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Patterns of Healthcare Utilization by COPD Severity: A Pilot Study

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Abstract

Global Initiative on Chronic Obstructive Lung Disease (GOLD) guidelines recently removed stage 0, a group with symptoms but without airways obstruction, from their severity staging. However, in practice this group may still be diagnosed and medically managed. The aim of this study was to characterize healthcare utilization patterns of chronic obstructive pulmonary disease (COPD) patients by disease severity, focusing on the possible unique attributes of patients who would have been classified as GOLD stage 0. This is a prospective cohort pilot study performed at the Hines Veterans Administration Hospital. One hundred twenty patients with a diagnosis of COPD were enrolled. The participants completed quality-of-life questionnaires and a pulmonary function test. Healthcare utilization data were obtained 1 year prior and 2 years after the enrollment date. Three disease severity groups were defined based on GOLD criteria for comparison [GOLD stage 1–2 (GS 1–2), GOLD stage 3–4 (GS 3–4), and formerly GOLD stage 0 (“at risk”)]. The “at risk” group had an average of 14.4 (SD = 30.5) outpatient visits/year and 0.3 (SD = 0.8) hospitalizations/year, which were higher than the other groups, but this was not statistically significant. Respiratory medications were used by 6 (26%), 30 (59%), and 40 (91%) patients from “at risk” to GS 3–4, respectively. Patients in the “at risk” group had a decrement in health status, significant utilization of healthcare services, and were often receiving medications not consistent with guidelines.

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Acknowledgments

This study was partly funded by an unrestricted research grant from Boehringer-Ingelheim Pharmaceuticals. This material was also based upon work supported by the HSR&D Service, Center for Management of Complex Chronic Care COE, Hines VA Hospital. The funding agency had no role in the design, conduct, or interpretation of the study results. Kevin Weiss was the Director for the Management of Complex Chronic Care, Hines VA Hospital, Hines, IL, and the Institute for Healthcare Studies at Northwestern University Feinberg School of Medicine, Chicago, IL, when this work was performed. This work was performed while all authors were employees of the Hines Veterans Administration Hospital. As U.S. government employees, this article was made in that capacity, thus assignment applies only to the extent allowable by U.S. law.

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Authors and Affiliations

  1. Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Illinois at Chicago, 840 S. Wood St., M/C 719, Chicago, IL, 60612, USA

    Min J. Joo

  2. Center for the Management of Complex Chronic Care, Jesse Brown VA Hospital, Chicago, IL, USA

    Min J. Joo

  3. Center for the Management of Complex Chronic Care, Hines VA Hospital, Hines, IL, 60141, USA

    Min J. Joo, Todd A. Lee & Brian Bartle

  4. Institute for Healthcare Studies, Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA

    Todd A. Lee

  5. Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL, 60626, USA

    William B. van de Graaff

  6. Division of Pulmonary and Critical Care Medicine, Hines VA Hospital, Hines, IL, 60141, USA

    William B. van de Graaff

  7. American Board of Medical Specialties, Evanston, IL, 60201, USA

    Kevin B. Weiss

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  1. Min J. Joo
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  2. Todd A. Lee
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  3. Brian Bartle
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  4. William B. van de Graaff
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  5. Kevin B. Weiss
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Correspondence to Min J. Joo.

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Joo, M.J., Lee, T.A., Bartle, B. et al. Patterns of Healthcare Utilization by COPD Severity: A Pilot Study. Lung 186, 307–312 (2008). https://doi.org/10.1007/s00408-008-9095-5

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  • DOI: https://doi.org/10.1007/s00408-008-9095-5

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