Table 2.
COPD Quality of Health Care and Utilization Outcomes
| Primary Outcomes (Quality Metrics) | Rural, % (n = 400) | Urban, % (n = 401) | Difference (95% CI), % | P Value |
|---|---|---|---|---|
|
| ||||
| Spirometry | 51 | 82 | 31 (25 to 37) | < .01 |
|
| ||||
| Pneumonia vaccine | 88 | 91 | 3 (−1 to 7) | .40 |
|
| ||||
| Influenza vaccine | 79 | 81 | 3 (−3 to 8) | .32 |
|
| ||||
| Short-acting inhaler | 66 | 68 | 3 (−4 to 9) | .44 |
|
| ||||
| Long-acting inhaler | 61 | 59 | 1 (−5 to 8) | .69 |
| LAMA | 36 | 34 | .59 | |
| LABA/ICS | 46 | 46 | .97 | |
| LABA | 4 | 3 | .85 | |
| ICS | 5 | 6 | .45 | |
|
| ||||
| Health Care Utilization Secondary Outcomes | ||||
|
| ||||
| Home oxygen therapy | 8 | 9 | 1 (−2 to 5) | .45 |
|
| ||||
| Corticosteroid usea | 17 | 31 | 14 (9 to 20) | < .01 |
|
| ||||
| Antibiotic usea | 18 | 32 | 14 (8 to 20) | < .01 |
|
| ||||
| Emergency department visitsa | 7 | 13 | 6 (2 to 10) | < .01 |
|
| ||||
| Hospitalizationsa,b | 5 | 6 | 1 (−2 to 4) | .65 |
|
| ||||
| Pulmonology visitsc | 6 | 9 | 3 (−1 to 6) | .55 |
Abbreviations: COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroid; LABA, long-acting beta agonist; LABA/ICS, long-acting beta agonist/inhaled corticosteroid; LAMA, long-acting muscarinic antagonist.
a
For COPD exacerbation.
b
No patients needed mechanical ventilation.
c
Seen by VA pulmonologist: rural: 20/24; urban: 35/35.