Richard H. Stanford

Seasonal variation in asthma-related hospital and intensive care unit admissions.

Seasonal trends in asthma-related hospitalizations are widely recognized; however, little is known about trends in asthma-related intensive care unit (ICU) admissions or intubations. The objective of this study is to examine monthly rates of asthma-related ICU admissions and/or intubations as a percent of total asthma-related admissions and to identify seasonality. This analysis was performed in a database of 285 hospitals representing > 3 million annual inpatient visits. Asthma-related hospital admissions for patients aged 5 and older were identified with a primary diagnosis of asthma (493.xx) during calendar years 2001–2002. The percents of the total admissions per month were compared. Monthly means were calculated and data were presented as moving averages. A total of 76,916 hospital admissions were identified with a primary diagnosis of asthma. Just over 10% (n = 7,803) were admitted to the ICU and/or intubated, with the majority among patients > 35 years of age (> 70%). A peak in asthma-related hospitalizations occurred in the winter months (10.3%) and a nadir in the summer months (5.9%; p < 0.004) with similar trends for ICU admissions. Despite this finding, ICU admissions and intubations remained relatively constant as a percent of total asthma-related hospitalizations, ranging from 9.2 to 10.9% and did not dip during the summer months when the overall asthma-related hospitalization rates were lowest. Significant differences in seasonal variation were also noted by age group and by region, but not by gender. These findings suggest a need for year-round vigilance and improved compliance with asthma therapy, especially during the summer when asthma attacks are perceived to be infrequent.

Qualitative Development of the Rhinitis Control Assessment Test (RCAT), an Instrument for Evaluating Rhinitis Symptom Control

AbstractBackground: Effective management of allergic rhinitis requires ongoing monitoring of its control. This article describes the qualitative phase of development of a patient-completed instrument, the Rhinitis Control Assessment Test (RCAT), designed to assist patients and providers in the detection of problems with rhinitis symptom control.n Objective: To identify concepts to be measured and to develop initial questionnaire items to be tested further in the next phase of development.n Methods: A literature review and input from patient focus groups were utilized to generate concepts to be measured in the draft questionnaire. The draft items were subjected to cognitive testing to ensure that the items were understood by patients and to eliminate ambiguity as well as to select an optimal recall period and meaningful response scales. Patients aged ≥18 years self-reporting a rhinitis diagnosis who had experienced rhinitis symptoms in the past 12 months were eligible for participation in the focus groups (n=39) and the cognitive interviews (n=23).n Results: This qualitative process yielded a draft instrument with 26 items assessing five constructs of rhinitis symptom control: frequency and bother-someness of nasal and non-nasal symptoms, symptom impact, activity interference, symptom control, and medication use. A five-point Likert response scale and a 1-week recall period for each item were adopted based on patient input.n Conclusion: The qualitative phase of development of the RCAT produced constructs and items for an instrument that is anticipated to facilitate accurate assessment of rhinitis control and improve the quality of care for patients with allergic rhinitis.

Cost of Chronic Obstructive Pulmonary Disease in the Emergency Department and Hospital

AbstractStudy objectives: Treatment of chronic obstructive pulmonary disease (COPD) in the emergency department (ED) or hospital accounts for a significant portion of COPD costs. This study estimates the cost of a COPD ED or hospitalization visit in the US.n Design: This observational study utilized administrative data from 218 acute care hospitals. ED/hospital discharges for COPD (International Classification of Diseases — Ninth Revision — Clinical Modification codes 491.xx. 492.xx, 496.xx) during 2001 were identified. Costs were determined for three groups: (i) ED only; (ii) standard admission; and (iii) severe admissions (intensive care unit [ICU] or intubation). Severe admissions were stratified into: (i) ICU/no intubation; (ii) intubation/no ICU; and (iii) ICU + intubation. Mean total costs and length of stay (LOS) were calculated for each group.n Results: A total of 59 735 ED/hospital encounters were identified: 20 431 ED only, 33 210 standard admissions, and 6094 severe admissions (4456 ICU/no intubation, 496 intubation/no ICU, and 1142 ICU/intubation). ED visits had a mean cost of

Cost-efficacy analysis of fluticasone propionate versus zafirlukast in patients with persistent asthma.

US571 ± 507 (year 2001 value). Inpatient costs ranged from

Physician perceptions of the treatment and management of allergic and nonallergic rhinitis.

US5997 (± 5752) for a standard admission to

Cost and occurrence of thrombocytopenia in patients receiving venous thromboembolism prophylaxis following major orthopaedic surgeries

US36 743 (± 62 886) for ICU plus intubation admissions, while LOS ranged from 5.1 days (±4.5) to 14.8 days (± 16.7), respectively. In addition, only 10% of encounters required an intubation/ICU admission, but these accounted for 34% of the cost.n Conclusion: Cost of a COPD hospitalization is substantial in the US, with one-third of those costs being associated with severe admissions, which make up only 10% of all COPD admissions. Treatments aimed at reducing hospitalizations and length of stay could result in substantial cost savings.

Initial Treatment Regimen and Risk of Hospitalization in Patients with Chronic Obstructive Pulmonary Disease

AbstractObjective: To compare the relative value of an inhaled corticosteroid, fluticasone propionate 88μg twice daily, versus an oral leukotriene receptor antagonist, zafirlukast 20mg twice daily, in patients with persistent asthma currently receiving short acting β2-agonists alone.n Study design: A cost-efficacy analysis using resource utilisation and clinical data obtained prospectively from a multicentre, randomised, double-blind, double-dummy, placebo-controlled 12-week clinical trial conducted in the US.n Perspective: Third-party payor.n Patients and methods: A total of 451 corticosteroid-naive patients with persistent asthma were treated with either fluticasone propionate 88μg twice daily or zafirlukast 20mg twice daily. All patients were given salbutamol (albuterol) to be used as rescue medication. Data were examined using intent-to-treat analysis.n Results: Mean daily per person cost-efficacy ratios using improvement in forced expiratory volume in 1 second (FEV1) [≥12% increase from baseline] were

Validation of a New Risk Measure for Chronic Obstructive Pulmonary Disease Exacerbation Using Health Insurance Claims Data.

US3.47 for fluticasone propionate compared with

Clinical and economic outcomes associated with low-dose fluticasone propionate versus montelukast in children with asthma aged 4 to 11 years.

US7.81 for zafirlukast (1999 values). The mean daily per person cost-efficacy ratios for symptom-free days obtained were

Barriers and Benefits to the Use of Patient-Reported Outcome Measures in Routine Clinical Care: A Qualitative Study:

US5.51 for fluticasone propionate compared with