Diagnosing Chronic Obstructive Pulmonary Disease Among Afghanistan and Iraq Veterans: Veterans Affair's Concordance With Clinical Guidelines for Spirometry Administration
- PMID: 28885968
- PMCID: PMC5817986
- DOI: 10.7205/MILMED-D-16-00332
Diagnosing Chronic Obstructive Pulmonary Disease Among Afghanistan and Iraq Veterans: Veterans Affair's Concordance With Clinical Guidelines for Spirometry Administration
Abstract
Background: Early diagnosis and treatment of chronic obstructive pulmonary disease (COPD) can slow disease progression. The Department of Veterans Affairs (VA)/Department of Defense Clinical Practice Guidelines (CPG), established to improve patient outcomes, recommend the use of spirometry in the COPD diagnostic process. The aims of this study were to assess VA health care providers' performance related to CPG-recommended spirometry administration in the evaluation of newly diagnosed COPD among veterans, determine the patient characteristics that may influence the adherence rate, and compare VA concordance rates to those of other health plans.
Methods: Administrative health care data related to Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) veterans was used to identify newly diagnosed COPD cases and the proportion of cases receiving spirometry. Cases were defined as veterans who had their first medical encounter with a coded diagnosis of COPD ≥ 6 months after their initial VA health care evaluation. The relationship between prediagnostic and comorbid conditions and the administration of CPG-concordant spirometry was examined using regression analyses.
Findings: Among the 923,646 OEF/OIF/OND veterans receiving VA health care between January 2002 and December 2014, 32,076 (3%) had a coded diagnosis of COPD. Among those, 22,156 (69%) were identified as newly diagnosed COPD cases; only 6,827 (31%) had CPG-concordant spirometry. Concordant spirometry was more likely to occur in veterans aged ≥40. A pre-existing tobacco use disorder marginally changed the concordance rate.
Discussion: VA provider adherence to CPG-concordant spirometry would decrease the prevalence of false-positive COPD cases and lead to more targeted disease treatment. Future research should focus on such cases by assessing the association between COPD diagnosis and bronchodilator responsiveness.
Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.
Figures
Comment in
-
Treatment of Chronic Obstructive Pulmonary Disease: Guidelines from the VA/DoD.Am Fam Physician. 2021 Jul 1;104(1):98-99. Am Fam Physician. 2021. PMID: 34264617 No abstract available.
Similar articles
-
Gender differences in service utilization among Operations Enduring Freedom, Iraqi Freedom, and New Dawn Veterans Affairs patients with severe mental illness and substance use disorders.Psychol Serv. 2018 Feb;15(1):11-20. doi: 10.1037/ser0000144. Epub 2017 May 18. Psychol Serv. 2018. PMID: 28517950
-
The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: a meta-analysis.J Anxiety Disord. 2015 Apr;31:98-107. doi: 10.1016/j.janxdis.2015.02.003. Epub 2015 Feb 19. J Anxiety Disord. 2015. PMID: 25768399 Review.
-
Gestational diabetes and hypertensive disorders of pregnancy among women veterans deployed in service of operations in Afghanistan and Iraq.J Womens Health (Larchmt). 2014 Oct;23(10):792-800. doi: 10.1089/jwh.2013.4681. Epub 2014 Aug 4. J Womens Health (Larchmt). 2014. PMID: 25090022 Free PMC article.
-
Access to VA services for returning veterans with PTSD.Mil Med. 2012 Jul;177(7):814-22. doi: 10.7205/milmed-d-12-00009. Mil Med. 2012. PMID: 22808888 Review.
-
Brief report: Comparison of methods to identify Iraq and Afghanistan war veterans using Department of Veterans Affairs administrative data.J Rehabil Res Dev. 2010;47(8):815-21. doi: 10.1682/jrrd.2009.08.0115. J Rehabil Res Dev. 2010. PMID: 21110254
Cited by
-
Contributions of particulate and gas phases of simulated burn pit smoke exposures to impairment of respiratory function.Inhal Toxicol. 2023 May-Jun;35(5-6):129-138. doi: 10.1080/08958378.2023.2169416. Epub 2023 Jan 24. Inhal Toxicol. 2023. PMID: 36692431 Free PMC article.
-
Characteristics Associated with Spirometry Guideline Adherence in VA Patients Hospitalized with Chronic Obstructive Pulmonary Disease.J Gen Intern Med. 2023 Feb;38(3):619-626. doi: 10.1007/s11606-022-07826-5. Epub 2022 Oct 14. J Gen Intern Med. 2023. PMID: 36241942 Free PMC article.
-
Obesity and Morbidity Risk in the U.S. Veteran.Healthcare (Basel). 2020 Jun 29;8(3):191. doi: 10.3390/healthcare8030191. Healthcare (Basel). 2020. PMID: 32610637 Free PMC article.
References
-
- Kang HK, Bullman TA. Mortality among US veterans of the Persian Gulf War: 7-year follow-up. Am J Epidemiol. 2001;154(5):399–405. - PubMed
-
- Murphy DE, Chaudhry Z, Almoosa KF, Panos RJ. High prevalence of chronic obstructive pulmonary disease among veterans in the urban Midwest. Mil Med. 2011;176(5):552–60. - PubMed
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical