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

Respiratory Research

Carlos A Camargo²  David FM Brown²  Chu-Lin Tsai²  Yusuke Tsugawa¹  Kohei Hasegawa² 

[1] Harvard Interfaculty Initiative in Health Policy, Cambridge, MA, USA;Harvard Medical School, Boston, MA, USA

关键词: Healthcare utilization;    Cost;    Mechanical ventilation;    Hospitalization;    Emergency service;    Epidemiology;    Recurrence;    Exacerbation;    Chronic obstructive pulmonary disease;   

Others  :  790346
DOI  :  10.1186/1465-9921-15-40

 received in 2013-10-19, accepted in 2014-04-03,  发布年份 2014

【 摘 要 】

Background

Little 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.

Methods

We 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.

Results

The 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).

Conclusions

In 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.

【 授权许可】

   
2014 Hasegawa et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH: Chronic obstructive pulmonary disease surveillance-United States, 1999–2011. Chest 2013, 144:284-305.
• [2]Kanner RE, Anthonisen NR, Connett JE, Group LHSR: Lower respiratory illnesses promote FEV(1) decline in current smokers but not ex-smokers with mild chronic obstructive pulmonary disease: results from the lung health study. Am J Respir Crit Care Med 2001, 164:358-364.
• [3]Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA: Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002, 57:847-852.
• [4]Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA: Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998, 157:1418-1422.
• [5]The Global Initiative for Chronic Obstructive Lung Disease (GOLD). NHLBI/WHO Gobal Strategy for the Diagnosis, Management and Prevention of COPD [http://www.goldcopd.org/ webcite]
• [6]Strassels SA, Smith DH, Sullivan SD, Mahajan PS: The costs of treating COPD in the United States. Chest 2001, 119:344-352.
• [7]Healthy people 2020 [http://www.healthypeople.gov/2020/default.aspx webcite]
• [8]Hurst JR, Vestbo J, Anzueto A, Locantore N, Mullerova H, Tal-Singer R, Miller B, Lomas DA, Agusti A, Macnee W, Calverley P, Rennard S, Wouters EF, Wedzicha JA: Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 2010, 363:1128-1138.
• [9]Kim V, Han MK, Vance GB, Make BJ, Newell JD, Hokanson JE, Hersh CP, Stinson D, Silverman EK, Criner GJ, Investigators CO: The chronic bronchitic phenotype of COPD: an analysis of the COPDGene Study. Chest 2011, 140:626-633.
• [10]Yeatts KB, Lippmann SJ, Waller AE, Lich KH, Travers D, Weinberger M, Donohue JF: Population-based Burden of COPD-related Visits in the Emergency Department (ED): Return ED Visits, Hospital Admissions, and Comorbidity Risks. Chest 2013, 144:784-793.
• [11]Tsai CL, Griswold SK, Clark S, Camargo CA Jr: Factors associated with frequency of emergency department visits for chronic obstructive pulmonary disease exacerbation. J Gen Intern Med 2007, 22:799-804.
• [12]Overview of the State Emergency Department Databases (SEDD). Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality [http://www.hcup-us.ahrq.gov/seddoverview.jsp webcite]
• [13]Overview of the State Inpatient Databases (SID). Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality [http://www.hcup-us.ahrq.gov/sidoverview.jsp webcite]
• [14]National Center for Health Statistics: Centers for Disease Control and Prevention. [http://www.cdc.gov/nchs/ webcite]
• [15]Healthcare Cost and Utilization Project Comorbidity Software [http://www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp webcite]
• [16]Elixhauser A, Steiner C, Harris DR, Coffey RM: Comorbidity measures for use with administrative data. Med Care 1998, 36:8-27.
• [17]Hasegawa K, Brown DF, Tsugawa Y, Camargo CA Jr: Epidemiology of emergency department visits for opioid overdose: a population-based study. Mayo Clin Proc 2014, 89(4):462-471.
