Beyond Access: Factors Associated with Spirometry Underutilization among Patients with a Diagnosis of COPD in Urban Tertiary Care Centers

Arianne K Baldomero, Ken M. Kunisaki, AnnMarie K Bangerter, David B Nelson, Christine H Wendt, Spyridon Fortis, Hildi J Hagedorn, R. Adams Dudley

Research output: Contribution to journalArticlepeer-review

Abstract

Rationale: Many patients with suspected chronic obstructive pulmonary disease (COPD) do not undergo spirometry to confirm the diagnosis. Underutilization is often attributed to barriers to accessing spirometry. Objective: Our objective was to identify factors associated with spirometry underutilization for patients who are less likely to face access barriers related to travel, insurance, and availability of spirometry. Methods: A retrospective analysis was conducted of patients enrolled in the Veterans Health Administration and living in urban areas with a new diagnosis of COPD between 2012 to 2015, reducing out-of-pocket cost and travel barriers, respectively. We included only patients whose primary care clinic was located in an academically affiliated tertiary level facility with spirometry available. We used logistic regression to estimate associations between patient characteristics and receipt of spirometry within 2 years before or after COPD diagnosis. Results: Of 24,300 patients, 59.7% had spirometry. Compared to patients <55 years, patients 75–84 years had an adjusted odds ratio (aOR) of undergoing spirometry of 0.80 (95% confidence interval [CI]: 0.72–0.90), while patients ≥85 years had an aOR of 0.47 (95%CI: 0.40–0.54). Compared to patients with a Charlson Comorbidity Index (CCI) ≥3, patients with a CCI of 0 had an aOR of 0.60 (95%CI: 0.54–0.67). Patients who had not seen a pulmonary specialist had lower odds of receiving spirometry (aOR 0.38 [95%CI: 0.35–0.41]). Conclusion: Spirometry underutilization persists among patients who are less likely to have access barriers related to travel, insurance, and availability of spirometry. Spirometry underutilization is associated with older age, not having received pulmonary care, and having fewer comorbidities. COPD care quality initiatives will need to address these factors.

Original languageEnglish (US)
Pages (from-to)538-548
Number of pages11
JournalChronic Obstructive Pulmonary Diseases
Volume9
Issue number4
DOIs
StatePublished - 2022

Bibliographical note

Funding Information:
Abbreviations: chronic obstructive pulmonary disease, COPD; adjusted odds ratio, aOR; confidence interval, CI; Charlson Comorbidity Index, CCI; Veterans Health Administration, VA; VA Corporate Data Warehouse, CDW; International Classification of Diseases-Ninth Revision, ICD-9; ICD-Tenth Revision, ICD-10; Rural-Urban Community Area, RUCA; area deprivation index, ADI; Veterans Integrated Services Networks, VISN Funding Support: This research was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences, grants KL2TR002492 and UL1TR002494 (AKB). The views expressed in this article are those of the authors and do not reflect the views of the United States Government, the Department of Veterans Affairs, the National Institutes of Health, the National Institutes of Health’s National Center for Advancing Translational Sciences or any of the authors’ affiliated academic institutions. Date of Acceptance: August 25, 2022 | Published Online Date: August 30, 2022 Citation: Baldomero AK, Kunisaki KM, Bangerter A, et al. Beyond access: factors associated with spirometry underutilization among patients with a diagnosis of COPD in urban tertiary care centers. Chronic Obstr Pulm Dis. 2022;9(4):538-548. doi: https://doi.org/10.15326/ jcopdf.2022.0303

Funding Information:
This research was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences, grants KL2TR002492 and UL1TR002494 (AKB). The views expressed in this article are those of the authors and do not reflect the views of the United States Government, the Department of Veterans Affairs, the National Institutes of Health, the National Institutes of Health’s National Center for Advancing Translational Sciences or any of the authors’ affiliated academic institutions. AKB, KMK, and RAD conceived the current analysis. AKB, KMK, RAD, and DBN designed the analysis. AKB obtained funding. AB acquired the data. DBN provided statistical expertise. AKB and DBN performed the data analysis. AKB and RAD drafted the manuscript. All authors provided critical input and revised the manuscript for important intellectual content and approved the final manuscript. All authors take responsibility for the integrity of the data and the accuracy of the data analysis. This material is the result of work supported with resources and the use of facilities at the Minneapolis VA Health Care System.

Publisher Copyright:
© 2022 COPD Foundation. All rights reserved.

Keywords

  • chronic obstructive pulmonary disease
  • health care services
  • pulmonary disease
  • spirometry
  • Veterans Affairs

PubMed: MeSH publication types

  • Journal Article

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