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Abstract：
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends at least annual spirometry for patients with chronic obstructive pulmonary disease (COPD). Since spirometry acquisition is variable in clinical practice, identifying characteristics associated with annual spirometry may inform strategies to improve care for patients with COPD.
We included veterans hospitalized for COPD at Veterans Health Administration (VHA) facilities from 10/2012 to 09/2015. Our primary outcome was spirometry within 1 year of COPD hospitalization. Patient demographics, health factors, and comorbidities as well as practice and geographic variables were identified using Corporate Data Warehouse; provider characteristics were obtained from the Survey of Healthcare Experiences of Patients. We used logistic regression with a random intercept to account for potential clustering within facilities.
Spirometry was completed 1 year before or after hospitalization for 20,683/38,148 (54.2%) veterans across 114 facilities. Patients with spirometry were younger, (mean=67.2 years (standard deviation (SD)=9.3) vs. 69.4 (10.3)), more likely non-white (21.3% vs. 19.7%), and more likely to have comorbidities (p<0.0001 for asthma, depression, and post-traumatic stress disorder). Pulmonary clinic visit was most strongly associated with spirometry (odds ratio (OR)=3.14 [95% confidence interval 2.99-3.30]). There was no association for facility complexity. In a secondary analysis including provider-level data (3862 patients), results were largely unchanged. There was no association between primary care provider age, gender, or type (physician vs. advanced practice registered nurse vs. physician assistant) and spirometry.
In a cohort of high-risk COPD patients, just over half completed spirometry within 1 year of hospitalization. Pulmonary clinic visit was most strongly associated with 1-year spirometry, though provider variables were not. Spirometry completion for high-risk COPD patients remains suboptimal and strategies to improve post-hospitalization care for patients not seen in pulmonary clinic should be developed to ensure guideline concordant care.
We included veterans hospitalized for COPD at Veterans Health Administration (VHA) facilities from 10/2012 to 09/2015. Our primary outcome was spirometry within 1 year of COPD hospitalization. Patient demographics, health factors, and comorbidities as well as practice and geographic variables were identified using Corporate Data Warehouse; provider characteristics were obtained from the Survey of Healthcare Experiences of Patients. We used logistic regression with a random intercept to account for potential clustering within facilities.
Spirometry was completed 1 year before or after hospitalization for 20,683/38,148 (54.2%) veterans across 114 facilities. Patients with spirometry were younger, (mean=67.2 years (standard deviation (SD)=9.3) vs. 69.4 (10.3)), more likely non-white (21.3% vs. 19.7%), and more likely to have comorbidities (p<0.0001 for asthma, depression, and post-traumatic stress disorder). Pulmonary clinic visit was most strongly associated with spirometry (odds ratio (OR)=3.14 [95% confidence interval 2.99-3.30]). There was no association for facility complexity. In a secondary analysis including provider-level data (3862 patients), results were largely unchanged. There was no association between primary care provider age, gender, or type (physician vs. advanced practice registered nurse vs. physician assistant) and spirometry.
In a cohort of high-risk COPD patients, just over half completed spirometry within 1 year of hospitalization. Pulmonary clinic visit was most strongly associated with 1-year spirometry, though provider variables were not. Spirometry completion for high-risk COPD patients remains suboptimal and strategies to improve post-hospitalization care for patients not seen in pulmonary clinic should be developed to ensure guideline concordant care.
摘要：
背景：慢性阻塞性肺疾病全球倡议（GOLD）建议慢性阻塞性肺疾病（COPD）患者至少每年进行肺活量测定。由于肺活量测定采集在临床实践中是可变的，确定与年度肺活量测定相关的特征可能为改善COPD患者护理的策略提供依据.
方法：我们纳入了2012年10月至2015年09月在退伍军人健康管理局（VHA）机构因COPD住院的退伍军人。我们的主要结果是COPD住院1年内的肺活量测定。患者人口统计学，健康因素,和合并症以及实践和地理变量使用企业数据仓库进行了识别;提供商的特征是从患者的医疗保健经验调查中获得的。我们使用具有随机截距的逻辑回归来解释设施内的潜在聚类。
结果：在114个设施中，20,683/38,148名（54.2%）退伍军人在住院之前或之后1年完成了肺活量测定。肺活量测定的患者更年轻，（平均值=67.2年（标准差（SD）=9.3）与69.4（10.3）），更有可能是非白人(21.3%与19.7%），更可能有合并症(哮喘的p<0.0001，抑郁症,和创伤后应激障碍)。肺部门诊就诊与肺活量测定密切相关（比值比（OR）=3.14[95％置信区间2.99-3.30]）。设施复杂性没有关联。在包括提供者级别数据的二次分析中(3862名患者)，结果基本没有变化。初级保健提供者年龄之间没有关联，性别,或类型(医生vs.高级执业注册护士vs.医师助理)和肺活量测定。
结论：在一组高危COPD患者中，超过一半的人在住院后1年内完成了肺活量测定.肺部门诊就诊与1年肺活量测定最密切相关，虽然提供程序变量不是。高危COPD患者的肺活量测定仍不理想，应制定策略来改善未在肺部诊所就诊的患者的住院后护理，以确保指南的一致护理。
方法：我们纳入了2012年10月至2015年09月在退伍军人健康管理局（VHA）机构因COPD住院的退伍军人。
结果：在114个设施中，20,683/38,148名（54.2%）退伍军人在住院之前或之后1年完成了肺活量测定。
结论：在一组高危COPD患者中，
