Factors Driving High Hospitalization Rates of COPD Frequent Flyers: A Repeat Cross-Sectional Study – Pulmonology Consults,Pulmonary Function Tests,and Code Status

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. Additionally, in 2017, the Pulmonary Disease Navigator (PDN) scope was expanded to include COPD.

Methods:

For 2019, 2020, and 2021, we extracted adult subjects 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 PFTs, pulmonology consults, and code status, each variable was compared with a z-test.

Results:

We identified 33 subjects with ≥ 5 visits per year during 2020-2021. There was a significant difference between cohorts in proportions of pulmonology consults and PFTs. For the current cohort, 30% of PFTs were ordered by PCPs and 60% by pulmonologists. 61% of the subjects in the current cohort are followed by a PDN. Other results are reported in accompanying abstracts.

Conclusions:

Compared to the original cohort, a larger proportion of subjects in the current cohort were seen by a pulmonologist and received a PFT during the pandemic where PFTs were considered high-risk elective procedures. This is an indicator that COPD patients are receiving more comprehensive care, potentially due to initiatives implemented after the original study, as well as PDN involvement. Another indicator is a reduction in total subjects extracted with the same inclusion criteria. As reported in accompanying abstracts, these 33 subjects may be more medically complex and older in age, which aligns with the possible increased proportions of DNR and palliative/hospice status. We recommend that COPD patients receive more pulmonology referrals and that providers other than pulmonologists be more inclined to order PFTs. This study was limited by a small sample size and no access to the original dataset. We conclude that progress in COPD frequent flyer care is evidenced by increased utilization of PFTs, pulmonology consults, and PDNs.