Obstructive Lung Diseases |

Factors Associated With Healthcare Cost in Patients With Chronic Obstructive Pulmonary Disease (COPD) at the Cincinnati Veterans Administration Medical Center FREE TO VIEW

Kyle Darnell*, MD; Alok Dwivedi, PhD; Zhouyang Weng, MA; Ralph Panos, MD
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Cincinnati Veteran Administration Medical Center, Cincinnati, OH

Chest. 2012;142(4_MeetingAbstracts):719A. doi:10.1378/chest.1390108
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PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: COPD affects over 1/3 of Veterans and is a significant cause of morbidity and mortality. To determine the clinical factors associated with the cost of COPD management, we analyzed the relationship between clinical characteristics and healthcare costs due to COPD in Veterans at the Cincinnati VAMC.

METHODS: We queried the Veterans Healthcare Administration (VHA) Decision Support System for patients with a diagnosis of COPD and calculated their individual VHA COPD-related encounters and costs in FY2008. Patients were ranked by COPD-related cost. We selected 840 patients by modified systematic sampling and reviewed their charts to extract factors related to COPD. Univariate and multivariable ordinary linear regression analysis were performed to determine clinical factors associated with cost.

RESULTS: 3263 unique individuals were diagnosed with and received care for COPD at the Cincinnati VAMC in FY 2008. These individuals had 11,869 encounters with a primary or secondary diagnosis of COPD: 10,032 clinic visits, 505 emergency department (ED) visits, and 1,332 hospitalizations and incurred a total COPD-related healthcare cost of $21.4M: $2.4M clinic visits, $0.21M ED visits, and $18.7M hospitalizations and $0.89M for COPD-related prescription costs. Univariate analysis showed significant associations with 24 clinical variables; the 4 most highly associated factors were nursing home residence, total hospital admissions, use of oral corticosteroids, and supplemental oxygen (p<0.001 for all). In multivariate analysis, total number of admissions (p<0.001), management by pulmonologist (p<0.001), number of clinic visits (p<0.001), use of short acting anticholinergic (p=0.001), forced expiratory volume in 1 second (FEV1) (p=0.011), number of prescriptions (p=0.011), body mass index (BMI) (p=0.025), and use of inhaled corticosteroid (p=0.043) were associated with COPD management cost.

CONCLUSIONS: The total number of admissions, clinic visits, physiologic impairment, BMI, number of medications, and type of provider are strongly associated with the total cost of COPD management.

CLINICAL IMPLICATIONS: These factors may be used to focus COPD management toward patients with the potential for high utilization of healthcare resources.

DISCLOSURE: The following authors have nothing to disclose: Kyle Darnell, Alok Dwivedi, Zhouyang Weng, Ralph Panos

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Cincinnati Veteran Administration Medical Center, Cincinnati, OH




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