Quality of Care Delivered to Veterans with COPD Exacerbation and the Association with 30-Day Readmission and Death

Figures & data

Figure 1. Cohort selection diagram.

Figure 2. Performance data for the five hospitals. The line in the middle of each box represents the median performance percentile and the box extends to the interquartile range (IQR). The whisker lines emerging from the boxes extend to the maximum and minimum values. The ideal acute care composite measurement indicates receiving all of the following five therapies recommended by guidelines: short-acting bronchodilators, steroids, antibiotics, chest radiography and arterial blood gas measurement. The ideal ICU care composite measurement indicates receiving all of the five therapies from acute care in addition to the appropriate use of positive-pressure ventilation for acute hypercarbic respiratory failure. ABG = arterial blood gas. SABD = short-acting bronchodilators.

Figure 3. Delivery of guideline recommended COPD care over years 2005–2011.

Table 1. Inpatient quality care scores are not associated with patient outcomes.

Acute care score	Readmit/Death	Readmit	Death
0–3 (n = 738)	0.92 (0.71–1.17)	0.94 (0.72–1.25)	0.68 (0.42–1.09)
4 (n = 851)	0.98 (0.79–1.23)	0.88 (0.64–1.21)	0.66 (0.42–1.06)
5 (n = 351)	0.75 (0.53–1.05)	0.77 (0.56–1.11)	0.55 (0.33–1.30)
ICU care score
0–4 (n = 98)	1.04 (0.59–1.85)	1.04 (0.57–1.97)	1.12 (0.48–2.59)
5 (n = 164)	0.96 (0.54–1.67)	0.96 (0.51–1.79)	0.90 (0.39–2.10)
6 (n = 162)	0.74 (0.44–1.26)	0.61 (0.33–1.13)	0.92 (0.44–1.94)

Note. All values expressed as adjusted odds ratios (95% confidence interval). Values are adjusted for patient age, BMI, smoking status, diabetes, obstructive sleep apnea, congestive heart failure, and prior COPD exacerbation history.