Unidad de Neumología, Hospital Francesc de Borja, Gandía, Valencia, España.
Arch Bronconeumol. 2010 Feb;46(2):64-9. doi: 10.1016/j.arbres.2009.10.012. Epub 2009 Dec 8.
To examine the quality of COPD diagnosis in hospitalised patients.
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)).
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.
研究住院患者 COPD 诊断的质量。
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））。
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。
