A comparison of generalist and pulmonologist care for patients hospitalized with severe chronic obstructive pulmonary disease : Resource intensity, hospital costs, and survival.
Both generalist and pulmonologist physicians care for patients with severe chronic obstructive pulmonary disease (COPD).
We studied patients hospitalized with severe COPD to explore whether supervision of care by pulmonologists is associated with greater costs or better survival.
SUBJECTS AND METHODS
We studied 866 adults with severe COPD enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT), a prospective study at five academic medical centers.
Patients were admitted to the hospital or transferred to an intensive care setting for treatment of severe COPD, defined by hypoxia (PaO2<60 mm Hg) and hypercapnia (PaCO2>50 mm Hg) or hypercapnia alone if on supplemental oxygen.
Resource intensity was measured using a modified version of the Therapeutic Intervention Scoring System and estimated hospital costs.
To account for differences in the patient case mix, propensity scores were developed to represent each patient's probability of having a pulmonologist as attending physician and each patient's probability of being in an intensive care unit (ICU) at study admission.
Of the 866 patients studied, 512 had generalists and 354 pulmonologists as their attending physicians.
The median patient age was 70 years ; 52% were male ; 14% died within 30 days. (...)
Mots-clés Pascal : Bronchopneumopathie obstructive, Chronique, Indice gravité, Traitement, Implémentation, Ressource, Coût, Hospitalisation, Survie, Médecin, Spécialité médicale, Etude comparative, Homme, Appareil respiratoire pathologie, Poumon pathologie, Bronche pathologie, Economie santé
Mots-clés Pascal anglais : Obstructive pulmonary disease, Chronic, Severity score, Treatment, Implementation, Resource, Costs, Hospitalization, Survival, Physician, Medical specialty, Comparative study, Human, Respiratory disease, Lung disease, Bronchus disease, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0021382
Code Inist : 002B11B. Création : 31/05/1999.