High Prevalence of Chronic Obstructive Pulmonary Disease Among Veterans in the Urban Midwest

Murphy, Daniel; Chaudhry, Zeshan A.; Almoosa, Khalid F.; Panos, Ralph J.

doi:10.7205/milmed-d-10-00377

Cited by 31 publications

(18 citation statements)

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“…This estimated prevalence of diagnosed COPD compares well with the 8.2% prevalence rate among Veterans in the southeastern US (Veterans Integrated Service Network 16) calculated by Sharafkhaneh and colleagues [26] and the 9.40% prevalence of diagnosed COPD within the VHA nationally in 1999 estimated by Yu and coworkers [27]. Previously, we demonstrated that the prevalence of measured airflow limitation was significantly greater than the prevalence of diagnosed COPD and that two thirds of Veterans with airflow limitation did not have a diagnosis of COPD [1]. Assuming that only one third of patients with COPD are diagnosed, the prevalence of diagnosed Veterans with COPD, 9.3%, is comparable to our previously measured 43% prevalence of airflow limitation using a threshold of FEV 1 /FVC < 0.7.…”

Section: Discussionmentioning

confidence: 97%

“…At the Cincinnati Veteran’s Administration Medical Center (VAMC), the prevalence of airflow limitation is estimated to be 33-43% and COPD is significantly under-diagnosed and misdiagnosed [1]. In a 1996–2001 utilization review, 19% of men and 17% of women who received care from the Veterans Healthcare Administration (VHA) were diagnosed with COPD and COPD was the fourth most common discharge diagnosis at VHA hospitals [2].…”

Section: Introductionmentioning

confidence: 99%

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

Darnell

Dwivedi

Weng

et al. 2013

Cost Eff Resour Alloc

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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.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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

Darnell

Dwivedi

Weng

et al. 2013

Cost Eff Resour Alloc

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“…The prevalence of AFL at the Cincinnati VAMC is much higher than the general population and approximately two thirds of affected patients are not diagnosed with COPD. The prevalence of AFL at the Cincinnati VAMC is much higher than the general population and approximately two thirds of those affected patients are not diagnosed with COPD 10. All of our patients with AFL by LLN also met FR criteria and nine (20%) patients had COPD by FR alone.…”

Section: Discussionmentioning

confidence: 70%

“…Patients were recruited in random, chronological order and spirometry was performed according to the 1994 American Thoracic Society guidelines 21. Each participant completed a questionnaire about smoking habits, occupational exposures, respiratory diagnoses, and symptoms 10. AFL was defined by either fixed ratio (FR), the ratio of FEV 1 to the forced vital capacity (FVC), <0.70 or lower limit of normal (LLN), FEV 1 /FVC < LLN as determined by NHANES III 22.…”

Section: Methodsmentioning

confidence: 99%

Diagnosis of COPD and clinical course in patients with unrecognized airflow limitation

Murphy¹,

Panos²

2013

COPD

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Chronic obstructive pulmonary disease (COPD) is frequently under-recognized and underdiagnosed. To determine the natural history of recognized and unrecognized COPD, we studied the rate of diagnosis, health care utilization, and mortality in patients with airflow limitation (AFL). Three hundred forty-seven outpatients at the Cincinnati Veterans Administration Medical Center performed spirometry and completed a respiratory questionnaire. Patients were followed for a minimum of 30 months and medical records were reviewed for COPD diagnosis, mortality, respiratory-related health care utilization, comorbidities, and respiratory medications. Three hundred twenty-five of 347 (94%) patients performed technically adequate spirometry and completed questionnaires. When AFL was defined by fixed ratio (FR, forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] < 0.7), patients with AFL and a diagnosis of COPD had a higher annual mortality rate (7.1% ± 2% versus 2.4% ± 0.8%, P = 0.01), more hospitalizations per year (0.2 ± 0.06 versus 0.04 ± 0.01, P < 0.001 mean ± standard error of the mean), increased respiratory symptoms (12.0 ± 0.9 versus 7.2 ± 0.6, P < 0.0001), and higher Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage compared with undiagnosed patients. Ninety-two of 137 patients with AFL (67%) had unrecognized AFL; 16 (17%) of the 92 were subsequently diagnosed. When AFL was defined by the lower limit of normal (LLN, FEV1/FVC < LLN), 67 of 103 patients (65%) had unrecognized AFL; 12 (18%) of the 67 were subsequently diagnosed. Patients with AFL defined by FR who were subsequently diagnosed had more emergency department visits per year (0.33 ± 0.11 versus 0.11 ± 0.05, P = 0.009), increased respiratory symptoms (10.2 ± 1.6 versus 6.5 ± 0.7, P < 0.05), and higher GOLD stage, but similar mortality and hospitalizations compared with the persistently undiagnosed patients. The annual rate of documented COPD diagnosis was 7% for both FR and LLN definitions. Patients with AFL and a diagnosis of COPD have more severe disease, higher health care utilization, and mortality than undiagnosed patients. The annual rate of COPD diagnosis is 7% among individuals with unrecognized AFL. Worse AFL, increased respiratory symptoms, and ED visits are associated with a subsequent COPD diagnosis in individuals with unrecognized AFL.

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“…2 At the Cincinnati Veterans Affairs Medical Center (VAMC), between 33–43% of patients have airflow limitation and COPD is significantly misdiagnosed and under-diagnosed. 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 …”

Section: Introductionmentioning

confidence: 99%

Therapeutic paralysis in Veterans with COPD

Mulhall

Lach

Krzywkowski-Mohn

et al. 2013

Respiratory Medicine

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Summary Background Chronic Obstructive Pulmonary Disease (COPD) is a common disorder of Veterans that causes significant morbidity and mortality. To measure Veterans’ perceptions about COPD, the effect of COPD on their lives and health, and their needs for improved health, we performed a postal survey. Methods 3263 Veterans with a diagnosis of COPD who received care at the Cincinnati Veterans Affairs Medical Center in 2008 were stratified into quintiles by Veterans Health Administration - associated COPD healthcare cost and uniformly sampled. Results 493 of 1000 surveys (49%) were completed and returned. COPD had different effects on respondents in top and bottom quintiles (highest and lowest COPD-related cost) for: knowledge of COPD diagnosis (89% vs 73%, p=0.03); activities affected by breathing, including work (69% vs 45%), recreation (85% vs 62%), change in living arrangements (36% vs 16%), and increased need for help (54% vs 25%) (p<0.05 for all comparisons); emotional effect of respiratory symptoms, including depression (53% vs 30%), fear (41% vs 15%), and helplessness (49% vs 24%) (p<0.05 for all comparisons). 91% of Veterans were prescribed inhalers and one quarter had difficulties using them. 25% of Veterans did nothing when they had symptoms of an exacerbation. Conclusions COPD has profound effects on Veterans’ breathing related activities and generates many negative emotions. Primary care providers are critical in conveying the diagnosis of COPD and providing information about the disease and its management. Veterans with COPD adhere poorly to their medications, and report little instruction about COPD or its management.

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High Prevalence of Chronic Obstructive Pulmonary Disease Among Veterans in the Urban Midwest

Cited by 31 publications

References 0 publications

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

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

Diagnosis of COPD and clinical course in patients with unrecognized airflow limitation

Therapeutic paralysis in Veterans with COPD

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