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Vol. 46. Issue 2.
Pages 64-69 (February 2010)
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Vol. 46. Issue 2.
Pages 64-69 (February 2010)
Original Article
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Diagnosis of COPD in Hospitalised Patients
Calidad del diagnóstico de la enfermedad pulmonar obstructiva crónica en el ámbito hospitalario
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Concha Pellicer Císcara,
Corresponding author
, Juan José Soler Cataluñab, Ada Luz Andreu Rodríguezc, Josefa Bueso Fabrad
a Unidad de Neumología, Hospital Francesc de Borja, Gandía, Valencia, Spain
b Unidad de Neumología, Hospital de Requena, Valencia, Spain
c Servicio de Neumología, Hospital de San Juan, Alicante, Spain
d Sección de Neumología, Hospital General, Castellón, Spain
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Abstract
Objective

To examine the quality of Chronic Obstructive Pulmonary Disease (COPD) diagnosis in hospitalised patients.

Material and methods

Retrospective multicentre cross-sectional audit review of the clinical histories of patients discharged with a diagnosis of COPD. The diagnosis of COPD was considered correct (DxC) in cases where the combination of a bronchial obstruction (FEV1/FVC< 70%) and smoking (> 10 pack years) could be documented. In the rest of the cases the diagnosis was considered deficient (DxD). A DxC in at least 60% of patients was required to be considered an acceptable quality healthcare diagnosis. Demographic data such as, smoking, spirometry, the specialist who discharged the patient (P: Pneumologist; MS: Medical Specialty; CS: Surgical Specialty), and healthcare level (hospital complexity; low [H1], intermediate [H2] and high [H3]).

Results

A total of 840 cases were analysed (718 males, 122 females); mean age (SD) 73 (10), from 10 hospitals (3 H1, 4 H2, 3 H3). A DxD was obtained in 597 (71.1%), due to either lack of pirometry (538, 64%) or smoking criteria (319, 38%), (p <.001). Only two of the ten hospitals complied with the criteria of an acceptable quality healthcare diagnosis. Significant differences (p <.0001) were seen on comparing DxC and DxD by healthcare level (DxC: 56.2% in H1, 29.9% in H2, 20.9% in H3), and by specialist (DxC: 47.6% en P, 24.6% in SP, 17.4% in MS). A multivariate analysis associated DxC with the male sex, H1 and pneumology reports.

Conclusions

1. The quality healthcare for the diagnosis of COPD is deficient. 2. The lack of spirometry is the most common cause of DxD.

Keywords:
Quality healthcare
COPD diagnosis
Smoking
Spirometry
Resumen
Objetivo

Conocer la calidad del diagnóstico de enfermedad pulmonar obstructiva crónica (EPOC) en pacientes hospitalizados.

Material y métodos

Auditoría multicéntrica transversal de revisión retrospectiva de historias clínicas en pacientes a los que se dio de alta con diagnóstico de EPOC. Se consideró diagnóstico correcto (DxC) de EPOC en los casos donde pudo documentarse la combinación de obstrucción bronquial volumen espiratorio forzado en el primer segundo/capacidad vital forzada (FEV1/FVC < 70%) y tabaquismo (> 10 paquetes/año). En el resto de los casos se consideró diagnóstico deficiente (DxD). Se exigió un DxC en al menos el 60% de los pacientes para considerar una calidad asistencial diagnóstica aceptable. Se registraron los datos demográficos, el tabaquismo, la espirometría, el especialista que daba el alta (neumólogos [N], especialistas en Medicina Interna [EM] y especialistas quirúrgicos [EQ]) y el nivel asistencial (hospitales de baja complejidad [H1], hospitales de intermedia complejidad [H2] y hospitales de alta complejidad [H3]).

Resultados

Se analizaron 840 casos (718 hombres y 122 mujeres), edad media (desviación estándar) de 73 (10), procedentes de 10 hospitales (3 H1, 4 H2 y 3 H3). Se obtuvo un DxD en 597 pacientes (71,1%), motivado bien por falta de criterio espirométrico (538 [64%]) o tabáquico (319 [38%]) (p<0,001). Sólo 2 de los 10 hospitales cumplían el criterio de calidad asistencial diagnóstica aceptable. Se observaron diferencias significativas (p<0,0001) al comparar DxC y DxD por nivel asistencial (DxC: el 56,2% en H1, el 29,9% en H2 y el 20,9% en H3) y por especialista (DxC: el 47,6% por N, el 24,6% por EQ y el 17,4% por EM). Un análisis multivariado relacionó DxC con sexo masculino, H1 e informes neumológicos.

Conclusiones

1) La calidad asistencial para el diagnóstico de EPOC en hospitales es deficiente y 2) la falta de espirometría es la causa más frecuente de DxD.

Palabras clave:
Calidad asistencial
Diagnóstico de enfermedad pulmonar
obstructiva crónica
Tabaquismo
Espirometría
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