title: Early and Long-term Outcomes of Older Adults after Acute Care Encounters for Chronic Obstructive Pulmonary Disease Exacerbation.
abstract: BACKGROUND
  Older patients are at high risk of death and rehospitalization after hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AE-COPD). Emergency department visits comprise a substantial portion of acute care encounters in this patient population. The risks of mortality and repeat acute care encounters, including both hospital readmission and repeat emergency department visits, after AE-COPD among older adults are not well understood.
  
  
  OBJECTIVE
  To examine early and long-term rates of death and repeat acute care encounters after hospitalization or emergency department visit for AE-COPD in Medicare fee-for-service beneficiaries and to identify patient characteristics, including medical comorbid conditions, associated with these outcomes.
  
  
  METHODS
  A retrospective analysis was conducted using a nationally representative 5% sample of Medicare fee-for-service claims data from the U.S. Centers for Medicare and Medicaid Services to identify Medicare beneficiaries 65 years or older who had an acute care episode for an AE-COPD between January 1, 2006, and December 31, 2010 (n = 52,741). Outcomes of interest were all-cause mortality, repeat acute care encounters for any cause, and repeat acute care encounters for AE-COPD at 30 days, 1 year, and 3 years.
  
  
  RESULTS
  Acute care encounters, including hospitalizations and emergency department visits for AE-COPD, were associated with substantial subsequent mortality risk, with 4.6, 24.4, and 48.2% dying by 30 days, 1 year, and 3 years, respectively. The risk of repeat hospitalization or emergency department visit was similarly high, with 1 in 4 patients having a repeat acute care encounter within 30 days of discharge, increasing to 9 in 10 in the next 3 years. Several comorbid conditions and other patient factors, including heart failure, malnutrition, dual eligibility for Medicare and Medicaid, and prior supplemental oxygen use, were independently associated with increased risk of repeat acute care encounter.
  
  
  CONCLUSIONS
  Repeat hospitalizations and emergency department visits and death are common in older fee-for-service Medicare beneficiaries seen in acute care for AE-COPD. Our results suggest that addressing important comorbid conditions, such as heart failure or malnutrition, and targeting resources to oxygen-dependent or dual Medicare- and Medicaid-eligible patients may help modify these outcomes.
authors.affiliation: 1 Department of Medicine.|2 Durham VA Medical Center Geriatrics Research Education and Clinical Center, Durham, North Carolina.
authors.forename: Liza
authors.initials: L
authors.lastname: Genao
authors.affiliation: 1 Department of Medicine.|3 Duke Clinical Research Institute, and.
authors.forename: Michael T
authors.identifier: http://orcid.org/0000-0002-4186-5698
authors.initials: MT
authors.lastname: Durheim
authors.affiliation: 3 Duke Clinical Research Institute, and.
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Mi
authors.affiliation: 1 Department of Medicine.|3 Duke Clinical Research Institute, and.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Todd
authors.affiliation: 1 Department of Medicine.|4 Department of Ophthalmology.|5 Duke Aging Center, Duke University School of Medicine, Durham, North Carolina; and.|2 Durham VA Medical Center Geriatrics Research Education and Clinical Center, Durham, North Carolina.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Whitson
authors.affiliation: 1 Department of Medicine.|3 Duke Clinical Research Institute, and.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D010102:Oxygen Inhalation Therapy / Q000191:economics / Q000379:methods*; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Medicare; chronic obstructive pulmonary disease; health outcomes