住院患者的 COPD 诊断。

Diagnosis of COPD in hospitalised patients.

机构信息

Unidad de Neumología, Hospital Francesc de Borja, Gandía, Valencia, España.

出版信息

Arch Bronconeumol. 2010 Feb;46(2):64-9. doi: 10.1016/j.arbres.2009.10.012. Epub 2009 Dec 8.

DOI:10.1016/j.arbres.2009.10.012

PMID:20004051

Abstract

OBJECTIVE

To examine the quality of 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 packets/year) 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 health care diagnosis. Demographic data such as, smoking, spirometry, the specialist who discharged the patient (P: Pneumologist; MS: Medical Specialty; CS: Surgical Specialty), and health care 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 spirometry (538, 64%) or smoking criteria (319, 38%), (P<0.001). Only two of the ten hospitals complied with the criteria of an acceptable quality health care diagnosis. Significant differences (P<0.0001) were seen on comparing DxC and DxD by health care 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

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

摘要

目的

研究住院患者 COPD 诊断的质量。

材料与方法

对出院诊断为 COPD 的患者的临床病历进行回顾性多中心横断面审核研究。如果可以记录支气管阻塞（FEV1/FVC<70%）和吸烟史（>10 包/年），则认为 COPD 诊断正确（DxC）。其余情况下则认为诊断不足（DxD）。只有在至少 60%的患者中做出 DxC 诊断，才能认为这是一种可接受的医疗保健诊断质量。人口统计学数据，如吸烟、肺功能检查、诊断患者的专家（P：肺病专家；MS：医学专业；CS：外科专业）和医疗保健级别（医院复杂性；低（H1）、中（H2）和高（H3））。

结果

共分析了 840 例病例（718 例男性，122 例女性）；平均年龄（标准差）为 73（10）岁，来自 10 家医院（3 家 H1，4 家 H2，3 家 H3）。由于缺乏肺功能检查（538 例，64%）或吸烟标准（319 例，38%），导致 597 例（71.1%）诊断不足（DxD）（P<0.001）。仅 10 家医院中的 2 家符合可接受的医疗保健诊断质量标准。通过医疗保健级别（DxC：H1 为 56.2%，H2 为 29.9%，H3 为 20.9%）和专家（DxC：P 为 47.6%，SP 为 24.6%，MS 为 17.4%）比较 DxC 和 DxD 时，观察到显著差异（P<0.0001）。多变量分析将 DxC 与男性、H1 和肺病学报告相关联。