title: Hospitalizations and return visits after chronic obstructive pulmonary disease ED visits.
abstract: OBJECTIVE
  The aim of this study was to describe population-based patterns of chronic obstructive pulmonary disease (COPD)-related emergency department (ED) visits.
  
  
  METHODS
  We analyzed all COPD-related ED visits made by North Carolina residents 45 years or older in 2008 to 2009 using statewide surveillance system data. Return visits were identified when patients returned to the same ED within 3 or 14 days of a prior COPD-related visit. We quantify the prevalence of hospitalization and return visits by age, sex, and payment method and describe ED disposition patterns.
  
  
  RESULTS
  Nearly half (46.3%) of the 97 511 COPD-related ED visits resulted in hospital admission. The percent of visits preceded by another COPD-related visit within 3 and 14 days was 1.6% and 6.2%, respectively. Emergency department-related hospitalizations increased with age; there were no differences by sex. Hospitalizations were less likely for uninsured, Medicare, and Medicaid visits than for privately insured visits. In contrast, 3- and 14-day return visits were more likely to be uninsured, Medicare, and Medicaid visits than privately insured visits. Fourteen-day returns were more likely to be made by men. Return visits initially increased with age compared with the 45- to 49-year age group, then decreased steadily after age 65 years. When return visits were made, discharge at both visits was the most common disposition pattern. However, 33.7% of 3-day returns and 22.7% of 14-day returns were discharged at the first visit and hospitalized upon returning to the ED.
  
  
  CONCLUSIONS
  Chronic obstructive pulmonary disease-related hospital admissions and short-term return ED visits were common and varied by age and insurance status. Chronic obstructive pulmonary disease management remains a critical area for intervention and quality improvement.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Carolina Center for Health Informatics, Department of Emergency Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC. Electronic address: slippmann@unc.edu.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lippmann
authors.forename: Karin B
authors.initials: KB
authors.lastname: Yeatts
authors.forename: Anna E
authors.initials: AE
authors.lastname: Waller
authors.forename: Kristen
authors.initials: K
authors.lastname: Hassmiller Lich
authors.forename: Debbie
authors.initials: D
authors.lastname: Travers
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: James F
authors.initials: JF
authors.lastname: Donohue
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy*; D012737:Sex Factors; D014481:United States