Comorbidities, mortality, and management of chronic obstructive pulmonary disease patients who required admissions to public hospitals in Hong Kong – computerized data collection and analysis

Abstract

BackgroundCOPD is a common cause for hospital admission. Conventional studies of the epidemiology of COPD involved large patient number and immense resources and were difficult to be repeated. The present study aimed at assessing the utilization of a computerized data management system in the collection and analysis of the epidemiological and clinical data of a large COPD cohort in Hong Kong (HK).Patients and methodsIt was a computerized, multicenter, retrospective review of the characteristics of patients discharged from medical departments of the 16 participating hospitals with the primary discharge diagnosis of COPD in 1 year (2012). Comparison was made between the different subgroups in the use of medications, ventilatory support, and other health care resources. The mortality of the subjects in different subgroups was traced up to December 31, 2014. The top 10 causes of death were analyzed.ResultsIn total, 9,776 subjects (82.6% men, mean age = 78 years) were identified. Of the 1,918 subjects with lung function coding, 85 (4.4%), 488 (25.5%), 808 (42.1%), and 537 (28.0%) subjects had the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 2, 3, and 4 classes, respectively. Patients with higher GOLD classes had higher number of hospital admissions, longer hospital stay, increased usage of noninvasive mechanical ventilation (NIV), combinations of long-acting bronchodilators, and higher mortality. Of the 9,776 subjects, 2,278 (23.3%) received NIV, but invasive mechanical ventilation was uncommon (134 of 9,776 subjects [1.4%]); 4,427 (45.3%) subjects had died by the end of 2014. The top causes of death were COPD, pneumonia, lung cancer, and other malignancies.ConclusionPatients admitted to hospitals for COPD in HK had significant comorbidities, mortality, and imposed heavy burden on health care resources. It is possible to collect and analyze data of a large COPD cohort through a computerized system. Suboptimal coding of lung function results was observed, and underutilization of long-acting bronchodilators was common.

Excess Mortality and Life-Years Lost in People With Schizophrenia and Other Non-affective Psychoses: An 11-Year Population-Based Cohort Study

“…4,5 One possible explanation is that a significant proportion of our patients with pneumonia as their assigned cause of death might have underlying COPD, a risk factor of and one of the most frequent comorbidities with pneumonia, which is a major cause of death among COPD patients. 40 As our mortality analysis was based on a single cause of death per deceased person, this may introduce inaccuracy in death-cause assignment for patients with multi-comorbidity, which is nonetheless more common in schizophrenia patients than the general population. Alternatively, our findings that mortality rates for cancers were not significantly elevated among patient groups are at odds with most, 41 though not all, 42 past studies reporting heightened cancer mortality rate in schizophrenia.…”

Hospital Burden of Chronic Obstructive Pulmonary Disease in Hong Kong – The Trend from 2006 to 2014

“…Anonymized patient data could be retrieved and analyzed using the HA Clinical Data Analysis and Reporting System (CDARS) software program. 3–5 Previous published data of 14 public hospitals in HK showed that it is possible to review the health-care utilization of an anonymized COPD patient cohort (N = 9776) in year 2012 using CDARS. 3 The present study aimed to assess the trend of hospital burden of COPD from 2006 to 2014 – including the demographic data, use of health-care resources, mortality and survival.…”

“… 3–5 Previous published data of 14 public hospitals in HK showed that it is possible to review the health-care utilization of an anonymized COPD patient cohort (N = 9776) in year 2012 using CDARS. 3 The present study aimed to assess the trend of hospital burden of COPD from 2006 to 2014 – including the demographic data, use of health-care resources, mortality and survival. HK has a population of over 7 million and the present study included the medical departments of all acute public hospitals (N = 15) and chest hospitals (N = 4) in HK.…”

Clinical Audit on Chronic Obstructive Pulmonary Disease (COPD) Management in Primary Care: A Quality Improvement Project from Hong Kong

“… 20 Inaccurate diagnosis due to lack of a popper lung function test, underutilization of long-acting bronchodilators and lack of an integrative care model were postulated to be the main issues to be tackled. 21 To bridge this service gap, a COPD audit had been conducted across all primary care clinics of HAHK since 1st April 2017 with the purpose to plug these loopholes in COPD management and to enhance the quality of care. This study aimed to review the management of COPD cases from all primary care clinics of HAHK via a two phase clinical audit and to share out the improvement strategies.…”