Clinical StudiesA comparison of generalist and pulmonologist care for patients hospitalized with severe chronic obstructive pulmonary disease: resource intensity, hospital costs, and survival∗☆,
Section snippets
Study design
We analyzed data from patients enrolled from 1989 to 1994 in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT), a prospective study of patient preferences, decision making, and outcomes in seriously ill hospitalized adults 18, 19. The study had two parts: an observational period (Phase I) and a subsequent interventional period (Phase II). During Phase II, patients assigned to the intervention had a dedicated clinical nurse specialist to facilitate
Physician and patient characteristics
Pulmonologists (n = 65) were slightly older than generalists (n = 235; median age 43 years for pulmonologists versus 42 years for generalists, P <0.001) and were more likely to be male (96% versus 80%, P <0.001). Patients of pulmonologists were younger, less likely to be female, and had more severe acute disease as evidenced by worse mean acute physiology score upon enrollment, worse arterial oxygenation, and worse estimated survival than did patients cared for by generalists (Table 1). There
Discussion
In our study of hospitalized, seriously ill patients with COPD, we found that patients who had pulmonologists as their attending physicians received more resource intensive care and experienced higher mortality than those cared for by generalists. However, these patients were younger and more acutely ill upon admission as evidenced by worse APACHE III scores, measures of oxygenation, and prognostic models. After adjustment for differences in case mix, there were no significant differences in
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2020, Respiratory MedicineCitation Excerpt :Pothirat et al. [35] compared the management of patients with COPD by pulmonologists vs internists and also found higher guideline adherence by pulmonologists as well as significantly lower rates and frequencies of severe adverse events in patients managed by them. Other studies, however, did not observe differences in resource utilization intensity or patient survival [36,37]. Nevertheless, the overall results suggest that in order to maximize treatment efficiency it might be beneficial to integrate specialists early into the treatment process [38].
Geographic Accessibility of Pulmonologists for Adults With COPD: United States, 2013
2016, ChestCitation Excerpt :It is also unclear whether current outcomes of patients with COPD in the United States differ between those treated by pulmonologists and those treated by primary care physicians. In one US study of patients with COPD hospitalized with severe COPD from 1989 to 1994, patients seen by pulmonologists compared with those seen by generalists were younger, had more severe acute disease, and had worse estimated survival on admission, but survival at 30 days did not differ significantly after adjustment for differences in case mix.24 Whether patients with COPD seen by a pulmonologist in the United States are more likely to receive recommended therapies and show greater adherence than those seen by primary care physicians in actual practice also is not established; however, it could be assumed that pulmonologists would be more likely to have greater awareness of new treatment modalities.
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2010, Archivos de BronconeumologiaA review of the application of propensity score methods yielded increasing use, advantages in specific settings, but not substantially different estimates compared with conventional multivariable methods
2006, Journal of Clinical EpidemiologyCitation Excerpt :We excluded 48 articles that did not include analysis of data (28), randomized clinical trials (9), case-control studies (2), and articles primarily analyzing cost-effectiveness (6) or practice patterns (3). Our search revealed 58 substantive medical research studies that used PS in 2003 [18–75], 38 in 2002 [76–113], 28 in 2001 [114–141], 6 in 2000 [142–147], 5 in 1999 [148–152], 5 in 1998 [153–157], and a total of 5 before 1998 [158–162]. Additional articles found through a citation search of the significant methods articles written about PS, using Science Citation Index, yielded 13 medical research studies that used PS in 2003 [163–175], 13 in 2002 [176–188], 11 in 2001 [189–199], 3 in 2000 [200–202], 1 in 1999 [203], 3 in 1998 [204–206], and a total of 3 before 1998 [207–209].
Does uptake of specialty care affect HRQoL development in COPD patients beneficially? A difference-in-difference analysis linking claims and survey data
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This study was supported by the Robert Wood Johnson Foundation. The opinions and findings contained in this article are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation or its board of trustees. Dr. Regueiro was supported in part by National Research Service Award: 5 T32 PE11001-09. Dr. Hamel was supported in part by a Career Development Award from the National Institute on Aging (KO8 A60075-02).
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