Potentially avoidable hospitalizations for COPD and pneumonia - The role of physician and practice characteristics

Background: Hospitalizations for bacterial pneumonia and chronic obstructive pulmonary disease (COPD) occur frequently, but many are potentially avoidable. Objective: To examine associations between elderly patients' usual physician and practice characteristics, and the risk of hospitalization for bacterial pneumonia and COPD. Research Design: Time-to-event analysis of Medicare claims from 2000 (baseline year) through 2001-2002 (follow-up years) for beneficiaries whose usual physician participated in the 2000-2001 Community Tracking Study Physician Survey. Subjects: A total of 509,613 patients and 5764 physicians for pneumonia hospitalizations; subset of 91,318 beneficiaries with an antecedent diagnosis of COPD and 5074 physicians for COPD hospitalizations. Measures: Hospitalizations for bacterial pneumonia or COPD occurring in 2001-2002. Results: Beneficiaries whose usual physician had been in practice for > 10 years (vs. :! 10 years) were at lower risk for both pneumonia (AHR [adjusted hazard ratio] 0.88, 95% CL [confidence limits] 0.82-0.94, and COPD hospitalization (AHR 0.87, 95% CL 0.800.96). Risk of hospitalization for COPD was lower among beneficiaries whose usual physician reported that clinical practice guidelines had an important effect, compared with those reporting relatively little impact, on their clinical practice (AHR 0.88, 95% CL 0.80-0.96). Patients had higher risk of both types of hospitalizations if their physician's practice had >5% Medicaid revenue (vs. 0-5%, P < 0.0001), or reported more (vs. less) difficulty securing ancillary services (P < 0.01 for bacterial pneumonia and P = 0.05 for COPD). Patient socioeconomic status, previous respiratory hospitalizations, and comorbidities had the strongest associations with hospitalization. Conclusions: Given that physicians who report limited access to ancillary services and high Medicaid case volume have patients who experience higher rates of admission for COPD and pneumonia, additional resources and quality improvement interventions targeting these providers should be priorities.