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Spirometry Utilization Among Patients with Asthma

Authors Roychowdhury P, Badwal J, Alkhatib F, Singh DK, Lindenauer PK, Knee A, Lagu T

Received 18 March 2020

Accepted for publication 29 May 2020

Published 30 June 2020 Volume 2020:13 Pages 193—203


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Luis Garcia-Marcos

Prithwijit Roychowdhury,1 Jasdeep Badwal,2 Fadi Alkhatib,3 Dilpreet Kaur Singh,4 Peter K Lindenauer,5,6 Alexander Knee,5,7 Tara Lagu5,6

1University of Massachusetts Medical School (UMMS), Worcester, MA, USA; 2Allergy and Immunology Associates of New England, Greenfield, MA, USA; 3Larkin Community Hospital, South Miami, FL, USA; 4Arthritis Treatment Center, Springfield, MA, USA; 5Department of Medicine, UMMS-Baystate, Springfield, MA, USA; 6Institute of Healthcare Delivery & Population Science, UMMS-Baystate, Springfield, MA, USA; 7Epidemiology and Biostatistics Research Core, Office of Research, Baystate Medical Center, Springfield, MA, USA

Correspondence: Prithwijit Roychowdhury
University of Massachusetts Medical School (UMMS), Worcester, MA, USA

Objective: To examine predictors of spirometry use at a tertiary academic health system and association between receipt of spirometry and outcomes.
Patients and Methods: We conducted a retrospective cohort study of adult patients with an ICD-9 CM diagnostic code for asthma and a 2014 outpatient visit in either a community health center or private practice associated with a tertiary academic medical center. The main outcome was receipt of spirometry during a 2007– 2015 “exposure period.” We secondarily examined future hospitalizations and emergency department (ED) visits during a follow-up period (2016– 2019).
Results: In a sample of 394 patients, the majority were white (48%; n=188) and female (72%; n=284). Mean (SD) age was 52 years. Approximately half (185, 47%) of the patients received spirometry and 25% (n=97) saw a specialist during the exposure period. Nearly, 88% (n=85) of patients who saw a specialist received spirometry. More than half of the cohort (220/394, 56%) had an ED visit or admission during the follow-up period. Of these, 168 (76.4%) had not seen a specialist and 111 (50.5%) had not received spirometry within the exposure period. We saw no association between spirometry in the exposure window and future ED visit or hospitalization.
Conclusion: In a cohort of patients at a tertiary medical center, spirometry was underused. We observed a strong association between seeing a specialist and use of spirometry, suggesting a need to better incorporate spirometry into routine primary care for patients with asthma. Among 220 patients who had an asthma-related hospitalization or ED visit in 2016– 2019, the majority had no record of receiving spirometry and no documentation indicating a prior specialist visit.

Keywords: asthma, spirometry, health care delivery, quality of care, population health

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