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Factors Associated with Frequency of Emergency Department Visits for Chronic Obstructive Pulmonary Disease Exacerbation

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Abstract

Background

Little is known about the factors associated with frequency of emergency department visits (FEDV) in chronic obstructive pulmonary disease (COPD) patients with recurrent exacerbations.

Objective

To characterize the use of emergency department (ED) services in patients with COPD exacerbation and identify factors associated with FEDV.

Design

A prospective, multicenter cohort study.

Patients

Three hundred eighty-eight patients were included. Fifty-two percent were women and the median age was 69 years (interquartile range 62–76).

Measurements

Using a standard questionnaire, consecutive ED patients with COPD exacerbation were interviewed. The number of ED visits in the previous year was retrospectively collected.

Results

Over the past year, this cohort reported a total of 1,090 ED visits because of COPD exacerbation. Thirteen percent of COPD patients had 6 or more ED visits, accounting for 57% of the total ED visits in the past year. Multivariate analysis showed that patients with an increased FEDV were more likely to be Hispanic (incidence rate ratio [IRR] 1.97, 95% confidence interval [CI] 1.16–3.33), to have more severe COPD as determined by previous hospitalizations (IRR 2.06, 95% CI 1.51–2.82), prior intubations (IRR 1.49, 95% CI 1.02–2.18), prior use of systemic corticosteroids (IRR 1.57, 95% CI 1.16–2.13) and methylxanthine (IRR 1.48, 95% CI 1.04–2.12), and less likely to have a primary care provider (IRR 0.51, 95% CI 0.31–0.82).

Conclusions

Our results suggest that both disease and health care-related factors were associated with FEDV in COPD exacerbation. Multidisciplinary efforts through primary care provider follow-up should be assessed to test the effects on reducing the high morbidity and cost of recurrent COPD exacerbations.

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Abbreviations

COPD:

Chronic obstructive pulmonary disease

ED:

Emergency department

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Ackowledgments

The authors thank the EMNet investigators for their ongoing dedication to public health research, with an emphasis on the treatment and prevention of respiratory/allergy emergencies. The cohort studies were supported by an unrestricted grant from Boehringer Ingelheim (Ridgefield, Conn, USA and Burlington, Ontario, Canada).

EMNet Steering Committee: Michelle P. Blanda, MD; Edwin D. Boudreaux, PhD; Carlos A. Camargo, Jr., MD (Chair); Rita K. Cydulka, MD; Theodore J. Gaeta, DO, MPH; Susan Key, RN, MS, CEN; Steven Polevoi, MD; Michael S. Radeos, MD, MPH; and Benjamin C. Sun, MD, MPP.

EMNet Coordinating Center: Christina Ahn; Carlos A. Camargo, Jr., MD (Director); Sunday Clark, MPH, ScD; Lisa A. Dubois; Kate E. Delaney; Adit A. Ginde, MD; Andrea J. Pelletier, MS, MPH; Ashley F. Sullivan, MS, MPH; Chu-Lin Tsai, MD, MPH (all from the Massachusetts General Hospital, Boston, Mass, USA).

Principal Investigators at the 29 Participating Sites: FC Baker III (Maine Medical Center, Portland, Maine, USA); MP Blanda (Summa Health System, Akron, Ohio, USA); ED Boudreaux (Earl K. Long Memorial Hospital, Baton Rouge, La, USA); BE Brenner (The Brooklyn Hospital Center, Brooklyn, NY, USA); CA Camargo, Jr. (Massachusetts General Hospital, Boston, Mass, USA); RK Cydulka (MetroHealth Medical Center, Cleveland, Ohio, USA); TJ Gaeta (New York Methodist Hospital, Brooklyn, NY, USA); B Goldfeder (Shands Hospital at the Univeristy of Florida, Gainesville, Fla, USA); RJ Grant (Hartford Hospital, Hartford, Conn, USA); RO Gray (Hennepin County Medical Center, Minneapolis, Minn, USA); A Guttman (Sir Mortimer B. Davis, Jewish General Hospital, Montreal, Quebec, Canada); LW Kreplick (Christ Hospital and Medical Center, Oak Lawn, Ill, USA); DS Mackey (Lethbridge Regional Hospital, Lethbridge, Alberta, Canada); A Mangione (Albert Einstein Medical Center, Philadelphia, Pa, USA); J Peters (University of Texas Health Sciences Center at San Antonio, San Antonio, Tex, USA); MS Radeos (Lincoln Medical Center, Bronx, NY); PL Rice (Brigham and Women’s Hospital, Boston, Mass, USA); BH Rowe (University of Alberta Hospital, Edmonton, Alberta, Canada); M Sama (St. Joseph Mercy Hospital, Ann Arbor, Mich, USA); D Schreiber (Stanford University Medical Center, Stanford, Calif, USA); NI Shapiro (Beth Israel Deaconess Medical Center, Boston, Mass, USA); PC Shukla (University of Texas Southwestern Medical Center, Dallas, Tex, USA); D Sinclair (Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada); H Smithline (Baystate Medical Center, Springfield, Mass, USA); PE Sokolove (UC Davis Medical Center, Sacramento, Calif, USA); M Steffens (Palmetto Richland Memorial Hospital, Columbia, SC, USA); CA Terregino (Cooper Hospital/University Medical Center, Camden, NJ, USA); A Travers (Royal Alexandria Hospital, Edmonton, Alberta, Canada); and EJ Weber (UCSF Medical Center, San Francisco, Calif, USA).

Conflict of interest statement

Dr. Camargo has received financial support (research grants, consulting, lectures) from AstraZeneca (Wilmington, Del, USA), Boehringer Ingelheim (Ridgefield, Conn, USA), GlaxoSmithKline (Research Triangle Park, NC, USA), Novartis (East Hanover, NJ, USA), and Schering Plough (Kenilworth, NJ, USA). All other authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Chu-Lin Tsai MD, MPH & Carlos A. Camargo Jr. MD, DrPH

  2. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Chu-Lin Tsai MD, MPH, Sunday Clark MPH, ScD & Carlos A. Camargo Jr. MD, DrPH

  3. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Sharon K. Griswold MD

  4. Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA, 02114, USA

    Chu-Lin Tsai MD, MPH

Authors
  1. Chu-Lin Tsai MD, MPH
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  2. Sharon K. Griswold MD
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  3. Sunday Clark MPH, ScD
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  4. Carlos A. Camargo Jr. MD, DrPH
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Corresponding author

Correspondence to Chu-Lin Tsai MD, MPH.

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Tsai, CL., Griswold, S.K., Clark, S. et al. Factors Associated with Frequency of Emergency Department Visits for Chronic Obstructive Pulmonary Disease Exacerbation. J GEN INTERN MED 22, 799–804 (2007). https://doi.org/10.1007/s11606-007-0191-7

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  • DOI: https://doi.org/10.1007/s11606-007-0191-7

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