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      Explaining the link between access-to-care factors and health care resource utilization among individuals with COPD

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          Limited accessibility to health care may be a barrier to obtaining good care. Few studies have investigated the association between access-to-care factors and COPD hospitalizations. The objective of this study is to estimate the association between access-to-care factors and health care utilization including hospital/emergency department (ED) visits and primary care physician (PCP) office visits among adults with COPD utilizing a nationally representative survey data.


          We conducted a pooled cross-sectional analysis based upon a bivariate probit model, utilizing datasets from the 2011–2012 Behavioral Risk Factor Surveillance System linked with the 2014 Area Health Resource Files among adults with COPD. Dichotomous outcomes were hospital/ED visits and PCP office visits. Key covariates were county-level access-to-care factors, including the population-weighted numbers of pulmonary care specialists, PCPs, hospitals, rural health centers, and federally qualified health centers.


          Among a total of 9,332 observations, proportions of hospital/ED visits and PCP office visits were 16.2% and 44.2%, respectively. Results demonstrated that access-to-care factors were closely associated with hospital/ED visits. An additional pulmonary care specialist per 100,000 persons serves to reduce the likelihood of a hospital/ED visit by 0.4 percentage points (pp) ( P=0.028). In contrast, an additional hospital per 100,000 persons increases the likelihood of hospital/ED visit by 0.8 pp ( P=0.008). However, safety net facilities were not related to hospital utilizations. PCP office visits were not related to access-to-care factors.


          Pulmonary care specialist availability was a key factor in reducing hospital utilization among adults with COPD. The findings of our study implied that an increase in the availability of pulmonary care specialists may reduce hospital utilizations in counties with little or no access to pulmonary care specialists and that since availability of hospitals increases hospital utilization, directing patients with COPD to pulmonary care specialists may decrease hospital utilizations.

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            Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention.

            Self-management interventions improve various outcomes for many chronic diseases. The definite place of self-management in the care of chronic obstructive pulmonary disease (COPD) has not been established. We evaluated the effect of a continuum of self-management, specific to COPD, on the use of hospital services and health status among patients with moderate to severe disease. A multicenter, randomized clinical trial was carried out in 7 hospitals from February 1998 to July 1999. All patients had advanced COPD with at least 1 hospitalization for exacerbation in the previous year. Patients were assigned to a self-management program or to usual care. The intervention consisted of a comprehensive patient education program administered through weekly visits by trained health professionals over a 2-month period with monthly telephone follow-up. Over 12 months, data were collected regarding the primary outcome and number of hospitalizations; secondary outcomes included emergency visits and patient health status. Hospital admissions for exacerbation of COPD were reduced by 39.8% in the intervention group compared with the usual care group (P =.01), and admissions for other health problems were reduced by 57.1% (P =.01). Emergency department visits were reduced by 41.0% (P =.02) and unscheduled physician visits by 58.9% (P =.003). Greater improvements in the impact subscale and total quality-of-life scores were observed in the intervention group at 4 months, although some of the benefits were maintained only for the impact score at 12 months. A continuum of self-management for COPD patients provided by a trained health professional can significantly reduce the utilization of health care services and improve health status. This approach of care can be implemented within normal practice.
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              Deaths: final data for 2010.

              This report presents final 2010 data on U.S. deaths, death rates, life expectancy, infant mortality, and trends by selected characteristics such as age, sex, Hispanic origin, race, state of residence, and cause of death. Information reported on death certificates, which is completed by funeral directors, attending physicians, medical examiners, and coroners, is presented in descriptive tabulations. The original records are filed in state registration offices. Statistical information is compiled in a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Prevention's National Center for Health Statistics. Causes of death are processed in accordance with the International Classification of Diseases, Tenth Revision. In 2010, a total of 2,468,435 deaths were reported in the United States. The age-adjusted death rate was 747.0 deaths per 100,000 standard population, lower than the 2009 rate (749.6) and a record low rate. Life expectancy at birth rose 0.2 year, from 78.5 years in 2009 to a record high of 78.7 in 2010. Age-specific death rates decreased for each age group under 85, although the decrease for ages 1-4 was not significant. The age-specific rate increased for ages 85 and over. The leading causes of death in 2010 remained the same as in 2009 for all but one of the 15 leading causes. Pneumonitis due to solids and liquids replaced Assault (homicide) as the 15th leading cause of death in 2010. The infant mortality rate decreased 3.8% to a historically low value of 6.15 deaths per 1,000 live births in 2010. The decline of the age-adjusted death rate to a record low value for the United States, and the increase in life expectancy to a record high value of 78.7 years, are consistent with long-term trends in mortality.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                22 February 2016
                : 11
                : 357-367
                [1 ]Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, USA
                [2 ]OSF St Francis Medical Center, University of Illinois College of Medicine at Peoria, Peoria, USA
                [3 ]Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA
                [4 ]Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
                [5 ]Battelle Memorial Institute, Atlanta, GA, USA
                Author notes
                Correspondence: Minchul Kim, Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, One Illini Drive, Peoria, IL 61656-1649, USA, Tel +1 309 671 8429, Fax +1 309 671 8438, Email mchkim@
                © 2016 Kim et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research

                Respiratory medicine

                pulmonary specialist, copd, hospital utilization


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