Population-Based Burden of COPD-Related Visits in the ED

Yeatts, Karin; Lippmann, Steven; Waller, Anna; Lich, Kristen Hassmiller; Travers, Debbie; Weinberger, Morris; Donohue, James F.

doi:10.1378/chest.12-1899

Cited by 28 publications

(17 citation statements)

References 21 publications

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“…In the present study, we found that adults at highest risk of frequent ED visits were more likely to have public insurance, and to have lower socioeconomic status. These results support prior reports of higher rates of frequent ED visits for COPD among these vulnerable populations [10,11]. Although the precise role of lower socioeconomic status to this disparity in COPD healthcare utilizations is unclear [5], the asthma literature would suggest that differences in health beliefs, less self-management education, and limited access to preventive and specialist care in this population might lead to a heavier reliance on episodic symptom treatment and emergency care [32].…”

Section: Discussionsupporting

confidence: 91%

Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease

et al. 2014

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BackgroundLittle is known about patients who frequently visit the emergency department (ED) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We aimed to quantify the proportion and characteristics of patients with frequent ED visits for AECOPD and associated healthcare utilization.MethodsWe conducted a retrospective cohort study of adults aged ≥40 years with at least one ED visit for AECOPD between 2010 and 2011, derived from population-based all-payer data of State ED and Inpatient Databases for two large and diverse states: California and Florida. Outcome measures were frequency of ED visits for AECOPD, 30-day ED revisits, subsequent hospitalizations, near-fatal events (AECOPD involving mechanical ventilation), and charges for both ED and inpatient services (available only for Florida) during the year after the first ED visit.ResultsThe analytic cohort comprised 98,280 unique patients with 154,736 ED visits for AECOPD. During the 1-year period, 29.4% (95% CI, 29.1%-29.7%) of the patients had two or more (frequent) visits, accounting for 55.2% (95% CI, 54.9%-55.4%) of all ED visits for AECOPD. In the multivariable model, significant predictors of frequent ED visits were age 55–74 years (vs. 40–54 years), male sex, non-Hispanic white or black race, Medicaid insurance (vs. private), and lower median household income (all P < 0.001). At the visit-level, 12.3% of ED visits for AECOPD were 30-day revisit events (95% CI, 12.1%-12.4%). Additionally, 62.8% of ED visits for AECOPD (95% CI, 62.6%-63.0%) resulted in a hospitalization; patients with frequent ED visits comprised 55.5% (95% CI, 55.2%-55.8%) of all hospitalizations. Furthermore, 7.3% (95% CI, 7.3%-7.5%) of ED visits for AECOPD led to a near-fatal event; patients with frequent ED visits accounted for 64.4% (95% CI, 63.5%-65.3%) of all near-fatal events. Total charges for AECOPD were $1.94 billion (95% CI, $1.90-1.97 billion) in Florida; patients with frequent ED visits accounted for $1.07 billion (95% CI, $1.04-1.09 billion).ConclusionsIn this large cohort study, we found that 29% had frequent ED visits for AECOPD and that lower socioeconomic status was significantly associated with a higher frequency of ED visits. Individuals with frequent ED visits for AECOPD accounted for a substantial amount of healthcare utilization and financial burden.

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Section: Discussionsupporting

confidence: 91%

Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease

et al. 2014

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“…The primary limitation of this study, shared by other studies based on data from large national surveys, is its reliance on the self-reporting of the physician diagnoses of chronic bronchitis, emphysema, asthma, and the ten comorbid conditions. However, it is encouraging that the results of this study corroborate some of the results from previous studies based on both self-reported data 28 and studies of state-based 23 and national 22 registries of utilization. A second limitation of our study is its lamentable lack of diagnoses for mental health disorders, as prior studies have shown that depression and substance abuse in patients with COPD contribute tangibly to health care utilization.…”

Section: Discussionsupporting

confidence: 87%

“…A second limitation of our study is its lamentable lack of diagnoses for mental health disorders, as prior studies have shown that depression and substance abuse in patients with COPD contribute tangibly to health care utilization. 23 , 29 Last, because our study is observational in nature, we make no claims of causality.…”

Section: Discussionmentioning

confidence: 99%

Contributions of COPD, asthma, and ten comorbid conditions to health care utilization and patient-centered outcomes among US adults with obstructive airway disease

