The optimization of the diagnostic work-up in patients with suspected obstructive lung disease

BMC Pulmonary Medicine

Research Article

Milena JMM van der Vegt¹  Frank J Visser¹  Julius P Janssen¹  Gert Jan van der Wilt² 

[1] Canisius Wilhelmina Hospital, Nijmegen, The Netherlands Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands;Department of Epidemiology, Biostatistics, and Health Technology Assessment, Radboud University Hospital, Nijmegen, The Netherlands;

关键词: Asthma;    Final Diagnosis;    Forced Vital Capacity;    Outpatient Visit;    Obstructive Lung Disease;   

DOI  :  10.1186/1471-2466-10-60

 received in 2010-06-05, accepted in 2010-11-23,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundPulmonary function testing is a key procedure in the work-up of patients who are suspected of having asthma and chronic obstructive lung disease (COPD). Therein, clinical visits and pulmonary function tests (PFTs) are the major contributors to the overall financial costs.The aim of this study was to assess whether a specific diagnostic test protocol contributes to the optimization of the work-up of patients who are suspected of having asthma and COPD.MethodsA prospective, single-blind, and randomized controlled study was performed. In the control group (CG), all of the PFTs that were ordered by the lung specialist were carried out. In the experimental group (EG), specific PFTs were selected according to our protocol. The primary end point was the total cost of achieving a final diagnosis.ResultsOne hundred and seventy-nine patients were included into this study: 86 in the CG and 93 in the EG. The mean number of tests to diagnosis was 3.8 in the CG versus 2.9 in the EG (P < 0.001). The mean number of redundant PFTs before diagnosis was 1.2 in the CG versus 0.08 in the EG (P < 0.001). The number of patients who required an additional outpatient visit to complete diagnosis was higher in the CG in comparison to the EG (P = 0.02). The mean cost of work-up per diagnosis was €227 in the CG versus €181 in the EG (P < 0.001).ConclusionsIn this group of patients with suspected obstructive lung disease, protocol-driven, PFT-based selection is more cost-effective than test selection at the discretion of lung physicians.

【 授权许可】

CC BY   
© Visser et al; licensee BioMed Central Ltd. 2010