Determinants of elevated healthcare utilization in patients with COPD

被引：45

作者：

Simon-Tuval, Tzahit ^{[1
]}

Scharf, Steven M. ^{[2
]}

Maimon, Nimrod ^{[3
]}

Bernhard-Scharf, Barbara J. ^{[4
]}

Reuveni, Haim ^{[3
]}

Tarasiuk, Ariel ^{[3
]}

机构：

[1] Ben Gurion Univ Negev, Guilford Glazer Fac Business & Management, Dept Hlth Syst Management, IL-84105 Beer Sheva, Israel

[2] Univ Maryland, Div Pulm & Crit Care, Baltimore, MD 21201 USA

[3] Ben Gurion Univ Negev, Fac Hlth Sci, IL-84105 Beer Sheva, Israel

[4] Mt Washington Pediat Hosp, Baltimore, MD USA

来源：

RESPIRATORY RESEARCH | 2011年 / 12卷

关键词：

OBSTRUCTIVE PULMONARY-DISEASE; EXACERBATIONS; OUTCOMES; ANXIETY; COSTS;

D O I：

10.1186/1465-9921-12-7

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

Background: Chronic obstructive pulmonary disease (COPD) imparts a substantial economic burden on western health systems. Our objective was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system. Methods: Three-hundred eighty-nine adults with COPD were matched 1: 3 to controls by age, gender and area of residency. Total healthcare cost 5 years prior recruitment and presence of comorbidities were obtained from a computerized database. Health related quality of life (HRQoL) indices were obtained using validated questionnaires among a subsample of 177 patients. Results: Healthcare utilization was 3.4-fold higher among COPD patients compared with controls (p < 0.001). The "most-costly" upper 25% of COPD patients (n = 98) consumed 63% of all costs. Multivariate analysis revealed that independent determinants of being in the "most costly" group were (OR; 95% CI): age-adjusted Charlson Comorbidity Index (1.09; 1.01 - 1.2), history of: myocardial infarct (2.87; 1.5 - 5.5), congestive heart failure (3.52; 1.9 - 6.4), mild liver disease (3.83; 1.3 - 11.2) and diabetes (2.02; 1.1 - 3.6). Bivariate analysis revealed that cost increased as HRQoL declined and severity of airflow obstruction increased but these were not independent determinants in a multivariate analysis. Conclusion: Comorbidity burden determines elevated utilization for COPD patients. Decision makers should prioritize scarce health care resources to a better care management of the "most costly" patients.

引用

页数：8

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