Potentially Avoidable Hospitalizations for COPD and Pneumonia
Bacterial pneumonia and chronic obstructive pulmonary disease (COPD) are respectively the third and fifth most common reason for Americans over 65 being hospitalized. This study examines the association between elderly patients being treated by their usual physician, physician practice characteristics and the risk of hospitalization for these two conditions. Cohorts of 509,613 Medicare patients and 5,764 physicians were studied for pneumonia hospitalizations; a subset of 91,318 Medicaid beneficiaries and 5,074 physicians were studied for COPD hospitalizations. The researchers found that patients were more likely to be hospitalized for pneumonia or COPD if treated by physicians with (1) less experience, (2) a higher proportion of practice revenue from Medicaid, (3) a lower proportion of practice revenue from managed care, and (4) less access to ancillary services such as home oxygen and outpatient management programs. Patients of physicians reporting a large impact of clinical practice guidelines on their practices were less likely to be hospitalized for COPD.
The results suggest that improving aspects of outpatient management, adopting treatment standards outlined in clinical practice guidelines and relying more on supportive services may improve outcomes of care and result in less hospitalizations for Medicare beneficiaries.