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

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 uti...

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Autores principales: Hasegawa, Kohei, Tsugawa, Yusuke, Tsai, Chu-Lin, Brown, David FM, Camargo, Carlos A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997196/
https://www.ncbi.nlm.nih.gov/pubmed/24717062
http://dx.doi.org/10.1186/1465-9921-15-40
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author Hasegawa, Kohei
Tsugawa, Yusuke
Tsai, Chu-Lin
Brown, David FM
Camargo, Carlos A
author_facet Hasegawa, Kohei
Tsugawa, Yusuke
Tsai, Chu-Lin
Brown, David FM
Camargo, Carlos A
author_sort Hasegawa, Kohei
collection PubMed
description 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.
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spelling pubmed-39971962014-04-24 Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease Hasegawa, Kohei Tsugawa, Yusuke Tsai, Chu-Lin Brown, David FM Camargo, Carlos A Respir Res Research 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. BioMed Central 2014 2014-04-10 /pmc/articles/PMC3997196/ /pubmed/24717062 http://dx.doi.org/10.1186/1465-9921-15-40 Text en Copyright © 2014 Hasegawa et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Hasegawa, Kohei
Tsugawa, Yusuke
Tsai, Chu-Lin
Brown, David FM
Camargo, Carlos A
Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease
title Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease
title_full Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease
title_fullStr Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease
title_full_unstemmed Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease
title_short Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease
title_sort frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997196/
https://www.ncbi.nlm.nih.gov/pubmed/24717062
http://dx.doi.org/10.1186/1465-9921-15-40
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