Temporal Trends in Hospitalization Rates for Older Adults with Chronic Obstructive Pulmonary Disease

Abstract

BACKGROUND Over the last 15 years, substantial advances have been made in the treatment of chronic obstructive pulmonary disease (COPD). Little information is available, however, on whether these treatments have resulted in reduced rates of hospitalization and acute exacerbations among COPD patients. This retrospective cohort study examined changes in hospitalization rates among Medicare beneficiaries with COPD from 1999 to 2008. METHODS We analyzed data from 424,418 fee-for-service Medicare beneficiaries enrolled between 1999 and 2008 who were diagnosed with COPD. We examined temporal changes in the frequency of hospitalization and acute exacerbations among Medicare beneficiaries with COPD. RESULTS Over the 10-year study period, the hospitalization rates for COPD patients—adjusted for age, sex, race, socioeconomic status, region, and number of comorbidities—decreased: from 131 to 107 per 100 person-years for all causes (P < .001); from 58 to 44 per 100 person-years for all respiratory causes (P < .001); and from 73 to 63 per 100 person-years for nonrespiratory causes (P < .001). There was no change in prevalence of COPD in the Medicare population over this time. Additionally, the percentage of COPD patients hospitalized with 2 or more acute exacerbations decreased from 5.5% to 4.3% over the 10-year study period (P < .001). CONCLUSION Between 1999 and 2008, hospitalization rates decreased substantially among Medicare beneficiaries diagnosed with COPD.

Impact of Pulmonary Rehabilitation on Hospitalizations for Chronic Obstructive Pulmonary Disease Among Members of an Integrated Health Care System

“…9 Together, these differences in baseline health care resource use and changes after PR between this study and previous reports could reflect differences in data collection methods, decision to include only patients who completed PR, 9 fee-for-service versus capitated care models, secular changes in the US health care system with the advent of health care reform, and national trends in decreased hospitalizations for COPD. 21 Two of the largest randomized controlled trials of PR in stable COPD patients found no significant Participants with any available data were included in these analyses. …”

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD

“…Less than one-third of readmissions are related to acute exacerbation of COPD; the remainder are related to other comorbidities, 37,39 and the number of comorbidities correlates directly with frequency of 30-day readmission. 16,18,40,41 The complex overlap of symptoms with COPD creates challenges for the diagnosis and treatment of comorbid psychological disorders. 42,43 The potential biologic mechanism linking depression to exacerbation of COPD and consequent hospitalization is likely related to chronic psychological stress.…”

Rising total costs and mortality rates associated with admissions due to COPD exacerbations

“…The persistent increasing in-hospital mortality is surprising when considering the improvement in COPD overall management and regarding previous reports [21]. This is even more worrying since patients were in fact only slightly older (less than a year) and had no evidence of many coexisting diseases.…”