ED use lower among patients who received care in COPD center of excellence clinics

Patients with COPD who received care in an accredited advanced COPD center of excellence clinic had lower ED use compared with those who received care at another center, researchers reported.

Mandeep Singh, MD, from the department of pulmonary, critical care and sleep medicine at the University of Texas Medical Branch at Galveston, conducted a single-center, retrospective analysis of data from 4,646 patients with COPD (mean age, 65.4 years; 58.8% women) from April 2014 to March 2018. All patients were aged 40 years or older, had diagnosed COPD and had two or more outpatient visits 30 days apart. Researchers collected data on characteristics, performance measures, ED use and hospitalizations from patients treated at the University of Texas Medical Branch, which received accreditation for an advanced COPD center of excellence. The researchers compared performance measures at advanced COPD center of excellence clinics and primary care health system clinics.

Overall, 1,114 patients received care in a center of excellence clinic and 3,532 patients received care at a non-center of excellence clinic. The group of patients treated at center of excellence clinics had more individuals aged 60 to 70 years (33.7% vs. 28.4%) and 70 to 80 years (23.5% vs. 22.5%) and fewer women (55.8% vs. 59.8%). Patients who received care in center of excellence clinics also had more former smokers, patients with obstructive sleep apnea and congestive heart failure.

Researchers observed lower ED visit rates among patients treated in accredited medical centers compared with patients who were not (HR = 0.78; 95% CI, 0.65-0.93).

In addition, patients who received care in center of excellence clinics were more likely to receive tobacco cessation (28.3% vs. 17.5%), influenza (69.6% vs. 50.5%) and pneumococcal vaccines (71.3% vs. 54.9%), spirometry (53.2% vs. 14.8%), alpha-1 antitrypsin testing (6% vs. 0.5%), chest CT (61% vs. 29.2%) and bone density scans (17.8% vs. 8.6%).

There were no other significant differences between both groups.

“In conclusion, COPD patients who received care in a [center of excellence] clinic had lower ED visits compared to patients treated without a [center of excellence] clinic,” Singh said.