Population-based Burden of COPD-related Visits in the Emergency Department (ED): Return ED Visits, Hospital Admissions, and Comorbidity Risks.
Chest. 2013 Apr 11;
Authors: Yeatts KB, Lippmann SJ, Waller AE, Lich KH, Travers D, Weinberger M, Donohue JF
Abstract
ABSTRACT BACKGROUND: Little is known about the population-based burden of Emergency Department (ED) care for chronic obstructive pulmonary disease (COPD). METHODS: We analyzed statewide ED surveillance system data to quantify the frequency of COPD-related ED visits, hospital admissions, and co-morbidities. RESULTS: In 2008-2009 in North Carolina, 97,511 COPD-related ED visits were made by adults ≥ 45 years, at an annual rate of 13.8 ED visits/1,000 person-years. Among COPD patients (n=33,799), 7% and 28% had a COPD-related return ED visit within a 30- and 365-day period of their index visit, respectively. Compared with patients on private insurance, Medicare, Medicaid, and non-insured patients were more likely to have a COPD-related return visit within 30- and 365-days , and have >=3 COPD-related visits within 365 days. There were no differences in return visits by sex. Fifty-one percent of COPD patients were admitted to the hospital from the index ED visit. Subsequent hospital admission risk in the cohort increased with age, peaking at 65-69 years (Risk Ratio (RR) 1.41, (95% Confidence Interval (CI) 1.26, 1.57); there was no difference by sex. Patients with congestive heart failure (RR 1.29, 95% CI 1.22, 1.37), substance-related disorders (RR 1.35, 95% CI 1.13, 1.60), or respiratory failure/supplemental oxygen (RR 1.25, 95%CI 1.19, 1.31) were more likely to have a subsequent hospital admission compared with patients without these comorbidities. CONCLUSIONS: The population-based burden of COPD-related care in the ED is significant. Further research is needed to understand variations in COPD-related ED visits and hospital admissions.
PMID: 23579283 [PubMed - as supplied by publisher]