Lessons learned: Utilization of prescreening surveys and pulmonary function testing in population health screenings for COPD and asthma

An estimated 24 million adults in the U.S. remain undiagnosed for chronic obstructive pulmonary disease (COPD) and asthma. Especially in Los Angeles County, many community residents are at high risk for COPD and asthma due to the proximity of unhealthful particle pollution levels and other risk factors. In 2006, Glendale Adventist Medical Center implemented a screening strategy that allows for large-scale outreach to high-risk individuals in target populations. A self-scored risk-assessment survey was utilized to prescreen community residents. Participants scoring above an identified threshold are considered to have a moderate or higher risk for COPD/asthma and then receive pulmonary function testing to further evaluate their risk. Additionally, those who are symptomatic are referred to medical care providers and risk reduction classes. Of the 1,646 prescreened so far, 45% were identified as at-risk for COPD/asthma. Of the 242 clinically screened via pulmonary function testing, 37% showed mild to high risk FEV1/FVC and FVC% predicted levels-- indicators for pulmonary disease. These participants are also further evaluated for COPD/asthma risk with 88% identified as symptomatic for COPD/asthma. Only 12% indicated no pulmonary-related symptoms. In a four-month follow-up phone call (n=102), 35% made changes to their nutrition/diet, 10% increased their physical activity, 28% did a combination of exercise and nutrition to lose weight, while 4% made other changes to their health. Our model demonstrates a comprehensive integration of public health through community outreach, risk screenings, and referral case management, into the traditional health care system.