• Peter K Lindenauer, Penelope Pekow, Shan Gao, Allison S Crawford, Benjamin Gutierrez, and Evan M Benjamin.
• Division of Healthcare Quality, Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts 01199, USA. Peter.Lindenauer@bhs.org
• Ann. Intern. Med. 2006 Jun 20; 144 (12): 894-903.

BackgroundAcute exacerbation of chronic obstructive pulmonary disease (COPD) is 1 of the 10 leading causes of hospitalization among adults in the United States.ObjectiveTo evaluate the quality of care provided to patients hospitalized for acute exacerbations of COPD and to determine whether hospital or patient characteristics influence treatment.DesignRetrospective cohort study.Setting360 hospitals throughout the United States.Patients69,820 patients hospitalized for acute exacerbations of COPD.MeasurementsAdherence to diagnosis and treatment recommendations contained in guidelines produced by the American College of Physicians and the American College of Chest Physicians; analyses of associations between hospital and patient characteristics and composite measures of performance.ResultsOf the 69,820 patients, 66,276 (95%) underwent chest radiography, 63,715 (91%) received supplemental oxygen, 67 515 (97%) received bronchodilators, 59,240 (85%) received systemic steroids, and 59,053 (85%) were given antibiotics. In total, 45,800 (66%) received this entire set of recommended care processes. Numerous participants received tests or treatments that were not beneficial: 16,607 (24%) were treated with methylxanthine bronchodilators, 10,051 (14%) had sputum testing, 8354 (12%) underwent acute spirometry, 4299 (6%) had chest physiotherapy, and 1409 (2%) were treated with mucolytic medications. Overall, 31,519 patients (45%) received at least 1 of these nonrecommended care elements, and 22,929 (33%) received ideal care, defined as all of the recommended care processes and none of the nonrecommended ones. Individual hospital performance varied widely; whereas older patients and women were more likely to receive ideal care than their counterparts, a higher annual volume of admissions for COPD was not associated with improved hospital performance.LimitationsThe study used administrative data, not chart review, and was limited to the inpatient management of COPD.ConclusionsThe quality of care for patients hospitalized for acute exacerbations of COPD may be improved by increasing the use of systemic corticosteroid and antibiotic therapy, decreasing the use of unnecessary and potentially harmful treatments, and reducing variation in practice across hospitals.

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