Quality of care and its impact on clinical and economic outcome in patients hospitalized from chronic obstructive pulmonary disease (COPD).

摘要

Purpose: Overall objective of this study is to understand the geographical differences and associated factors of the adherence to guideline recommended care in patients post-discharged from COPD-related hospitalizations or ED visits as well as to compare the clinical and economic outcomes of who received guideline recommended care and who did not receive guideline recommended care. Methods: We used a retrospective population-based cohort study using enrollment and claims data for population insured by Blue Cross Blue Shield of Texas (BCBSTX) from the year 2008 to 2011. All hospital admissions and ED visits for COPD were extracted. Patients were identified as a recipient of guideline recommended care if, within 30 days of discharge, they had at least one claim of prescription fills for any maintenance medications and had at least one follow up visit with a primary care physician or pulmonologist. Clinical and economic outcomes include (1) the presence of a subsequent COPD-related exacerbation requiring hospitalization or an ED visit and (2) the annual total health care spending were assessed for one year post-discharge. Generalized linear mixed models were used to determine the patient-level, provider-level, and area-level factors that are associated with the receipt of guideline recommended care. Outcomes were compared between cohorts who receive and did not receive guideline recommended care using probit regression model with instrumental variable and a generalized linear mixed model. Results: Of the 2326 COPD-related hospitalizations/ED visits, 23.99% had at least one prescription filled for maintenance medication and at least one follow up visit with primary care physician or pulmonologist within 30 days of discharge. Patients who were discharged from ED, had admission/ED visit 30 days prior to an index stay, and older are more likely to receive guideline recommended care. While patients who have more comorbidity and live in a low SES area are less likely to receive guideline recommended care. None of the area-level and provider-level characteristics are significant predictors of the receipt of guideline recommended care. Receiving guideline recommended care within 30 days of discharge date was associated with a reduction of 4.4 percentage points in the probability of having subsequent COPD exacerbation requiring hospital admission/ED visits. However, this association was not statistically significant (p-value = 0.837). Total costs in patients who received guideline recommended care were significantly higher (