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

Objectives Pulmonary function testing (PFT) data, such as forced expiratory volume (FEV 1 ) has become increasingly siloed from the electronic health record (EHR). We hypothesised that FEV 1 %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 FEV 1 %pred <35%, compared with those with FEV 1 %pred ≥70%, while 5-year mortality odds were 3.83 (95% CI: 3.58 to 4.09). Discussion Our study shows that FEV 1 %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 FEV 1 recorded in the EHR, FEV 1 %pred is statistically significantly associated with increased risk of both 1-year and 5-year mortality, above and beyond the CAN score.