 |
|
Differences in Health Care Utilization at the End of Life Among Patients With Chronic Obstructive Pulmonary Disease and Patients With Lung Cancer
David H. Au, MD, MS;
Edmunds M. Udris, MPH;
Stephan D. Fihn, MD, MPH;
Mary B. McDonell, MS;
J. Randall Curtis, MD, MPH
Arch Intern Med. 2006;166:326-331.
Background We sought to examine health care resource utilization in the last 6 months of life among patients who died with chronic obstructive pulmonary disease (COPD) compared with those who died with lung cancer and to examine geographic variations in care.
Methods We performed a retrospective cohort study of patients diagnosed as having COPD or lung cancer, who were seen in 1 of 7 Veteran Affairs medical centers primary care clinics and who died during the study period. Our outcome of interest was health care resource utilization in the last 6 months of life.
Results In the last 6 months of life, patients with COPD were more likely to visit their primary care providers but had fewer hospital admissions compared with patients with lung cancer. Patients with COPD had twice the odds of being admitted to an intensive care unit (ICU), 5 times the odds of remaining there 2 weeks or longer, and received fewer opiates and benzodiazepine prescriptions compared with patients with lung cancer. There were geographic variations in the use of ICUs for patients with COPD but not for those with lung cancer. Total health care costs were $4000 higher for patients with COPD because of ICU utilization.
Conclusions In the last 6 months of life, patients with COPD were more likely to have had a primary care visit and been admitted to an ICU but less likely to receive palliative medications compared with patients with lung cancer. We found significant geographic variability in ICU utilization but only for patients with COPD.
Author Affiliations: Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Wash (Drs Au and Fihn, Mr Udris, and Ms McDonell); and Department of Medicine, University of Washington, Seattle (Drs Au, Fihn, and Curtis).
 CiteULike  Connotea  Delicious  Digg  Facebook  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Feasibility of a Webinar for Coaching Patients With Chronic Obstructive Pulmonary Disease on End-of-Life Communication
Reinke et al.
AM J HOSP PALLIAT CARE 2011;28:147-152.
ABSTRACT
Introduction
Spathis et al.
OSH Respiratory Disease: From advanced disease to bereavement 2011;1:med-9780199564033-div1-00-med-9780199564033-div1-00.
FULL TEXT
American College of Chest Physicians Consensus Statement on the Management of Dyspnea in Patients With Advanced Lung or Heart Disease
Mahler et al.
Chest 2010;137:674-691.
ABSTRACT
| FULL TEXT
Living with advanced chronic obstructive pulmonary disease: patients concerns regarding death and dying
Gardiner et al.
Palliat Med 2009;23:691-697.
ABSTRACT
Palliative and end-of-life care for patients with severe COPD
Curtis
Eur Respir J 2008;32:796-803.
ABSTRACT
| FULL TEXT
Advanced chronic obstructive pulmonary disease: rethinking models of care
Simpson and Rocker
QJM 2008;101:697-704.
ABSTRACT
| FULL TEXT
An Official American Thoracic Society Clinical Policy Statement: Palliative Care for Patients with Respiratory Diseases and Critical Illnesses
Lanken et al.
Am. J. Respir. Crit. Care Med. 2008;177:912-927.
FULL TEXT
Meeting Physicians' Responsibilities in Providing End-of-Life Care
Shanawani et al.
Chest 2008;133:775-786.
ABSTRACT
| FULL TEXT
The Epidemiology and Economics of Chronic Obstructive Pulmonary Disease
Mannino and Braman
Proc Am Thorac Soc 2007;4:502-506.
ABSTRACT
| FULL TEXT
|
