B.H. Heng

Economic burden of chronic obstructive pulmonary disease.

Background and objective:  The aim of this study was to estimate the direct medical costs of COPD in two public health clusters in Singapore from 2005 to 2009.

Stratifying healthcare costs using the Diabetes Complication Severity Index

OBJECTIVE We aim to determine whether healthcare costs for patients diagnosed with Type 2 Diabetes Mellitus (T2DM) are associated with the severity of diabetes complications as measured by the Diabetes Complication Severity Index (DCSI). METHODS Retrospective cohort analysis was performed on a 2007 primary care cohort of T2DM patients. The DCSI is a 13-point scale, which comprises 7 categories of complications and their severity levels. Healthcare cost data from 2008 and 2009 were used as primary outcome. Inpatient and outpatient costs incurred for services consumed by patients within the provider network were included. Generalized linear model with log-link and gamma distribution was used to predict healthcare costs. RESULTS Of the 59,767 T2DM patients, 2977 (5.0%) deaths occurred and 1336 (2.2%) were lost to follow up. Healthcare cost was strongly associated with increase in DCSI score. Compared to patients without complications, those with more complications (higher DCSI score) had an increased risk of higher healthcare costs. Risk ratio (RR) increased from 1.25 (95%CI: 1.19-1.32) for DCSI=1 to 1.61 (1.51-1.72) for DCSI=2; 2.10 (1.91-2.31) for DCSI=3; 2.52 (2.21-2.87) for DCSI=4 and 3.62 (3.09-4.25) for DCSI≥5. As a continuous score, a one-point increase in the DCSI was associated with a cost increase of 27% (95%CI: 1.25-1.29). CONCLUSION The DCSI score is a useful tool for predicting direct healthcare costs. The DCSI can be used to triage high-risk patients for more focused secondary prevention interventions at primary care level, in a bid to lower overall healthcare costs.

Predicting mortality among older adults hospitalized for community‐acquired pneumonia: An enhanced Confusion, Urea, Respiratory rate and Blood pressure score compared with Pneumonia Severity Index

Background and objective:  Pneumonia Severity Index (PSI) predicts mortality better than Confusion, Urea >7 mmol/L, Respiratory rate >30/min, low Blood pressure: diastolic blood pressure <60 mm Hg or systolic blood pressure <90 mm Hg, and age >65 years (CURB‐65) for community‐acquired pneumonia (CAP) but is more cumbersome. The objective was to determine whether CURB enhanced with a small number of additional variables can predict mortality with at least the same accuracy as PSI.

PRS2 CLINICAL OUTCOMES OF PATIENTS HOSPITALIZED WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) EXACERBATIONS IN SINGAPORE

OBJECTIVES: Iatrogenic chronic pain is increasingly recognized as a major adverse outcome after inguinal hernia repair. In order to assess chronic post-herniorrhaphy pain, we developed the 18item Inguinal Pain Questionnaire (IPQ). The aim of the present study was to test its validity and reliability and explore the prevalence of long term pain as determined by the questionnaire in a sample from the population-based Swedish Hernia Register. METHODS: Validity was tested in 100 patients who received the IPQ and the Brief Pain Inventory (BPI) 1 and 4 weeks after surgery (Group A). The reliability was tested in 100 patients who received the IPQ on two occasions one month apart 3 years after operation (Group B). From the Swedish Hernia Register 2853 operated 2000 were requested to fill in IPQ by mail. RESULTS: As an indication of construct validity, a significant (p < 0.001) decrease in IPQ-rated pain intensity was observed in the first 4 weeks after surgery. Significant (p < 0.05) correlations with corresponding BPI pain intensity items corroborated the criterion validity. The rate of logical incoherence did not exceed 5.5% for any item. Kappa values in the test-retest one month apart in group B were higher than 0.5 for all but three items, indicating acceptable reliability. Cronbachs alpha was 0.83 for questions on pain intensity and 0.51 for interference with daily activities. After two reminders, 2456 patients (86%), in the sample from the Hernia Register had responded to the questionnaire. In response to a question about “worst perceived pain last week”, 758 patients (31%) reported pain to some extent. In 144 cases (6%) the pain interfered with daily activities. CONCLUSION: The validity and reliability is sufficient to make IPQ a useful instrument in the routine assessment of post-herniorrhaphy pain. Disabling pain was found to be a widespread problem 3 years after surgery.