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Early and Long-term Outcomes of Older Adults after Acute Care Encounters for Chronic Obstructive Pulmonary Disease Exacerbation.

Publication ,  Journal Article
Genao, L; Durheim, MT; Mi, X; Todd, JL; Whitson, HE; Curtis, LH
Published in: Ann Am Thorac Soc
December 2015

RATIONALE: Older patients are at high risk of death and rehospitalization after hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AE-COPD). Emergency department visits comprise a substantial portion of acute care encounters in this patient population. The risks of mortality and repeat acute care encounters, including both hospital readmission and repeat emergency department visits, after AE-COPD among older adults are not well understood. OBJECTIVES: To examine early and long-term rates of death and repeat acute care encounters after hospitalization or emergency department visit for AE-COPD in Medicare fee-for-service beneficiaries and to identify patient characteristics, including medical comorbid conditions, associated with these outcomes. METHODS: A retrospective analysis was conducted using a nationally representative 5% sample of Medicare fee-for-service claims data from the U.S. Centers for Medicare and Medicaid Services to identify Medicare beneficiaries 65 years or older who had an acute care episode for an AE-COPD between January 1, 2006, and December 31, 2010 (n = 52,741). Outcomes of interest were all-cause mortality, repeat acute care encounters for any cause, and repeat acute care encounters for AE-COPD at 30 days, 1 year, and 3 years. MEASUREMENTS AND MAIN RESULTS: Acute care encounters, including hospitalizations and emergency department visits for AE-COPD, were associated with substantial subsequent mortality risk, with 4.6, 24.4, and 48.2% dying by 30 days, 1 year, and 3 years, respectively. The risk of repeat hospitalization or emergency department visit was similarly high, with 1 in 4 patients having a repeat acute care encounter within 30 days of discharge, increasing to 9 in 10 in the next 3 years. Several comorbid conditions and other patient factors, including heart failure, malnutrition, dual eligibility for Medicare and Medicaid, and prior supplemental oxygen use, were independently associated with increased risk of repeat acute care encounter. CONCLUSIONS: Repeat hospitalizations and emergency department visits and death are common in older fee-for-service Medicare beneficiaries seen in acute care for AE-COPD. Our results suggest that addressing important comorbid conditions, such as heart failure or malnutrition, and targeting resources to oxygen-dependent or dual Medicare- and Medicaid-eligible patients may help modify these outcomes.

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Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

December 2015

Volume

12

Issue

12

Start / End Page

1805 / 1812

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Survival Rate
  • Retrospective Studies
  • Pulmonary Disease, Chronic Obstructive
  • Prognosis
  • Oxygen Inhalation Therapy
  • Medicare
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Genao, L., Durheim, M. T., Mi, X., Todd, J. L., Whitson, H. E., & Curtis, L. H. (2015). Early and Long-term Outcomes of Older Adults after Acute Care Encounters for Chronic Obstructive Pulmonary Disease Exacerbation. Ann Am Thorac Soc, 12(12), 1805–1812. https://doi.org/10.1513/AnnalsATS.201504-250OC
Genao, Liza, Michael T. Durheim, Xiaojuan Mi, Jamie L. Todd, Heather E. Whitson, and Lesley H. Curtis. “Early and Long-term Outcomes of Older Adults after Acute Care Encounters for Chronic Obstructive Pulmonary Disease Exacerbation.Ann Am Thorac Soc 12, no. 12 (December 2015): 1805–12. https://doi.org/10.1513/AnnalsATS.201504-250OC.
Genao L, Durheim MT, Mi X, Todd JL, Whitson HE, Curtis LH. Early and Long-term Outcomes of Older Adults after Acute Care Encounters for Chronic Obstructive Pulmonary Disease Exacerbation. Ann Am Thorac Soc. 2015 Dec;12(12):1805–12.
Genao, Liza, et al. “Early and Long-term Outcomes of Older Adults after Acute Care Encounters for Chronic Obstructive Pulmonary Disease Exacerbation.Ann Am Thorac Soc, vol. 12, no. 12, Dec. 2015, pp. 1805–12. Pubmed, doi:10.1513/AnnalsATS.201504-250OC.
Genao L, Durheim MT, Mi X, Todd JL, Whitson HE, Curtis LH. Early and Long-term Outcomes of Older Adults after Acute Care Encounters for Chronic Obstructive Pulmonary Disease Exacerbation. Ann Am Thorac Soc. 2015 Dec;12(12):1805–1812.

Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

December 2015

Volume

12

Issue

12

Start / End Page

1805 / 1812

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Survival Rate
  • Retrospective Studies
  • Pulmonary Disease, Chronic Obstructive
  • Prognosis
  • Oxygen Inhalation Therapy
  • Medicare
  • Male
  • Humans