Failure of Administrative Data to Guide Asthma Care

Agarwal, Joel; LaBranche, Jennifer; Cohen, Jessica; Gara, Chris de; Vethanayagam, Dilini

doi:10.29173/spectrum27

Cited by 1 publication

(1 citation statement)

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“…Prior work by members of our group at a province-wide level, revealed the inability to quantify health administrative data related to PFT labs in the province of Alberta (for asthma diagnostics), in part due to inability to capture information from private FP labs [22]. That study found that spirometry was billed about half as often as the asthma diagnostic codes were used in the same period [22]. Such findings raise questions about how administrative data is captured, and whether it is providing a complete picture in Alberta.…”

Section: Discussionmentioning

confidence: 99%

Routine use of post-bronchodilator testing in pulmonary function testing labs

Agarwal

Saad

Fontaine

et al. 2019

CIM

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Purpose: Pulmonary function tests (PFTs), including spirometry with and without post-bronchodilator (post-BD) testing, are frequently performed in the assessment of asthma, along with other obstructive airway disorders. Multiple publications over the past 15 years have noted that one in three physician-diagnosed asthma cases are not in fact asthma. In this quality assurance project, we assess whether PFT labs in Alberta have policies on post-BD testing, as extraneous and unnecessary use of post-BD testing can lead to wasted staff and patient time and unnecessary expenses to the health care system. Methods: We reviewed, in collaboration with the College of Physicians and Surgeons of Alberta and Alberta Medical Association, all PFT labs in the province of Alberta (hospital-based private not-for-profit [NFP] and private for-profit [FP] labs). This health policy study of PFT labs involved identifying the proportions and regional distribution of NFP and private FP labs in the province of Alberta while assessing post-BD policies. Each PFT lab was asked for their policy regarding spirometry and asthma diagnosis from May 1 to August 31, 2017. Results: A total of 92 PFT labs were identified in Alberta, 74 of which were private FP (independent) labs, while 18 were private NFP (public) hospital-based labs. Policies were as follows: (i) post-BD policy existed (and if so routinely performed / not routinely done); (ii) no post-BD policy; and (iii) lab chose not to participate. All 18 hospital labs responded: 10 had no policy; six had a policy or algorithm; one did not perform post-BD testing (exercise testing) and one had multiple testing sites. Of the private FP labs, three had relevant policies and/or algorithm and 10 had none. No information was provided from 61 labs. Access to PFT labs in Northern Alberta was limited. Conclusions: Lab policies surrounding post-BD testing were found to be heterogeneous in Alberta. Low response rates, despite the use of a systems approach and requests in writing and in person from FP labs, were notable. Development of a standardized policy across the province would be beneficial. Further higher-level review of the appropriateness of post-BD use in both FP and NFP PFT labs is needed.

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Section: Discussionmentioning

confidence: 99%