Trajectories of care in patients with chronic obstructive pulmonary disease: A sequence analysis

RATIONALE: Patients with chronic obstructive pulmonary disease (COPD) navigate the healthcare system in different ways. However, those trajectories of care (TOCs) are not well described and their impact on mortality is unknown. OBJECTIVES: Our objectives were to identify and characterize COPD patients' TOCs and to evaluate the association between TOCs and mortality. METHODS: We conducted a retrospective cohort study with 3,352 COPD patients living in Quebec, who answered the Canadian Community Health Survey between 2007 and 2013. Three administrative databases were linked to the survey data to measure TOCs over 2 years, using sequence analysis. Patients' characteristics were compared between TOCs with chi-square and V tests. We evaluated the association between TOCs and death up to 5 years, using a Cox model. MAIN RESULTS: Six TOCs were identified: 1) low use of healthcare services (44.7%); 2) medium use of services (27.7%); 3) high use mainly with general practitioners (GPs) for respiratory causes (4.4%); 4) high use mainly with GPs for other causes than respiratory (6.5%); 5) high use mainly with specialists for other causes than respiratory (6.3%); and 6) high use mainly in acute care (10.4%). Patients' characteristics that best-described trajectories' membership were age, smoking status, marital status, level of education, comorbidities and, patients' perceived health. Patients belonging to trajectories 2, 4 and 6 were significantly more at risk of death than patients belonging to the first TOC. CONCLUSIONS: This knowledge can be used by clinicians to identify the most vulnerable patients, anticipate their needs and plan resource allocation accordingly.