• [18]Consumer price index. United States Department of Labor, Bureau of Labor Statistics [http://www.bls.gov/cpi/home.htm webcite]
• [19]McCullagh P, Nelder JA: Generalized Linear Models (Monographs on statistics and applied probability 37). London: Chapman Hall; 1989.
• [20]Glynn RJ, Buring JE: Ways of measuring rates of recurrent events. BMJ 1996, 312:364-367.
• [21]Tsai CL: Appropriate statistical treatment of frequent emergency department visits in health services research. Ann Emerg Med 2007, 49:385.
• [22]The Agency for Healthcare Research and Quality: Readmissions for chronic obstructive pulmonary disease. 2008. [http://www.hcup-us.ahrq.gov/reports/statbriefs/sb121.jsp webcite]
• [23]Sharma G, Kuo YF, Freeman JL, Zhang DD, Goodwin JS: Outpatient follow-up visit and 30-day emergency department visit and readmission in patients hospitalized for chronic obstructive pulmonary disease. Arch Intern Med 2010, 170:1664-1670.
• [24]Kim S, Emerman CL, Cydulka RK, Rowe BH, Clark S, Camargo CA, Investigators M: Prospective multicenter study of relapse following emergency department treatment of COPD exacerbation. Chest 2004, 125:473-481.
• [25]Baillargeon J, Wang Y, Kuo YF, Holmes HM, Sharma G: Temporal trends in hospitalization rates for older adults with chronic obstructive pulmonary disease. Am J Med 2013, 126:607-614.
• [26]Rabe KF, Wedzicha JA: Controversies in treatment of chronic obstructive pulmonary disease. Lancet 2011, 378:1038-1047.
• [27]Chiu S, Kelton C, Guo J, Wigle P, Lin A, Szeinbach S: Utilization, spending, and price trends for long-acting beta agonists and inhaled corticosteroids in the US Medicaid program from 1991 to 2010. Am Health Drug Benefits 2011, 4:140-149.
• [28]Setse RW, Euler GL, Gonzalez-Feliciano AG, Bryan LN, Furlow C, Weinbaum CM, Singleton JA: Influenza Vaccination Coverage—United States, 2000–2010. MMWR Surveill Summ 2011, 60:38-41.
• [29]Centers for Disease Control and Prevention: Trends in Current Cigarette Smoking Among high Hschool Students and Adults, United States, 1965--2010. Atlanta, GA: US Department of Health and Human Services; 2011; 2011.
• [30]Chavez PC, Shokar NK: Diagnosis and management of chronic obstructive pulmonary disease (COPD) in a primary care clinic. COPD 2009, 6:446-451.
• [31]Donaldson GC, Wedzicha JA: COPD exacerbations .1: epidemiology. Thorax 2006, 61:164-168.
• [32]Canino G, McQuaid EL, Rand CS: Addressing asthma health disparities: a multilevel challenge. J Allergy Clin Immunol 2009, 123:1209-1217. quiz 1218–1209
• [33]Lange P, Marott JL, Vestbo J, Ingebrigtsen TS, Nordestgaard BG: Socioeconomic Status and Prognosis of COPD in Denmark. COPD 2014. [Epub ahead of print]
• [34]Prevention quality indicators overview [http://www.qualityindicators.ahrq.gov/modules/pqi_overview.aspx webcite]
• [35]Han MK, Agusti A, Calverley PM, Celli BR, Criner G, Curtis JL, Fabbri LM, Goldin JG, Jones PW, Macnee W, Make BJ, Rabe KF, Rennard SI, Sciurba FC, Silverman EK, Vestbo J, Washko GR, Wouters EF, Martinez FJ: Chronic obstructive pulmonary disease phenotypes: the future of COPD. Am J Respir Crit Care Med 2010, 182:598-604.
• [36]Population estimates [http://www.census.gov/popest/ webcite]
• [37]Basu J, Mobley LR: Do HMOs reduce preventable hospitalizations for Medicare beneficiaries? Med Care Res Rev 2007, 64:544-567.
• [38]Hasegawa K, Tsugawa Y, Brown DF, Mansbach JM, Camargo CA Jr: Temporal trends in emergency department visits for bronchiolitis in the United States, 2006–2010. Pediatr Infect Dis J 2014, 33:11-18.
• [39]Effing T, Monninkhof EM, van der Valk PD, van der Palen J, van Herwaarden CL, Partidge MR, Walters EH, Zielhuis GA: Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2007, (4):CD002990.
• [40]O’Malley AS, Pham HH, Schrag D, Wu B, Bach PB: Potentially avoidable hospitalizations for COPD and pneumonia: the role of physician and practice characteristics. Med Care 2007, 45:562-570.