| Title |
Factors contributing to high-cost hospital care for patients with COPD
|
|---|---|
| Published in |
International Journal of Chronic Obstructive Pulmonary Disease, March 2017
|
| DOI | 10.2147/copd.s126607 |
| Pubmed ID | |
| Authors |
Sunita Mulpuru, Jennifer McKay, Paul E Ronksley, Kednapa Thavorn, Daniel M Kobewka, Alan J Forster |
| Abstract |
Chronic obstructive pulmonary disease (COPD) is a leading cause of hospital admission, the fifth leading cause of death in North America, and is estimated to cost $49 billion annually in North America by 2020. The majority of COPD care costs are attributed to hospitalizations; yet, there are limited data to understand the drivers of high costs among hospitalized patients with COPD. In this study, we aimed to determine the patient and hospital-level factors associated with high-cost hospital care, in order to identify potential targets for the reorganization and planning of health services. We conducted a retrospective cohort study at a Canadian academic hospital between September 2010 and 2014, including adult patients with a first-time admission for COPD exacerbation. We calculated total costs, ranked patients by cost quintiles, and collected data on patient characteristics and health service utilization. We used multivariable regression to determine factors associated with highest hospital costs. Among 1,894 patients included in the study, the mean age was 73±12.6 years, median length of stay was 5 (interquartile range 3-9) days, mortality rate was 7.8% (n=147), and 9% (n=170) required intensive care. Hospital spending totaled $19.8 million, with 63% ($12.5 million) spent on 20% of patients. Factors associated with highest costs for COPD care included intensive care unit admission (odds ratio [OR] 32.4; 95% confidence interval [CI] 20.3, 51.7), death in hospital (OR 2.6; 95% CI 1.3, 5.2), discharge to long-term care facility (OR 5.7; 95% CI 3.5, 9.2), and use of the alternate level of care designation during hospitalization (OR 23.5; 95% CI 14.1, 39.2). High hospital costs are driven by two distinct groups: patients who require acute medical treatment for severe illness and patients with functional limitation who require assisted living facilities upon discharge. Improving quality of care and reducing cost in this high-needs population require a strong focus on early recognition and management of functional impairment for patients living with chronic disease. |
X Demographics
The data shown below were collected from the profiles of 7 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 1 | 14% |
| United Kingdom | 1 | 14% |
| Unknown | 5 | 71% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 3 | 43% |
| Scientists | 2 | 29% |
| Science communicators (journalists, bloggers, editors) | 1 | 14% |
| Practitioners (doctors, other healthcare professionals) | 1 | 14% |
Mendeley readers
The data shown below were compiled from readership statistics for 106 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 106 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 18 | 17% |
| Student > Master | 15 | 14% |
| Student > Bachelor | 13 | 12% |
| Student > Ph. D. Student | 7 | 7% |
| Professor | 5 | 5% |
| Other | 17 | 16% |
| Unknown | 31 | 29% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 32 | 30% |
| Nursing and Health Professions | 15 | 14% |
| Pharmacology, Toxicology and Pharmaceutical Science | 4 | 4% |
| Social Sciences | 4 | 4% |
| Psychology | 4 | 4% |
| Other | 11 | 10% |
| Unknown | 36 | 34% |
Attention Score in Context
This research output has an Altmetric Attention Score of 15. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 28 March 2017.
All research outputs
#2,497,375
of 25,584,565 outputs
Outputs from International Journal of Chronic Obstructive Pulmonary Disease
#236
of 2,571 outputs
Outputs of similar age
#45,654
of 324,971 outputs
Outputs of similar age from International Journal of Chronic Obstructive Pulmonary Disease
#7
of 77 outputs
Altmetric has tracked 25,584,565 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 90th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 2,571 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.5. This one has done particularly well, scoring higher than 90% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 324,971 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 85% of its contemporaries.
We're also able to compare this research output to 77 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 92% of its contemporaries.