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dc.contributor.authorHasegawa, Koheien_US
dc.contributor.authorTsugawa, Yusukeen_US
dc.contributor.authorTsai, Chu-Linen_US
dc.contributor.authorBrown, David FMen_US
dc.contributor.authorCamargo, Carlos Aen_US
dc.date.accessioned2014-05-06T16:16:16Z
dc.date.issued2014en_US
dc.identifier.citationHasegawa, Kohei, Yusuke Tsugawa, Chu-Lin Tsai, David FM Brown, and Carlos A Camargo. 2014. “Frequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary disease.” Respiratory Research 15 (1): 40. doi:10.1186/1465-9921-15-40. http://dx.doi.org/10.1186/1465-9921-15-40.en
dc.identifier.issn1465-9921en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:12152849
dc.description.abstractBackground: Little is known about patients who frequently visit the emergency department (ED) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We aimed to quantify the proportion and characteristics of patients with frequent ED visits for AECOPD and associated healthcare utilization. Methods: We conducted a retrospective cohort study of adults aged ≥40 years with at least one ED visit for AECOPD between 2010 and 2011, derived from population-based all-payer data of State ED and Inpatient Databases for two large and diverse states: California and Florida. Outcome measures were frequency of ED visits for AECOPD, 30-day ED revisits, subsequent hospitalizations, near-fatal events (AECOPD involving mechanical ventilation), and charges for both ED and inpatient services (available only for Florida) during the year after the first ED visit. Results: The analytic cohort comprised 98,280 unique patients with 154,736 ED visits for AECOPD. During the 1-year period, 29.4% (95% CI, 29.1%-29.7%) of the patients had two or more (frequent) visits, accounting for 55.2% (95% CI, 54.9%-55.4%) of all ED visits for AECOPD. In the multivariable model, significant predictors of frequent ED visits were age 55–74 years (vs. 40–54 years), male sex, non-Hispanic white or black race, Medicaid insurance (vs. private), and lower median household income (all P < 0.001). At the visit-level, 12.3% of ED visits for AECOPD were 30-day revisit events (95% CI, 12.1%-12.4%). Additionally, 62.8% of ED visits for AECOPD (95% CI, 62.6%-63.0%) resulted in a hospitalization; patients with frequent ED visits comprised 55.5% (95% CI, 55.2%-55.8%) of all hospitalizations. Furthermore, 7.3% (95% CI, 7.3%-7.5%) of ED visits for AECOPD led to a near-fatal event; patients with frequent ED visits accounted for 64.4% (95% CI, 63.5%-65.3%) of all near-fatal events. Total charges for AECOPD were $1.94 billion (95% CI, $1.90-1.97 billion) in Florida; patients with frequent ED visits accounted for $1.07 billion (95% CI, $1.04-1.09 billion). Conclusions: In this large cohort study, we found that 29% had frequent ED visits for AECOPD and that lower socioeconomic status was significantly associated with a higher frequency of ED visits. Individuals with frequent ED visits for AECOPD accounted for a substantial amount of healthcare utilization and financial burden.en
dc.language.isoen_USen
dc.publisherBioMed Centralen
dc.relation.isversionofdoi:10.1186/1465-9921-15-40en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997196/pdf/en
dash.licenseLAAen_US
dc.subjectChronic obstructive pulmonary diseaseen
dc.subjectExacerbationen
dc.subjectRecurrenceen
dc.subjectEpidemiologyen
dc.subjectEmergency serviceen
dc.subjectHospitalizationen
dc.subjectMechanical ventilationen
dc.subjectCosten
dc.subjectHealthcare utilizationen
dc.titleFrequent utilization of the emergency department for acute exacerbation of chronic obstructive pulmonary diseaseen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalRespiratory Researchen
dash.depositing.authorHasegawa, Koheien_US
dc.date.available2014-05-06T16:16:16Z
dc.identifier.doi10.1186/1465-9921-15-40*
dash.contributor.affiliatedHasegawa, Kohei
dash.contributor.affiliatedCamargo, Carlos


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