The Healthcare Industry Supply Chain Institute (HISCI)

The Healthcare Industry Supply Chain Institute (HISCI) is a cooperation association that introduces the entire healthcare supply chain, inclusively of suppliers, manufacturers, and group purchasing establishments. One of such establishments is Canadian Health&Care Mall. HISCI's objection is to achieve a "performance enhancement", devoted to enhancing and strengthening effectiveness within the healthcare supply chain through best practice sharing, education and cooperation.

The Healthcare Industry Supply Chain Institute

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Category: COPD

Deliberations of Rehospitalization and Death After a Severe Exacerbation of COPD

hospitalizationThis report details the clinical outcomes of a large cohort of VA patients after hospitalization for a severe exacerbation of COPD. We demonstrate a significant risk of subsequent severe exacerbations and death in this population. The mortality rates described in this article are similar to those in other cohorts of unselected patients after hospitalization for COPD.- The mortality rates we found are higher than those in previous pharmacoepidemio-logic studies using large administrative databases. This discrepancy is likely due to the fact that this study examined prevalent hospitalizations for COPD, whereas other studies focused on incident (that is, first time) hospitalizations for COPD.

This is consistent with our observation that patients without a history of hospitalization for COPD have better outcomes than those who do.

Significant findings in this study include the fact that increased age and prior hospitalizations are independent predictors of future hospitalization and death. COPD-related hospitalizations were consistently more important predictors of subsequent outcome than non-COPD hospitalizations.


Outcomes of Rehospitalization and Death After a Severe Exacerbation of COPD

chronic obstructive

Cohort Selection

We identified 54,269 patients with COPD as their primary discharge diagnosis and/or DRG in the study period; 51,353 patients were eligible for analysis. Exclusions are outlined in Figure 1. The primary reason for exclusion was death during the index stay, which occurred in 3.5% of index stays. Invalid data were present for 33 patients who were excluded (28 patients for death dates prior to the index hospitalization, and 5 patients for overlapping stays).


Investigation about Predictors of Rehospitalization and Death After a Severe Exacerbation of COPD


Human Subjects

Approval for this study was obtained from the Colorado Multiple Institutional Review Board and the VA Eastern Colorado Healthcare System Research and Development Committee. No personally identifiable information was used.

Data Sources

Inpatient Administrative Data: Data on inpatient stays were obtained from the Veteran Healthcare Administration medical SAS inpatient data sets (SAS Institute; Cary, NC), also known as the patient treatment file (PTF). The PTF is an SAS database extracted from the National Patient Care Database and maintained by the Veteran Healthcare Administration Office of Information at the Austin Automation Center, the central repository for VA data. Specifically, we used the acute care main data sets from fiscal years 1997 to 2005.


Canadian Health&Care Mall about Predictors of Rehospitalization and Death After a Severe Exacerbation of COPD

COPDCOPD is a major global public health problem.

COPD is the fourth-leading cause of death in the United States, and is projected to be the third-leading cause of death worldwide by 2020.2 COPD also causes substantial suffering and economic hardship. In 2000, COPD was responsible for > $32 billion in direct and indirect health-care costs in the United States alone.

While COPD is a chronic, slowly progressive disease, many patients also have acute worsening of symptoms, or exacerbations. Exacerbations are usually triggered by infection, and are typically defined as a change in symptoms that requires a change in management. Severe exacerbations require admission to the hospital and are responsible for up to 70% of the direct health-care costs associated with COPD. Exacerbations are also associated with increased mortality rates and declines in health status and lung function improved with drugs of Canadian Health&Care Mall