PURPOSE: The Global Initiative on Obstructive Lung Disease (GOLD) designates 5 stages of COPD severity (Stage 0 to Stage IV). Little is known about the health status and healthcare utilization patterns based on this staging, especially in the Veterans Administration (VA) system. The objective of this study was to evaluate the association between COPD stage and health status and healthcare utilization.
METHODS: Patients with a diagnosis of COPD were identified. 120 patients were enrolled from 4/2003 to 9/2004. The participants completed a single visit including questionnaires ( SF36, EuroQol (EQ-5D), St. George’s Respiratory Questionnaire (SGRQ)), and spirometry. Healthcare utilization data was obtained 1 year prior and 2 years after the enrollment date. Three disease severity groups were defined based on GOLD criteria for comparison [Group 0= Stage 0,Group 1=Stage I and II, Group 2=Stage III and IV].
RESULTS: There were 23 Group 0, 49 Group 1, and 44 Group 2 participants. Overall 94% were white, 98% were male and the average age was 71.5(SD=10.4) years. The SGRQ total scores were 29.1(SD=16.8), 36.0(SD=18.3), and 52.9(SD=17.3) in Groups 0 to 2, respectively. All differences between groups had a p<0.01 except between Group 0 and Group 1. The SGRQ symptom domain was the least responsive to differences between groups. Overall healthcare utilization trended in the opposite direction as expected with the average number of outpatient visits being the highest in Group 0 (43.3 visits/3 years). The mean number of COPD-related outpatient visits was: Group 1=1.8, Group 2=4.8, and Group 3=7.9 visits/3 years. Respiratory medications were used by 6(26%), 30 (61%), and 40 (91%) patients from Groups 0 to 2, respectively.
CONCLUSION: The SGRQ consistently delineated between GOLD stages II and III only. About a fourth of the GOLD stage 0 group received medications not consistent with guidelines and had the most all-cause outpatient utilization which may be a proxy for comorbidities.
CLINICAL IMPLICATIONS: Better understanding of this GOLD stage 0 group may lead to improved diagnosis and optimize healthcare costs associated with COPD.
DISCLOSURE: Min Joo, None.