Variations in practice patterns and resource utilization in patients treated for chronic obstructive pulmonary...

Area of Science:

• Pulmonary Medicine
• Healthcare Management

Background:

• Patient-related factors influencing hospital length of stay (LOS) in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are well-studied.
• Physician-related factors and practice patterns are increasingly recognized as significant contributors to LOS in AECOPD patients.

Purpose of the Study:

• To evaluate practice pattern differences between teaching and nonteaching hospital services.
• To determine the effect of these practice patterns on LOS in AECOPD patients within a large community hospital setting.

Main Methods:

• A retrospective analysis of 354 AECOPD patients admitted between January 2009 and December 2011.
• Exclusion criteria included patients requiring mechanical ventilation for acute respiratory failure.
• Key practice patterns examined were the use of oral versus intravenous steroids and antibiotics, and the utilization of consultations.

Main Results:

• Teaching services demonstrated significantly lower LOS (2.80 days) compared to nonteaching services (5.04 days).
• Teaching services utilized oral steroids (85% vs. 8.9%) and oral antibiotics (72% vs. 33%) more frequently, and consultations less often (0.3 vs. 1.4 per patient).
• After adjusting for practice patterns, the teaching service was no longer independently associated with decreased LOS, with consult utilization being the only practice pattern linked to increased LOS.

Conclusions:

• The observed reduction in LOS in teaching services for AECOPD was fully attributable to differences in practice patterns.
• Opportunities exist for more efficient and cost-effective AECOPD care by streamlining consultations, favoring oral over intravenous steroids, and implementing antibiotic stewardship.