Acute exacerbations of COPD are one of the ten leading causes of hospitalization among adults in the United States yet little is known about the quality of inpatient care or whether hospital and paitent characteristics influence treatment.
We conducted a retrospective cohort study involving 69,820 patients hospitalized for acute exacerbations of COPD at 360 hospitals throughout the United States. We measured adherence to diagnosis and treatment recommendations contained in guidelines produced by the American College of Physicians, and examined the association between hospital and patient characteristics and composite measures of performance.
Summary of Results:
Of the recommended diagnostic tests and treatments, 66276 (95%) patients underwent chest radiography, 63715 (91%) received supplemental oxygen, 67515 (97%) patients were administered bronchodilators, 59240 (85%) received systemic steroids, and 59053 (85%) were given antibiotics. Of the treatments considered not beneficial, 16607 (24%) patients received methylxanthine bronchodilators, 10051 (14%) had sputum testing, 8354 (12%) underwent acute spirometry, 4299 (6%) had chest physiotherapy and 1409 (2%) were treated with mucolytic medications. Forty five thousand eight hundred patients (66%) received the entire set of recommended care processes and 22929 (33%) received ideal care. Individual hospital performance varied widely, and while older patients and women were more likely to receive ideal care than their counterparts, a higher annual volume of COPD admissions was not associated with improved hospital performance.
Statement of Conclusions:
The quality of care for patients hospitalized for acute exacerbations of COPD may be improved by increasing the use of systemic steroids and antibiotics, decreasing the use of unnecessary and potentially harmful treatments, and reducing variation in practice across hospitals.
Author Disclosure Block:
P. Lindenauer, None; P. Pekow, None; S. Gao, None; A. Crawford, None; B. Gutierrez, None; E. Benjamin, None.