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Original ResearchCOPDPredictors of Rehospitalization and Death After a Severe Exacerbation of COPD
Section snippets
Human Subjects
Approval for this study was obtained from the Colorado Multiple Institutional Review Board and the VA Eastern Colorado Healthcare System Research and Development Committee. No personally identifiable information was used.
Inpatient Administrative Data:
Data on inpatient stays were obtained from the Veteran Healthcare Administration medical SAS inpatient data sets (SAS Institute; Cary, NC), also known as the patient treatment file (PTF). The PTF is an SAS database extracted from the National Patient Care Database and
Cohort Selection
We identified 54,269 patients with COPD as their primary discharge diagnosis and/or DRG in the study period; 51,353 patients were eligible for analysis. Exclusions are outlined in Figure 1. The primary reason for exclusion was death during the index stay, which occurred in 3.5% of index stays. Invalid data were present for 33 patients who were excluded (28 patients for death dates prior to the index hospitalization, and 5 patients for overlapping stays).
Descriptive Statistics
The majority of the patients were white,
Discussion
This report details the clinical outcomes of a large cohort of VA patients after hospitalization for a severe exacerbation of COPD. We demonstrate a significant risk of subsequent severe exacerbations and death in this population. The mortality rates described in this article are similar to those in other cohorts of unselected patients after hospitalization for COPD.710 The mortality rates we found are higher than those in previous pharmacoepidemiologic studies232425 using large administrative
Conclusion
Age, gender, race/ethnicity, prior health-care utilization, and comorbid conditions were important modifiers of the risk of death and rehospitalization in this cohort of patients discharged after a severe exacerbation of COPD. Future work should explore potentially modifiable risk factors, and should examine these findings in databases with more detailed clinical information.
Acknowledgments
The authors thank Drs. Phoebe Barton and Lee Newman (review of Master's thesis); Drs. Andy Kramer and James Murphy (advice on modeling); Dr. Todd Lee (help with VA data); and Angela Keniston (assistance with figures).
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Cited by (0)
Portions of this manuscript have been presented in abstract form at the 24th Annual Epidemiologic Research Exchange, Denver, CO, February 24, 2006; at the American Thoracic Society International Conference, San Diego, CA, May 24, 2006; and at the Third Annual Respiratory Disease Young Investigator's Forum, Boston, MA, October 7, 2006.
This work was performed at the University of Colorado Health Sciences Center.
This work as supported by the Flight Attendant's Medical Research Institute Young Clinical Scientist Award (052390); the National Institutes of Health Clinical Research Loan Repayment Program; NRSA 2 T32 HL 007085; US Department of Veteran's Affairs Colorado REAP to Improve Care Coordination-REA 06-173; University of Colorado Health Sciences Center, Division of Pulmonary Sciences and Critical Care Medicine; the COPD Clinical Research Network Clinical Research Skills Development Core; and the Hartford/Jahnigen Center of Excellence in Geriatrics.
Dr. Sutherland has served as an advisor or consultant to Dey, GlaxoSmithKline, Pfizer, Talecris, and Schering-Plough; has received speaking honoraria from IVAX; and has received unrestricted investigator-initiated grant funding from Boehringer Ingelheim and GlaxoSmithKline. Drs. McGhan, Radcliff, Welsh, and Make, and Mr. Fish report no financial or other potential conflicts of interest.