 |
 |
|
|
|  PubMed
|
| |||||||||||||||||||||||||||||||||||||||||
20 June 2006 | Volume 144 Issue 12 | Pages 894-903
Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is 1 of the 10 leading causes of hospitalization among adults in the United States.
Objective: To evaluate the quality of care provided to patients hospitalized for acute exacerbations of COPD and to determine whether hospital or patient characteristics influence treatment.
Design: Retrospective cohort study.
Setting: 360 hospitals throughout the United States.
Patients: 69 820 patients hospitalized for acute exacerbations of COPD.
Measurements: Adherence to diagnosis and treatment recommendations contained in guidelines produced by the American College of Physicians and the American College of Chest Physicians; analyses of associations between hospital and patient characteristics and composite measures of performance.
Results: Of the 69 820 patients, 66 276 (95%) underwent chest radiography, 63 715 (91%) received supplemental oxygen, 67 515 (97%) received bronchodilators, 59 240 (85%) received systemic steroids, and 59 053 (85%) were given antibiotics. In total, 45 800 (66%) received this entire set of recommended care processes. Numerous participants received tests or treatments that were not beneficial: 16 607 (24%) were treated with methylxanthine bronchodilators, 10 051 (14%) had sputum testing, 8354 (12%) underwent acute spirometry, 4299 (6%) had chest physiotherapy, and 1409 (2%) were treated with mucolytic medications. Overall, 31 519 patients (45%) received at least 1 of these nonrecommended care elements, and 22 929 (33%) received ideal care, defined as all of the recommended care processes and none of the nonrecommended ones. Individual hospital performance varied widely; whereas older patients and women were more likely to receive ideal care than their counterparts, a higher annual volume of admissions for COPD was not associated with improved hospital performance.
Limitations: The study used administrative data, not chart review, and was limited to the inpatient management of COPD.
Conclusions: The quality of care for patients hospitalized for acute exacerbations of COPD may be improved by increasing the use of systemic corticosteroid and antibiotic therapy, decreasing the use of unnecessary and potentially harmful treatments, and reducing variation in practice across hospitals.
Editors' Notes
Context
Contribution
Cautions
Implications
—The Editors
Author and Article Information
From Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts; University of Massachusetts–Amherst, Amherst, Massachusetts; and Premier Healthcare Informatics, Charlotte, North Carolina.
Acknowledgments: The authors thank Michael Rothberg, MD, MPH, and Dale Bratzler, DO, MPH, for their comments on an earlier version of this manuscript.
Grant Support: None.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Peter K. Lindenauer, MD, MSc, Division of Healthcare Quality, Baystate Medical Center, 759 Chestnut Street, P-5928, Springfield, MA 01199; e-mail, Peter.Lindenauer{at}bhs.org.
Current Author Addresses: Drs. Lindenauer, Pekow, and Benjamin: Division of Healthcare Quality, Baystate Medical Center, 759 Chestnut Street, P-5928, Springfield, MA 01199.
Ms. Gao and Ms. Crawford: 408 Arnold House, School of Public Health and Health Sciences, University of Massachusetts, 715 North Pleasant Street, Amherst, MA 01003-9304.
Dr. Gutierrez: Premier Healthcare Informatics, 2320 Cascade Pointe Boulevard, Charlotte, NC 28208. IMPROVING PATIENT CARE
Improving Patient Care is a special section within Annals supported in part by the U.S. Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ). The opinions expressed in this article are those of the authors and do not represent the position or endorsement of AHRQ or HHS.
Quality of Care for Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  A. D. Auerbach, J. F. Hilton, J. Maselli, P. S. Pekow, M. B. Rothberg, and P. K. Lindenauer Shop for Quality or Volume? Volume, Quality, and Outcomes of Coronary Artery Bypass Surgery Ann Intern Med, May 19, 2009; 150(10): 696 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Stolz, M. Christ-Crain, N. G. Morgenthaler, D. Miedinger, J. Leuppi, C. Muller, R. Bingisser, J. Struck, B. Muller, and M. Tamm Plasma Pro-Adrenomedullin But Not Plasma Pro-Endothelin Predicts Survival in Exacerbations of COPD Chest, August 1, 2008; 134(2): 263 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Lee, S. Joffe, A. S. Artz, R. E. Champlin, S. M. Davies, M. Jagasia, N. A. Kernan, F. R. Loberiza Jr, R. J. Soiffer, and M. Eapen Individual Physician Practice Variation in Hematopoietic Cell Transplantation J. Clin. Oncol., May 1, 2008; 26(13): 2162 - 2170. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Al-Shaer, E. S. Suleiman, W. P. Jerome, E. S. Chu, R. K. Albert, M. Wei, D. van Amerongen, P. K. Lindenauer, M. B. Rothberg, and A. D. Auerbach Outcomes of Care by Hospitalists N. Engl. J. Med., April 17, 2008; 358(16): 1755 - 1758. [Full Text] [PDF]
|
|
|
|
|
|
B. S. Quon, W. Q. Gan, and D. D. Sin Contemporary Management of Acute Exacerbations of COPD: A Systematic Review and Metaanalysis Chest, March 1, 2008; 133(3): 756 - 766. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Anzueto, S. Sethi, and F. J. Martinez Exacerbations of Chronic Obstructive Pulmonary Disease Proceedings of the ATS, October 1, 2007; 4(7): 554 - 564. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Stolz, M. Christ-Crain, R. Bingisser, J. Leuppi, D. Miedinger, C. Muller, P. Huber, B. Muller, and M. Tamm Antibiotic Treatment of Exacerbations of COPD: A Randomized, Controlled Trial Comparing Procalcitonin-Guidance With Standard Therapy Chest, January 1, 2007; 131(1): 9 - 19. [Abstract] [Full Text] [PDF]
|
|
Read all Rapid Responses
