Factors Driving High Hospitalization Rates of COPD Frequent Flyers: A Repeat Cross-Sectional Study – Non-Compliance and Housing

Abstract

Background:

Frequent flyer hospital visits account for a disproportionately large share of overall visits and costs. A 2011-2012 Intermountain Healthcare study investigated factors driving high hospitalization rates of COPD frequent flyers. We repeated this study on new subjects for 2019-2021 to detect changes in demographics, treatment, comorbidities, and non-compliance. Following the original study, initiatives were implemented to improve COPD patient care. Also, in 2017, the Pulmonary Disease Navigator (PDN) scope was expanded to include COPD.

Methods:

For 2019, 2020, and 2021, we extracted adult subjects (≥ 18 y) assigned a COPD exacerbation diagnosis associated with ≥ 5 visits (ER or admission) per year at all Intermountain hospitals. We performed retrospective electronic medical record reviews on these subjects, including all variables from the original study. To assess differences between cohorts in comorbidities, each variable was compared with a z-test. For cohort differences in housing, chi-square analysis was used.

Results:

We identified 33 subjects with ≥ 5 visits per year during the 2020-2021 period. There was a significant difference between cohorts in proportions of non-compliance with medication and clinic appointments. 61% of the subjects in the current cohort are followed by a PDN. Additionally, since 2012, 62% of subjects in the current cohort quit smoking and 31% reduced to half a pack a day or less. Other results are reported in accompanying abstracts.

Conclusions:

Compared to the previous cohort, a larger proportion of subjects in the current cohort exhibit medication and clinic appointment non-compliance, suggesting COPD frequent flyer care has not improved. However, we extracted fewer total subjects, and a larger proportion of these subjects may be homeless. This suggests that there are fewer frequent flyer COPD patients overall, and that the current cohort consists of more subjects with behavioral issues and lack of resources. We attribute smoking cessation success and the reduction in total COPD frequent flyers to PDN involvement and initiatives implemented after the original study. We commend the improvements and recommend increased efforts to assist and educate homeless COPD patients. This study was limited by a small patient population and no access to the original dataset. Overall, we found a reduction in COPD frequent flyers and that medication and clinic appointment non-compliance have increased, possibly due to an increase in homelessness.