Navigating data availability challenges in healthcare: assessing the added value of pulmonary function testing to the Care Assessment Need score for mortality risk.

Abstract

Objectives: Pulmonary function testing (PFT) data, such as forced expiratory volume (FEV₁) has become increasingly siloed from the electronic health record (EHR). We hypothesised that FEV₁ %pred is independently associated with mortality risk, even after adjusting for the Care Assessment Needs (CAN) score, a validated method developed by the Veterans Health Administration (VA) to predict mortality. Additionally, we hypothesised that the integration of PFT data into the EHR has declined in recent years.

Methods: We conducted a retrospective cohort study using national VA data on PFTs from 2013 to 2018. Using logistic regression adjusted for CAN scores, we assessed the associations between FEV1 percent predicted (%pred) and all-cause mortality at 1 year and 5 years.

Results: While the number of PFTs performed has generally increased since 2000, the integration of PFT data into the EHR has declined since 2006. The CAN-adjusted odds of 1-year mortality were 2.94 (95% CI: 2.66 to 3.24) for those with FEV₁ %pred <35%, compared with those with FEV₁ %pred ≥70%, while 5-year mortality odds were 3.83 (95% CI: 3.58 to 4.09).

Discussion: Our study shows that FEV₁ %pred is statistically significantly associated with increased risk of mortality, above and beyond the CAN score. However, the declining integration of PFT data into the VA EHR highlights a concerning trend of isolating critical test results from clinical care.

Conclusion: Among people with FEV₁ recorded in the EHR, FEV₁ %pred is statistically significantly associated with increased risk of both 1-year and 5-year mortality, above and beyond the CAN score.