Murphy¹,

McAvay²,

Allore³

et al. 2017

COPD

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BackgroundAmong persons with obstructive airway disease, the relative contributions of chronic obstructive pulmonary disease (COPD), asthma, and common comorbid conditions to health care utilization and patient-centered outcomes (PCOs) have not been previously reported.MethodsWe followed a total of 3,486 persons aged ≥40 years with COPD, asthma, or both at baseline, from the Medical Expenditure Panel Survey (MEPS) cohorts enrolled annually from 2008 through 2012 for 1 year. MEPS is a prospective observational study of US households recording self-reported COPD, asthma, and ten medical conditions: angina, arthritis, cancer, coronary heart disease, cognitive impairment, diabetes, hypertension, lung cancer, myocardial infarction, and stroke/transient ischemic attack. We studied the separate contributions of these conditions to health care utilization (all-cause and respiratory disease hospitalization, any emergency department [ED] visit, and six or more outpatient visits) and PCOs (seven or more days spent in bed due to illness, incident loss of mobility, and incident decline in self-perceived health).ResultsCOPD made the largest contributions to all-cause and respiratory disease hospitalization and ED visits, while arthritis made the largest contribution to outpatient health care. Arthritis and COPD, respectively, made the greatest contributions to the PCOs.ConclusionCOPD made the largest and second largest contributions to health care utilization and PCOs among US adults with obstructive airway disease. The twelve medical conditions collectively accounted for between 52% and 61% of the health care utilization outcomes and between 53% and 68% of the PCOs. Cognitive impairment, diabetes, hypertension, and stroke also made significant contributions.

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“…1 The WHO estimated that 65 million people have moderate-severe COPD, accounting for 5% of all causes of death in 2005. 2 …”

Section: Introductionmentioning

confidence: 99%

<p>The Long-Term Burden of COPD Exacerbations During Maintenance Therapy and Lung Function Decline</p>

Kerkhof¹,

Voorham²,

Dorinsky³

et al. 2020

COPD

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Introduction Early identification of preventable risk factors of COPD progression is important. Whether exacerbations have a negative impact on disease progression is largely unknown. We investigated whether the long-term occurrence of exacerbations is associated with lung function decline at early stages of COPD. Methods Patients diagnosed with mild/moderate COPD (obstruction and FEV 1 % predicted 50–90%), aged ≥35 years, and a smoking history, who had ≥6 years of UK electronic medical records after initiation of maintenance therapy were studied. Multilevel mixed-effect linear regression was performed to determine the association between the count of any year in which the patient had ≥1 exacerbation over a 6-year period and FEV 1 decline, adjusted for sex, age, anthropometrics and smoking habits. Exacerbations were defined as any prescription for an acute oral corticosteroid course and/or lower respiratory-related antibiotics and/or any COPD-related emergency or inpatient hospitalization. Results Of 11,337 patients included (mean age 65 years; 49% female) 31.6%, 23.3%, 16.6%, 11.6%, 8.1%, 5.3% and 3.4% had 0, 1, 2, 3, 4, 5 and 6 years with ≥1 exacerbation. The mean annual FEV 1 decline accelerated by 1.50 mL/year (95% Confidence Interval 1.02; 1.98) with every additional year with ≥1 exacerbation from 31.0 mL/year in subjects without any exacerbation to 40.0 mL/year in patients experiencing ≥1 exacerbation every year. Patients with more years with ≥1 exacerbation had a lower mean FEV 1 at first diagnosis: 14.7 mL (11.7; 17.8) lower with every additional year with exacerbations. When counting years with ≥2 exacerbations, greater effects were observed (2.19 [1.50; 2.88] mL/year excess decline per year with ≥2 exacerbations; 16.5 mL [12.1; 20.8] lower FEV 1 at diagnosis). Conclusion Patients who experienced a greater exacerbation burden after initiation of maintenance therapy had worse lung function at diagnosis and a more rapid lung function decline thereafter, which emphasizes the need for better treatment strategies.

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Population-Based Burden of COPD-Related Visits in the ED

Abstract: Background:Little is known about the population-based burden of ED care for COPD. Methods: We analyzed statewide ED surveillance system data to quantify the frequency of COPDrelated ED visits, hospital admissions, and comorbidities.

Cited by 28 publications

References 21 publications

Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease

Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease

Contributions of COPD, asthma, and ten comorbid conditions to health care utilization and patient-centered outcomes among US adults with obstructive airway disease

<p>The Long-Term Burden of COPD Exacerbations During Maintenance Therapy and Lung Function Decline</p>

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