Potentially avoidable hospitalizations for COPD and pneumonia: The role of physician and practice characteristics Journal Article
| Authors: | O'Malley, A. S.; Pham, H. H.; Schrag, D.; Wu, B.; Bach, P. B. |
| Article Title: | Potentially avoidable hospitalizations for COPD and pneumonia: The role of physician and practice characteristics |
| Abstract: | BACKGROUND:: Hospitalizations for bacterial pneumonia and chronic obstructive pulmonary disease (COPD) occur frequently, but many are potentially avoidable. OBJECTIVE:: To examine associations between elderly patients usual physician and practice characteristics, and the risk of hospitalization for bacterial pneumonia and COPD. RESEARCH DESIGN:: Time-to-event analysis of Medicare claims from 2000 (baseline year) through 2001ĝ€"2002 (follow-up years) for beneficiaries whose usual physician participated in the 2000ĝ€"2001 Community Tracking Study Physician Survey. SUBJECTS:: A total of 509,613 patients and 5764 physicians for pneumonia hospitalizations; subset of 91,318 beneficiaries with an antecedent diagnosis of COPD and 5074 physicians for COPD hospitalizations. MEASURES:: Hospitalizations for bacterial pneumonia or COPD occurring in 2001ĝ€"2002. RESULTS:: Beneficiaries whose usual physician had been in practice for >10 years (vs. ĝ‰Currency sign10 years) were at lower risk for both pneumonia (AHR [adjusted hazard ratio] 0.88, 95% CL [confidence limits] 0.82ĝ€"0.94, and COPD hospitalization (AHR 0.87, 95% CL 0.80ĝ€"0.96). Risk of hospitalization for COPD was lower among beneficiaries whose usual physician reported that clinical practice guidelines had an important effect, compared with those reporting relatively little impact, on their clinical practice (AHR 0.88, 95% CL 0.80ĝ€"0.96). Patients had higher risk of both types of hospitalizations if their physician's practice had >5% Medicaid revenue (vs. 0ĝ€"5%, P < 0.0001), or reported more (vs. less) difficulty securing ancillary services (P < 0.01 for bacterial pneumonia and P ≤ 0.05 for COPD). Patient socioeconomic status, previous respiratory hospitalizations, and comorbidities had the strongest associations with hospitalization. CONCLUSIONS:: Given that physicians who report limited access to ancillary services and high Medicaid case volume have patients who experience higher rates of admission for COPD and pneumonia, additional resources and quality improvement interventions targeting these providers should be priorities. Copyright © Lippingcott Williams & Wilkins. |
| Keywords: | aged; aged, 80 and over; united states; follow up; follow-up studies; clinical practice; physician's practice patterns; statistics; proportional hazards models; risk factors; risk factor; risk assessment; health care quality; medicare; hospitalization; proportional hazards model; physicians; insurance; physician; insurance claim review; quality of health care; chronic obstructive pulmonary disease; chronic obstructive lung disease; pulmonary disease, chronic obstructive; quality of care; bacterial pneumonia; pneumonia, bacterial; risk adjustment; avoidable hospitalizations; bacterialpneumonia; claims analyses; eelderly |
| Journal Title: | Medical Care |
| Volume: | 45 |
| Issue: | 6 |
| ISSN: | 0025-7079 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2007-06-01 |
| Start Page: | 562 |
| End Page: | 570 |
| Language: | English |
| DOI: | 10.1097/MLR.0b013e3180408df8 |
| PUBMED: | 17515784 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 10" - "Export Date: 17 November 2011" - "CODEN: MDLCB" - "Source: Scopus" |
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