Utilization of Pulmonary Function Tests by Primary Care Internists in a Community Hospital

Objective: A quality assurance effort to evaluate the use of pulmonary function tests by primary care physicians. Specifically, to examine the patient's un derstanding of the test, the types of tests physicians order, and the appropriateness of the ordered tests for answering questions posed by physicians. Design: Concurrent chart review, clinical interviews, and pa tient interviews. Setting: Community teaching hos pital. Patients: 101 consecutive inpatients and out patients, referred to the Pulmonary Function Labo ratory over a consecutive 5-month period. Measurements: Interview of the patient by a pulmo nary technician. Interview of the primary care phy sician by a pulmonary physician. Interview, where applicable, with the house staff. Final assessment by a pulmonary physician. Main Results: 64% of the patients understood the purpose of the test and 49% of the patients felt there was some potential benefit to be derived from participating in the testing. Sixty five percent of the physicians ordered specific tests on their patients. Seventy-two percent of physicians planned on using the data obtained from testing to formulate treatment decisions. Fifty percent of the interviewed physicians said they were using the re sults for decisions regarding further diagnostic eval uation and/or treatment. The reviewing pulmonary physician considered that 31 % of the pulmonary func tion tests ordered were appropriate for the goals de fined by the requesting physician. Sixty-eight percent of the ordered tests could have had some aspects of ordering improved, and 1 % of the testing was unnec essary. Conclusions: 1) There is a need to increase patient understanding of the indications and potential benefits of participating in pulmonary function test ing. 2) When physicians-in-training are involved in the process of requesting pulmonary function tests, greater staff-level supervision and involvement should be present. 3) There is a need to increase physician knowledge regarding the appropriate pul monary function tests that should be requested for specific clinical questions and situations. 4) The re questing form for pulmonary function testing may serve to remind and educate the physician, while documenting the indications for the testing and the physician's efforts. 5. Quality assurance/utilization review efforts can be combined with educational ef forts that could result in a diminution of the deficien cies.