Patients around the United States with obstructive lung diseases receive only about half of the recommended medical care, with care varying significantly based on individual conditions, according to a RAND Corporation study issued today.
Obstructive lung disease affects an estimated 12 to 50 million Americans and includes asthma and chronic obstructive pulmonary disease (COPD), the most common form being emphysema. Obstructive lung disease is a leading cause of death nationally. While many studies have identified proper care for the illnesses, little research has examined whether patients routinely receive proper care.
Researchers say improving care could save lives. For example, they estimate that increasing the number of COPD patients in the United States who receive oxygen treatment at home could prevent 27,000 to 57,000 deaths annually. Increasing the number of hospitalized asthmatic patients who receive systematic steroids could prevent nearly 2,000 deaths each year, the study estimates.
RAND – a nonprofit research organization – analyzed two years of medical records for 429 patients with obstructive lung disease living in 12 communities across America. Overall, researchers found that patients received 55 percent of the recommended care.
The study found different patterns of care provided to patients with asthma and COPD.
Patients with asthma received about 67 percent of the care recommended for routine management of their illness, but only 48 percent of the care recommended when their condition worsened.
The opposite pattern was seen among patients with COPD. Patients received just 46 percent of the routine care recommended for COPD, compared with about 60 percent of recommended care when their symptoms were worse.
Researchers say they are uncertain about the reasons for the pattern, although the trend observed among asthma patients may be due to two decades of efforts to improve the routine care of asthma.
"It looks like the previous efforts to improve routine care for asthma have made a difference," said Elizabeth McGlynn, associate director of RAND Health and the report's senior investigator. "Now we need to expand improvement efforts to include these other areas."
The study in the November edition of the journal Chest is a more detailed analysis from the largest project every undertaken to examine the quality of health care across the United States. Nearly 7,000 adults in 12 nationally representative metropolitan areas participated in the larger study, which evaluated performance on 439 indicators of quality for 30 acute and chronic conditions such as urinary tract infections, diabetes, depression, high blood pressure and heart disease – along with preventive care.
"Our findings show that the quality of care provided to patients with obstructive lung disease is lacking, just as it is for many other common health problems," said Dr. Richard A. Mularski, lead author of the study and a physician-researcher with the Center for Health Research, Kaiser Permanente. "We found several specific areas of care that could be targeted for improvement efforts."
Researchers found lower-than-expected use of tests that evaluate lung function among patients with COPD – one area they suggest should be targeted for quality improvement efforts. The study also found a low rate of the use of spacers with metered-dose inhalers for both COPD and asthma patients. Spacers help improve the use of inhalers.
The RAND Health study was supported by the Robert Wood Johnson Foundation and the Veterans Affairs Health Administration, which supported a fellowship for Mularski.
Other authors of the study appearing in Chest are: Dr. Steven M. Asch of the Veterans Affairs Greater Los Angeles Healthcare System and RAND; Dr. William H. Shrank of Brigham and Women's Hospital and the Harvard Medical School; Dr. Eve A. Kerr of the Veterans Affairs Ann Arbor Health Care System and the University of Michigan; and Claude M. Setodji, John L. Adams and Joan Keesey, all of RAND.
RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research organization, with a broad research portfolio that focuses on health care quality, costs, and delivery, among other topics.