Quantifying health services use for chronic obstructive pulmonary disease

Rationale — Chronic obstructive pulmonary disease (COPD), a common manageable condition, is a leading cause of death. A better understanding of its impact on healthcare systems would inform strategies to reduce its burden.

Objective — To quantify health services use in a large, North American COPD population.

Methods — The researchers conducted a cohort study using health administrative data from Ontario, a province with a population of 13 million and universal healthcare insurance. All individuals with physician diagnosed COPD in 2008 were identified and followed for 3 years. Proportions of all hospital visits, emergency department visits, ambulatory care visits, long term care residence places, and homecare by people made or used with COPD were determined and rates of each compared between people with and without COPD.

Measurements and Main Results — A total of 853,438 individuals with COPD (11.8% of the population age 35 and older) were responsible for 24% of hospitalizations, 24% of emergency department visits, 21% of ambulatory care visits and filled 35% of long term care places and used 30% of homecare services. After adjusting for several factors, people with COPD had rates of hospital, emergency department and ambulatory care visits that were, respectively, 63%, 85%, and 48% higher rates than the rest of the population. Their rates of long term care and homecare use were 56% and 59% higher.

Conclusions — Individuals with COPD use large and disproportionate amounts of health services. Strategies that target this group are needed to improve their health and minimize their need for health services.