November 6, 2006

National Study Shows Patients with Chronic Obstructive Pulmonary Disease and Asthma Receive Only Half of Recommended Care

(PORTLAND, Ore.) - Patients with obstructive lung diseases such as asthma and emphysema receive only about half (55 percent) of recommended medical care, according to a RAND Corporation study appearing in the November issue of Chest.

The chance of patients getting appropriate care also varies significantly according to their individual condition and whether they are seeking care for routine needs or seeking care during acute episodes. Patients with asthma received about 67 percent of the care recommended for routine management of the disease but only 48 percent of the care recommended when their condition worsened. The opposite pattern was found for patients with chronic obstructive pulmonary disease (COPD), the most common form being emphysema. Patients received just 46 percent of the routine care recommended for COPD but about 60 percent of recommended care when their symptoms worsened.

"Our findings show that the quality of care provided to patients with obstructive lung diseases is not as good as it should be or needs to be" says Richard A. Mularski, MD, lead author of the study and a physician-researcher with the Center for Health Research, Kaiser Permanente Northwest.

Obstructive lung disease affects an estimated 12 to 50 million Americans and is a leading cause of death nationally. Many studies have outlined appropriate care for obstructive lung diseases, but few have examined whether patients routinely receive proper care. This new study, part of the largest project ever undertaken to examine the quality of health care across the United States, analyzed two years of medical records for 429 patients with obstructive lung diseases living in 12 communities across the nation. Nearly 7,000 adults in 12 national representative metropolitan areas participated in the larger study, which evaluated health care performance on 439 indicators of quality for 30 acute and chronic conditions such as urinary tract infections, diabetes, asthma, high blood pressure and heart disease.

"We also found several specific areas of care that could be targeted for improvement efforts," Dr. Mularski says. "The knowledge of effective therapies for COPD has expanded greatly in the last decade - just as in asthma, we need to target preventive and routine care of this disorder that affects about 15 million Americans." Mularksi and his study colleagues estimate that increasing the number of COPD patients who receive appropriate oxygen treatment at home could prevent 27,000 to 57,000 deaths annually.

Increasing the number of hospitalized asthma patients who receive systemic steroids could prevent nearly 2,000 deaths every year. They found lower-than-expected use of tests that evaluate lung function among COPD patients as well as a low rate of the use of spacers with metered-dose inhalers among both COPD and asthma patients. Spacers help improve the use of inhalers.

The study appearing in the November issue of Chest was funded by the Robert Wood Johnson Foundation, Veterans Health Administration, California Healthcare Foundation, Health Care Financing Administration, and Agency for Healthcare Research and Quality. The work was performed at RAND Health, the nation's largest independent health policy research organization. Other authors of the study include Dr. Steven M. Asch of the Veterans Affairs Great 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, Joan Keesey, and Elizabeth A. McGlynn, all of RAND.

Kaiser Permanente's Center for Health Research, founded in 1964, is a non-profit research institution whose mission is advancing knowledge to improve health. Kaiser Permanente Northwest is a prepaid group practice health care organization serving the health care needs of 485,000 people in Oregon and Southwest Washington.

Additional information: The study was based on medical records of patients living in 12 metropolitan areas - Boston, MA; Cleveland, OH; Greenville, SC; Indianapolis, IN; Lansing, MI; Little Rock, AR; Miami, FL; Newark, NJ; Orange County, CA; Phoenix, AZ; Seattle, WA; and Syracuse, NY.  

For more infomation contact:

Terry Fitzpatrick - 503-335-6602, Terry.Fitzpatrick@kpchr.org   or 
Gail Mathabane - 503-813-4820, Gail.E.Mathabane@kp.org