A48 COPD: ISSUES IN HEALTH CARE DELIVERY: Electronic Medical Record Inaccuracies: A Multi-Center Analysis Of The Challenges For Population-Based Lung Cancer Screening

Publication Title

Am J Respir Crit Care Med

Document Type

Conference Proceeding

Publication Date

5-21-2017

Keywords

washington; swedish; swedish thoracic surgery

Abstract

Rationale Lung cancer screening (LCS) criteria are currently based on age and individual risk due to tobacco exposure. Chronic obstructive pulmonary disease (COPD) has been identified as an independent risk factor for lung cancer. Furthermore, the National Comprehensive Cancer Network (NCCN), in version 1.2015, expanded the criteria for LCS of high-risk individuals to include those age >50, a 20 pack-year history of smoking and one additional clinical risk factor, including COPD. The Electronic Medical Record (EMR) remains a potential source for relevant clinical information that could be helpful in identifying high-risk populations for LCS, including a diagnosis of COPD. An unsubstantiated diagnosis of COPD located within the EMR may potentially lead to inappropriate screening referrals. We aimed to detect the prevalence of unsubstantiated COPD diagnosis in the EMR of individuals referred for LCS to determine the efficacy of utilizing the EMR as an accurate population-based tool. Methods A multi-center retrospective review of all individuals referred to three LCSPs (Swedish Cancer Institute, Providence Regional Cancer Partnership and Providence Health and Services) from 2012-2015 was performed. Each individual’s EMR was searched for the diagnostic terms ‘COPD and chronic airway obstruction’, as well as ‘chronic bronchitis and emphysema’ as these are terms commonly interchanged with COPD. The presence of a diagnostic Pulmonary Functionality Test (PFT) as defined by the Global initiative for Obstructive Lung Disease criteria, was also determined. An unsubstantiated diagnosis of COPD was defined by an individual’s EMR containing a COPD term with no PFT’s present, or the presence of PFT’s without evidence of obstruction. Results A total of 2905 referred individuals were identified (Table). Overall, a COPD term was identified in 33% (n=955), of which 55% (n=524) were unsubstantiated diagnoses. A higher number of males (53%, n=1545) were referred than females (47%, n=1360); however, females (37%, n=497) carried a COPD term in the EMR significantly more often than males (30%, n=458, p<0.001), and also had a slightly higher number of unsubstantiated diagnosis (57%, n=284) than males (52%, n=240), p=0.141. Conclusion The rate of an unsubstantiated diagnosis of COPD in the EMR is high. This may impact the feasibility of utilizing the EMR to identify high-risk populations qualifying for LCS using certain criteria. These inaccuracies identify a risk of inappropriate referral for screening, which could negatively impact the efficiency and cost of LCS.

Clinical Institute

Cancer

Specialty

Population Health

Specialty

Oncology

Specialty

Pulmonary Medicine

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