerbations.

As an example, Dr. Mularski said, one indicator was that hospitalized asthma patients should receive systemic steroids, either orally or by injection.

The quality assessment scores for each care episode were reached by dividing the number of indicators passed by the number of possible indicators, he said.

Aside from the overall rating, the investigators also broke down the data by disease and found that asthma patients overall got 54% of the appropriate care, while Chronic obstructive pulmonary disease patients got 58%.

When the type of care was analyzed, he said, Asthma patients did relatively well for routine care, but treatment for exacerbations was “abysmal.” The situation was reversed for Chronic obstructive pulmonary disease.

Specifically:

     
  • For routine care, 66.9% of Asthma patients got appropriate care, with a 95% confidence interval ranging from 67.7% to 71.1%.  
  • But for exacerbations, it was only 47.8%, with a 95% confidence interval ranging from 41.4% to 54.1%.  
  • In Chronic obstructive pulmonary disease, patients got only 46.1% of appropriate routine care, with a 95% confidence interval ranging from 36.8% to 55.3%.  
  • But for exacerbations, it was 60.4%, with a 95% confidence interval ranging from 53.8% to 67%.

The low quality for Asthma exacerbations “may reflect efforts to improve routine care,” said, and it may be that treatment for exacerbations has slipped through the cracks. The reverse may be true for Chronic obstructive pulmonary disease, he said

There was also marked geographic variation, ranging from 46.1% in Newark, N.J., to 62.1% in Seattle, he said.

Source: CHEST 2005

Provided by ArmMed Media
Revision date: July 8, 2011
Last revised: by Janet A. Staessen, MD, PhD