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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).

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