title: Management of acute exacerbations of chronic obstructive pulmonary disease in the elderly: physician practices in the community hospital setting.
abstract: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and sixth most common reason that Medicare patients are hospitalized. We performed retrospective chart review on a statewide random sample of 409 Medicare patients discharged from October 1, 2000, through January 31, 2001, with a diagnosis of COPD. The most commonly performed diagnostic tests were chest radiography (96.8%) and oxygenation assessment (94.9%). The most common treatments provided were inhaled short-acting beta-agonist bronchodilators (98.5%) and oxygen (94.4%). Antibiotics (89.0%) and systemic corticosteroids (85.1%) were prescribed less frequently. The median length of stay was 5 days. The readmission rate was 27.4% (CI, 23.1-32.0) at 30 days and 43.0% (CI, 38.2-47.9) at 180 days. The in-hospital mortality rate was 1.7% (CI, 0.7-3.5) and the 180-day mortality rate was 23.7% (CI, 19.7-28.1). The morbidity and mortality associated with acute exacerbations of COPD remain high. There are opportunities to improve quality of care for this condition.
authors.affiliation: Oklahoma Foundation for Medical Quality, 14000 Quail Springs Parkway, Suite 400, Oklahoma City, OK 73134, USA. okpro.dbratzler@sdps.org
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
authors.forename: W H
authors.initials: WH
authors.lastname: Oehlert
authors.forename: Lisa M
authors.initials: LM
authors.lastname: McAdams
authors.forename: John
authors.initials: J
authors.lastname: Leon
authors.forename: Hui
authors.initials: H
authors.lastname: Jiang
authors.forename: Donna
authors.initials: D
authors.lastname: Piatt
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008485:Medical Audit; D006278:Medicare; D009825:Oklahoma; D010818:Practice Patterns, Physicians'; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome