Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida.
Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida.
Clin Ther. 2018 Apr;40(4):613-626.e1. doi: 10.1016/j.clinthera.2018.03.006. Epub 2018 Mar 31.
Chronic obstructive pulmonary disease (COPD) is a leading and costly cause of readmissions to the hospital, with one of the highest rates reported in Florida. From 2009 to 2014, strategies such as readmission reduction programs, as well as updated guidelines for COPD management, were instituted to reduce readmission rates for patients with COPD. Thus, the question has been raised whether COPD-related 30-day hospital readmission rates in Florida have decreased and whether COPD-related readmission costs during this period have changed. In addition, we examined trends in length of stay, hospital charges, and in-hospital mortality associated with COPD, as well as identified patient-level risk factors associated with 30-day readmissions.
A retrospective analysis of adult patients (≥18 years of age) with COPD was conducted by using the Healthcare Cost and Utilization Project Florida State Inpatient Database, 2009 to 2014. Weighted least squares regression was used to assess trends in the COPD readmission rate on a yearly basis, as well as other outcomes of interest. A multivariable logistic regression was used to identify patient characteristics that were associated with 30-day COPD readmissions.
Overall, 268,084 adults were identified as having COPD. Between 2009 and 2014, more than half of patients aged 65-84 years, most were white, 55% were female, and 73% had Medicare. The unadjusted rate for COPD-related 30-day readmissions did not change (8.04% to 7.85%; P = 0.434). However, the mean total charge for 30-day COPD-related readmissions was significantly higher in 2014 ($40,611) compared with that in 2009 ($36,714) (P = 0.011). The overall unadjusted in-hospital mortality of COPD-related hospitalizations significantly decreased from 1.83% in 2009 to 1.34% in 2014 (P < 0.001). In a multivariable logistic regression model, patients with COPD were 2% less likely to be readmitted to the hospital for each additional year (odds ratio [OR], 0.98 [95% confidence interval (CI), 0.97-0.99]). Factors associated with significantly higher odds of COPD-related readmission were: older age (45 ≤ age ≤ 64 years; OR, 1.91 [95% CI, 1.70-2.14]), being male (OR, 1.14 [95% CI, 1.10-1.17]), and being a Medicaid beneficiary (OR, 1.28 [95% CI, 1.21-1.35]).
Although the adjusted odds of COPD readmissions slightly decreased, as did the length of stay and all-cause in-patient mortality, the financial burden increased substantially. Future strategies to further reduce readmissions of patients with COPD and curb financial burden in Florida are needed.
慢性阻塞性肺疾病（COPD）是导致患者再次住院的主要且昂贵的原因之一，佛罗里达州的报告发病率最高。从 2009 年到 2014 年，实施了减少再入院率的策略，如再入院减少计划，以及更新 COPD 管理指南，以降低 COPD 患者的再入院率。因此，有人提出了一个问题，即佛罗里达州与 COPD 相关的 30 天医院再入院率是否有所下降，以及在此期间 COPD 相关再入院费用是否有所变化。此外，我们还研究了与 COPD 相关的住院时间、医院费用和住院死亡率的趋势，并确定了与 30 天再入院相关的患者个体风险因素。
通过使用 2009 年至 2014 年佛罗里达州立医院住院患者医疗保健成本和利用项目（HCUP Florida State Inpatient Database），对成年（≥18 岁）COPD 患者进行了回顾性分析。使用加权最小二乘回归来评估 COPD 再入院率的年度趋势以及其他感兴趣的结果。使用多变量逻辑回归来确定与 30 天 COPD 再入院相关的患者特征。
总体而言，确定了 268084 名成年人患有 COPD。2009 年至 2014 年间，超过一半的 65-84 岁患者为白人，55%为女性，73%为医疗保险受益人。未调整的 COPD 相关 30 天再入院率没有变化（8.04%降至 7.85%；P=0.434）。然而，与 2009 年相比，2014 年 COPD 相关 30 天再入院的总费用明显更高（36714 美元增加至 40611 美元）（P=0.011）。与 COPD 相关的住院治疗的总体未调整住院死亡率从 2009 年的 1.83%显著下降至 2014 年的 1.34%（P<0.001）。在多变量逻辑回归模型中，COPD 患者每增加一年，再次住院的可能性就会降低 2%（优势比[OR]，0.98[95%置信区间（CI），0.97-0.99]）。与 COPD 相关的再入院几率显著增加的因素包括：年龄较大（45≤年龄≤64 岁；OR，1.91[95%CI，1.70-2.14]）、男性（OR，1.14[95%CI，1.10-1.17]）和医疗补助受益人（OR，1.28[95%CI，1.21-1.35]）。
尽管 COPD 再入院的调整后几率略有下降，住院时间和全因住院死亡率也有所下降，但财务负担却大幅增加。需要制定进一步减少佛罗里达州 COPD 患者再入院率和遏制财务负担的策略。
