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Geographic variation in chronic obstructive pulmonary disease exacerbation rates
Min J Joo1, Todd A Lee, Kevin B Weiss
1Center for Management of Complex Chronic Care, Hines VA Hospital, Hines, IL, USA. joo@uic.edu
Journal of General Internal Medicine
|September 18, 2007
Summary
Chronic obstructive pulmonary disease (COPD) exacerbation rates varied significantly across Veterans Affairs regions. Healthcare system factors, not patient factors, appear to influence these COPD exacerbation events.
Area of Science:
- Pulmonary Medicine
- Health Services Research
- Epidemiology
Background:
- Chronic obstructive pulmonary disease (COPD) exacerbations are frequent, resource-intensive events.
- Exacerbations can signal disease progression in COPD patients.
- Little is known about geographic variations in COPD exacerbation rates within large healthcare systems.
Purpose of the Study:
- To investigate and compare COPD exacerbation rates across different regional service networks (VISNs) within the Veterans Health Administration (VA).
Main Methods:
- Retrospective observational study design.
- Included 198,981 patients diagnosed with COPD between October 1999 and September 2000.
- Analyzed acute COPD exacerbations during baseline and a two-year follow-up period (to September 2002).
Main Results:
- The average adjusted COPD exacerbation rate during follow-up was 0.589 events per person per year.
- Significant geographic variation observed, with rates ranging from 0.335 in VISN 1 to 0.749 in VISN 9.
- 12 VISNs showed higher adjusted exacerbation rates, and 9 showed lower rates compared to the median baseline rate.
Conclusions:
- Geographic variations in COPD exacerbation rates within the VA system suggest the influence of the medical care system, including provider factors.
- Patient factors appear to play a lesser role in observed exacerbation rate differences.
- Understanding these variations is crucial for improving future COPD care and patient outcomes.
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