Differences in health care utilization at the end of life among patients with chronic obstructive pulmonary disease and patients with lung cancer.
BACKGROUND
We sought to examine health care resource utilization in the last 6 months of life among patients who died with chronic obstructive pulmonary disease (COPD) compared with those who died with lung cancer and to examine geographic variations in care.


METHODS
We performed a retrospective cohort study of patients diagnosed as having COPD or lung cancer, who were seen in 1 of 7 Veteran Affairs medical centers primary care clinics and who died during the study period. Our outcome of interest was health care resource utilization in the last 6 months of life.


RESULTS
In the last 6 months of life, patients with COPD were more likely to visit their primary care providers but had fewer hospital admissions compared with patients with lung cancer. Patients with COPD had twice the odds of being admitted to an intensive care unit (ICU), 5 times the odds of remaining there 2 weeks or longer, and received fewer opiates and benzodiazepine prescriptions compared with patients with lung cancer. There were geographic variations in the use of ICUs for patients with COPD but not for those with lung cancer. Total health care costs were $4000 higher for patients with COPD because of ICU utilization.


CONCLUSIONS
In the last 6 months of life, patients with COPD were more likely to have had a primary care visit and been admitted to an ICU but less likely to receive palliative medications compared with patients with lung cancer. We found significant geographic variability in ICU utilization but only for patients with COPD.
Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Wash, USA. dau@u.washington.edu
David H
DH
Au
Edmunds M
EM
Udris
Stephan D
SD
Fihn
Mary B
MB
McDonell
J Randall
JR
Curtis
D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality / Q000628:therapy*; D008297:Male; D010044:Outpatient Clinics, Hospital; D010166:Palliative Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
D000701:Analgesics, Opioid; D001569:Benzodiazepines