GEOGRAPHIC VARIATION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) GUIDELINE COMPLIANCE RATES ACROSS HOSPITAL REFERRAL REGIONS (HRR) IN TEXAS: AN ANALYSIS OF PRIVATE INSURANCE POPULATION

Purpose: To explore the geographic variation in the adherence to guideline recommended care in patients post-discharged from COPD-related hospitalizations or emergency department (ED) visits in a private insured population in Texas

Method: All hospital admissions and ED visits for COPD during the period of 2008 to 2011 were identified from the Blue Cross Blue Shield of Texas claims data. Patients were included in the study if they: were enrolled in PPO, PPO+, RPO and POS plan; had drug benefits with BCBS of TX plan; were 40 years of age and over and resided in a Texas Hospital Referral Region (HRR). Patients were identified as a recipient of guideline recommended care if within 30 days of discharge, they had at least one claim of prescription fills for any long-acting bronchodilators either beta2-agonists and/or anticholinergics with or without inhaled corticosteroids AND had at least one follow up visit with a primary care physician or pulmonologist. The adherence to guideline recommended care rates for each HRR were calculated by dividing number of discharges that received guideline recommended care by number of COPD-related hospitalizations/ED visit for each HRR. Index of variation (each HRR guideline compliance rate compare to overall Texas means) and coefficients of variation (CV; standard deviations from the Texas means) were calculated to examine the variation in guideline compliance rate.

Result: Of the 2,326 COPD-related hospitalizations/ED visit (1,100 ED visits and 1,226 admissions), 23.99% (29.85% of ED visits and 17.45% of  admissions) had at least one prescription filled for maintenance medication and at least one follow up visit with primary care physician or pulmonologist within 30 days of discharge. Guideline compliance rates ranges from 15.38% in Waco HRR to 33.33% in Longview HRR with Texas coefficient of variation equal to 0.12.

Conclusion: Variations in guideline compliance rates were found among HRRs in Texas indicating inefficiencies in the treatment of COPD patients. Further investigation on factors contribute to this variation will provide insights for better policies and program interventions that may increase guideline compliance rates and reduce preventable COPD readmission.