https://scholars.lib.ntu.edu.tw/handle/123456789/515239
標題: | Healthcare utilization, medical costs and mortality associated with malnutrition in patients with chronic obstructive pulmonary disease: a matched cohort study | 作者: | JIH-SHUIN JERNG Tang C.-H. Cheng R.W.-Y. Wang M.Y.-H. KUAN-YU HUNG |
公開日期: | 2019 | 出版社: | Taylor and Francis Ltd | 卷: | 35 | 期: | 7 | 起(迄)頁: | 1265-1273 | 來源出版物: | Current Medical Research and Opinion | 摘要: | Objective: Although disease-related malnutrition has prognostic implications for patients with chronic obstructive pulmonary disease (COPD), its health-economic impact and clinical burdens are uncertain. We conducted a population-level study to investigate these questions. Methods: We excerpted data relevant to malnutrition, prolonged mechanical ventilation and medications from claims by 1,197,098 patients which were consistent with COPD and registered by the Taiwan National Health Insurance Administration between 2009 and 2013. These patients were separated into cohorts with or without respiratory failure requiring long-term mechanical ventilation, and each cohort was divided to compare cases who developed malnutrition after their first diagnosis consistent with COPD, versus non-malnourished propensity-score matched controls. Results: The prevalence of malnutrition was 3.8% overall (10,259/287,000 non-ventilator-dependent; 1198/15,829 ventilator-dependent). Propensity-score matched non-ventilator-dependent patients who became malnourished (N = 10,242) had comparatively more hospitalizations, emergency room and outpatient visits, longer hospitalization (all p <.01), and higher mortality (HR = 2.26, 95% CI 2.18–2.34) than non-malnourished controls (N = 40,968). Malnourished ventilator-dependent patients (N = 1197) had higher rates of hospitalization, emergency room and outpatient visits, but shorter hospitalization (all p <.001) and lower mortality (HR = 0.85, 95% CI 0.80–0.93) than matched non-malnourished controls (N = 4788). Total medical expenditure on malnourished non-ventilator-dependent COPD patients was 75% higher than controls (p <.001), whereas malnourished ventilator-dependent patients had total costs 7% lower than controls (p <.001). Conclusions: Malnourishment among COPD patients who were not dependent on mechanical ventilation was associated with greater healthcare resource utilization and higher aggregate medical costs. ? 2019, ? 2019 Informa UK Limited, trading as Taylor & Francis Group. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85063139929&doi=10.1080%2f03007995.2019.1574460&partnerID=40&md5=fb2006a2993e7961c2a24454656d7dae https://scholars.lib.ntu.edu.tw/handle/123456789/515239 |
ISSN: | 0300-7995 | DOI: | 10.1080/03007995.2019.1574460 | SDG/關鍵字: | aged; Article; artificial ventilation; chronic obstructive lung disease; cohort analysis; controlled study; emergency ward; female; health care cost; health care utilization; hospitalization; human; major clinical study; male; malnutrition; national health insurance; outpatient; prevalence; respiratory failure; Taiwan; validation study; adult; chronic obstructive lung disease; complication; cost; economics; health care cost; hospital emergency service; malnutrition; middle aged; patient attitude; retrospective study; very elderly; Adult; Aged; Aged, 80 and over; Cohort Studies; Costs and Cost Analysis; Emergency Service, Hospital; Female; Health Expenditures; Hospitalization; Humans; Male; Malnutrition; Middle Aged; Patient Acceptance of Health Care; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Taiwan |
顯示於: | 醫學系 |
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