Disproportionate utilization of healthcare resources among veterans with COPD: a retrospective analysis of factors associated with COPD healthcare cost.
Disproportionate utilization of healthcare resources among veterans with COPD: a retrospective analysis of factors associated with COPD healthcare cost.
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DOI：
10.1186/1478-7547-11-13
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Panos RJ
中科院分区：
文献类型：
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作者：
Darnell K;Dwivedi AK;Weng Z;Panos RJ
慢性阻塞性肺病是退伍军人健康管理局（VHA）发病率和死亡率的重要原因。为了确定与COPD管理成本相关的临床因素，我们分析了辛辛那提VAMC的临床特征与COPD医疗成本之间的关系。我们查询了在辛辛那提VAMC诊断为COPD的患者的VHA决策支持系统，并计算了他们在2008财年的VHA COPD相关遭遇和费用。根据copd相关费用对患者进行排名。我们通过改进的系统抽样确定了所选患者的详细临床特征，并进行了单变量和多变量普通线性回归分析，以确定与成本相关的因素。3263名退伍军人有11,869次原发性或继发性COPD诊断：10,032次门诊就诊，505次急诊科就诊，1,332次住院，与COPD相关的总医疗费用为2140万美元：240万次门诊就诊，21万次急诊科就诊，1,870万美元住院和89万美元COPD相关处方费用。当患者按VHA医疗保健费用进行排名时，前20%的患者占总费用的86%，占COPD初级或二级诊断代码的57%，占总费用的90%，占COPD初级诊断代码的75%。分析了3263例COPD患者中840例的临床特征和VHA医疗成本，以确定与COPD相关成本增加相关的特征。单因素分析显示与24个临床变量有显著相关性；4个高度相关的因素是养老院居住、总住院次数、口服皮质类固醇的使用和补充氧气（所有因素p < 0.001）。在多变量分析中，总入院人数（p < 0.001）、肺病专家管理（p < 0.001）、门诊就诊次数（p < 0.001）、短效抗胆碱能药物的使用（p = 0.001）、1秒用力呼气量（FEV1） （p = 0.011）、处方数量（p = 0.011）、体重指数（p = 0.025）和吸入皮质类固醇的使用（p = 0.043）与COPD管理成本相关。入院总人数、诊所访问量、生理损伤、BMI、药物数量和提供者类型与COPD管理的总成本密切相关。这些因素可用于将COPD管理重点放在具有医疗资源高利用率潜力的患者身上。
COPD is a significant cause of morbidity and mortality in the Veterans Health Administration (VHA). To determine the clinical factors associated with the cost of COPD management, we analyzed the relationship between clinical characteristics and COPD healthcare costs at the Cincinnati VAMC. We queried the VHA Decision Support System for patients diagnosed with COPD at the Cincinnati VAMC and calculated their VHA COPD-related encounters and costs in FY2008. Patients were ranked by COPD-related cost. We determined the detailed clinical characteristics of patients selected by modified systematic sampling and performed univariate and multivariable ordinary linear regression analysis to determine factors associated with cost. 3263 Veterans 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 $21.4 M: $2.4 M clinic visits, $0.21 M ED visits, and $18.7 M hospitalizations and $0.89 M for COPD-related prescription costs. When the patients were ranked by VHA healthcare costs, the top 20% of patients accounted for 86% of the total costs and 57% of the total encounters with a primary or secondary diagnosis code of COPD and 90% of the total costs and 75% of the total encounters with a primary diagnosis code of COPD. The clinical characteristics and VHA healthcare costs of 840 of the 3263 unique individuals with COPD were analyzed to determine those characteristics associated with increased COPD-related 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 a 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. 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. These factors may be used to focus COPD management toward patients with the potential for high utilization of healthcare resources.