Disproportionate utilization of healthcare resources among veterans with COPD: a retrospective analysis of factors associated with COPD healthcare cost

Abstract

BackgroundCOPD is a significant cause of morbidity and mortality in the Veterans Health Administration (VHA). To determine the clinical factors associated with the cost of COPD management, we analyzed the relationship between clinical characteristics and COPD healthcare costs at the Cincinnati VAMC.MethodsWe queried the VHA Decision Support System for patients diagnosed with COPD at the Cincinnati VAMC and calculated their VHA COPD-related encounters and costs in FY2008. Patients were ranked by COPD-related cost. We determined the detailed clinical characteristics of patients selected by modified systematic sampling and performed univariate and multivariable ordinary linear regression analysis to determine factors associated with cost.Results3263 Veterans had 11,869 encounters with a primary or secondary diagnosis of COPD: 10,032 clinic visits, 505 emergency department (ED) visits, and 1,332 hospitalizations and incurred a total COPD-related healthcare cost of $21.4 M: $2.4 M clinic visits, $0.21 M ED visits, and $18.7 M hospitalizations and $0.89 M for COPD-related prescription costs. When the patients were ranked by VHA healthcare costs, the top 20% of patients accounted for 86% of the total costs and 57% of the total encounters with a primary or secondary diagnosis code of COPD and 90% of the total costs and 75% of the total encounters with a primary diagnosis code of COPD. The clinical characteristics and VHA healthcare costs of 840 of the 3263 unique individuals with COPD were analyzed to determine those characteristics associated with increased COPD-related costs. Univariate analysis showed significant associations with 24 clinical variables; the 4 most highly associated factors were nursing home residence, total hospital admissions, use of oral corticosteroids, and supplemental oxygen (p < 0.001 for all). In multivariate analysis, total number of admissions (p < 0.001), management by a pulmonologist (p < 0.001), number of clinic visits (p < 0.001), use of short acting anticholinergic (p = 0.001), forced expiratory volume in 1 second (FEV1) (p = 0.011), number of prescriptions (p = 0.011), body mass index (BMI) (p = 0.025), and use of inhaled corticosteroid (p = 0.043) were associated with COPD management cost.ConclusionThe total number of admissions, clinic visits, physiologic impairment, BMI, number of medications, and type of provider are strongly associated with the total cost of COPD management. These factors may be used to focus COPD management toward patients with the potential for high utilization of healthcare resources.

Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study

“…HCC categories were grouped into 5 major chronic disease groups for risk adjustment: Cerebral (HCC 097–099), Heart (HCC 083–084), Vascular (HCC 104–105), Cancer (HCC 007–010), Diabetes (HCC 015–020) and Arrhythmias (HCC 092–093). These conditions are common among veterans and are associated with higher costs of care [18–21]. A patient might be found in multiple conditions, if more than one was documented.…”

Patient Heterogeneity in Health Economic Decision Models for Chronic Obstructive Pulmonary Disease: Are Current Models Suitable to Evaluate Personalized Medicine?

“…Three models specified COPD-related costs by age. Several studies investigated the association between age and COPD-related costs and found no significant impact of age on costs [43][44][45][46]. This may be because age and FEV1% predicted are correlated and in three of these studies FEV1% was also included in the multivariate model and found to be a significant predictor.…”

Therapeutic paralysis in Veterans with COPD

“…These Veterans have worse lung function but similar frequencies of co-morbidities. 4 This group of Veterans practices greater self-management and is more likely to treat episodes of breathlessness by increased utilization of inhalers, nebulizers, steroids/antibiotics, and more frequent visits to the urgent care clinic or the ED.…”

“…We have shown previously that the stratification of these patients by healthcare costs correlates with the severity of disease measured by spirometry and comorbidities. 4 This research protocol was approved by the Cincinnati VAMC Research and Development Committee and the University of Cincinnati Institutional Review Board.…”

“…3 In 2008, over 3200 Veterans received care for COPD at the Cincinnati VAMC, the top 20% of whom (ranked by COPD-related healthcare cost) accounted for all hospitalizations and Emergency Department (ED) visits, 90% of the expenditures, 60–70% of all encounters, and nearly 10% of the total operating budget for the hospital. 4 …”