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Chronic obstructive pulmonary disease (COPD) is a leading and costly cause of readmissions to the hospital, with one of the highest rates reported in Florida. From 2009 to 2014, strategies such as readmission reduction programs, as well as updated guidelines for COPD management, were instituted to reduce readmission rates for patients with COPD. Thus, the question has been raised whether COPD-related 30-day hospital readmission rates in Florida have decreased and whether COPD-related readmission costs during this period have changed. In addition, we examined trends in length of stay, hospital charges, and in-hospital mortality associated with COPD, as well as identified patient-level risk factors associated with 30-day readmissions.A retrospective analysis of adult patients (≥18 years of age) with COPD was conducted by using the Healthcare Cost and Utilization Project Florida State Inpatient Database, 2009 to 2014. Weighted least squares regression was used to assess trends in the COPD readmission rate on a yearly basis, as well as other outcomes of interest. A multivariable logistic regression was used to identify patient characteristics that were associated with 30-day COPD readmissions.Overall, 268,084 adults were identified as having COPD. Between 2009 and 2014, more than half of patients aged 65-84 years, most were white, 55% were female, and 73% had Medicare. The unadjusted rate for COPD-related 30-day readmissions did not change (8.04% to 7.85%; P = 0.434). However, the mean total charge for 30-day COPD-related readmissions was significantly higher in 2014 ($40,611) compared with that in 2009 ($36,714) (P = 0.011). The overall unadjusted in-hospital mortality of COPD-related hospitalizations significantly decreased from 1.83% in 2009 to 1.34% in 2014 (P0.001). In a multivariable logistic regression model, patients with COPD were 2% less likely to be readmitted to the hospital for each additional year (odds ratio [OR], 0.98 [95% confidence interval (CI), 0.97-0.99]). Factors associated with significantly higher odds of COPD-related readmission were: older age (45 ≤ age ≤ 64 years; OR, 1.91 [95% CI, 1.70-2.14]), being male (OR, 1.14 [95% CI, 1.10-1.17]), and being a Medicaid beneficiary (OR, 1.28 [95% CI, 1.21-1.35]).Although the adjusted odds of COPD readmissions slightly decreased, as did the length of stay and all-cause in-patient mortality, the financial burden increased substantially. Future strategies to further reduce readmissions of patients with COPD and curb financial burden in Florida are needed.

This study aimed to assess how pneumonia incidence, health care resource utilization, costs, and hospital length of stay differ by age category in the United States.A retrospective cross-sectional analysis of the Medical Expenditure Panel Survey database was conducted from 2007 to 2011 for patients with pneumonia. Study outcomes were pneumonia incidence, annual health care utilization, and expenditures across 5 age groups. Early trends of outcomes in the period after introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) (2011) were compared with the pre-PCV13 period (2007-2009).Pneumonia incidence rates for the 1790 patients ranged from 9.2 to 33.0 per 1000 patients. Patients5 years old had the highest incidence rate at 33.0 per 1000 patients, followed by patients ≥65 years old (27.2 per 1000 patients) and patients ≥45 to65 years old (14.4 per 1000 patients). The percentages of patients with pneumonia-related hospitalization were 26%, 7%, 15%, 24%, and 46%, respectively (P0.0001). Mean (SD) days in hospital stay were 1.73 (0.08), 0.31 (0.50), 0.58 (0.10), 1.86 (0.29), and 3.05 (0.33), respectively (P0.05), for patients5, ≥5 to18, ≥18 to45, ≥45 to65, and ≥65 years old. Mean total pneumonia-related medical costs in patients aged5 years ($3376; P = 0.009), ≥45 to ≤65 years ($4726; P0.0001), and65 years ($7206; P0.0001) were significantly higher compared with patients ≥5 to18 years old ($1175) after controlling for covariates. Compared with the pre-PCV13 period (2007-2009; n = 1075), a 16% decrease in incidence, a 27% decrease length of stay in hospital, and a 22% decrease in medical costs were observed in the post-PCV13 period (2011; n = 382), although these differences were not statistically significant (P0.05).Pneumonia remains a disease with significant burden in the United States, and clinical and economic outcomes varied widely by age. Hospitalization for pneumonia has a considerable effect on economic burden, particularly for the very young (5 years old), middle-aged (≥45 to65 years old), and elderly (≥65 years old) populations. A trend toward reductions in pneumonia incidence and associated medical costs was observed after the PCV13 was introduced, although these findings were not statistically significant.

The prevalence of gout has been increasing. Serum uric acid (sUA) levels ≥6 mg/dL have been associated with high morbidity and increased health care utilization.To assess the costs and patterns of health care resource utilization for patients with gout, categorized into 3 cohorts based on sUA levels.We retrospectively analyzed laboratory, pharmacy, and medical service claims data (January 2005 to June 2010) for patients ≥18 years old. Inclusion criteria were at least 2 sUA levels and at least 1 primary gout diagnosis (International Classification of Disease-9th revision code 274.xx), and/or at least 1 prescription for gout-specific medications. Outcomes including costs, health care resource utilization, and medication adherence and persistence were assessed for the 1-year postindex period and summarized for the 3 cohorts based on sUA levels:6 mg/dL, 6 to 8.99 mg/dL, and ≥9 mg/dL. Costs were adjusted based on preindex utilization and baseline characteristics.Three hundred fifty-two patients met the inclusion criteria: cohort 1 (sUA6 mg/dL), n = 38, mean age 59 years; cohort 2 (sUA 6-8.99 mg/dL), n = 231, mean age 61 years; and cohort 3 (sUA ≥9 mg/dL), n = 83, mean age 62 years. Mean adjusted gout-related health care costs were $332, $353, and $663, respectively (P0.05); mean adjusted all-cause health care costs were $11,365, $11,551, and $14,474, respectively, for the 3 cohorts (P0.05). sUA levels were positively associated with the percent of patients who had at least 1 hospitalization and the mean number of hospitalizations and emergency department visits (P0.05). Significantly more patients with sUA6 mg/dL achieved adherence rates of ≥80% and had a longer mean duration of continuous treatment compared with patients with sUA between 6 and 8.99 mg/dL or ≥9.0 mg/dL (P0.05).Patients with high levels of sUA had higher gout-related and all-cause health care costs, more all-cause hospitalizations, and emergency department visits, but they also exhibited poorer adherence and persistence.