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Abstract：
BACKGROUND: Although chronic obstructive pulmonary disease (COPD) admissions put a substantial burden on hospitals, most of the patients\' contacts with health services are in outpatient care. Traditionally, outpatient care has been difficult to capture in population-based samples. In this study we describe outpatient service use in COPD patients and assess associations between outpatient care (contact frequency and specific factors) and next-year COPD hospital admissions or 90-day readmissions.
METHODS: Patients over 40 years of age residing in Oslo or Trondheim at the time of contact in the period 2009-2018 were identified from the Norwegian Patient Registry (in- and outpatient hospital contacts, rehabilitation) and the KUHR registry (contacts with GPs, contract specialists and physiotherapists). These were linked to the Regular General Practitioner registry (characteristics of the GP practice), long-term care data (home and institutional care, need for assistance), socioeconomic and-demographic data from Statistics Norway and the Cause of Death registry. Negative binomial models were applied to study associations between combinations of outpatient care, specific care factors and next-year COPD hospital admissions and 90-day readmissions. The sample consisted of 24,074 individuals.
RESULTS: A large variation in the frequency and combination of outpatient service use for respiratory diagnoses (GP, emergency room, physiotherapy, contract specialist and outpatient hospital contacts) was apparent. GP and outpatient hospital contact frequency were strongly associated to an increased number of next-year hospital admissions (1.2-3.2 times higher by increasing GP frequency when no outpatient hospital contacts, 2.4-5 times higher in combination with outpatient hospital contacts). Adjusted for healthcare use, comorbidities and sociodemographics, outpatient care factors associated with lower numbers of next-year hospitalisations were fees indicating interaction between providers (7% reduction), spirometry with GP or specialist (7%), continuity of care with GP (15%), and GP follow-up (8%) or rehabilitation (18%) within 30 days vs. later following any current year hospitalisations. For 90-day readmissions results were less evident, and most variables were non-significant.
CONCLUSIONS: As increased use of outpatient care was strongly associated with future hospitalisations, this further stresses the need for good communication between providers when coordinating care for COPD patients. The results indicated possible benefits of care continuity within and interaction between providers.
METHODS: Patients over 40 years of age residing in Oslo or Trondheim at the time of contact in the period 2009-2018 were identified from the Norwegian Patient Registry (in- and outpatient hospital contacts, rehabilitation) and the KUHR registry (contacts with GPs, contract specialists and physiotherapists). These were linked to the Regular General Practitioner registry (characteristics of the GP practice), long-term care data (home and institutional care, need for assistance), socioeconomic and-demographic data from Statistics Norway and the Cause of Death registry. Negative binomial models were applied to study associations between combinations of outpatient care, specific care factors and next-year COPD hospital admissions and 90-day readmissions. The sample consisted of 24,074 individuals.
RESULTS: A large variation in the frequency and combination of outpatient service use for respiratory diagnoses (GP, emergency room, physiotherapy, contract specialist and outpatient hospital contacts) was apparent. GP and outpatient hospital contact frequency were strongly associated to an increased number of next-year hospital admissions (1.2-3.2 times higher by increasing GP frequency when no outpatient hospital contacts, 2.4-5 times higher in combination with outpatient hospital contacts). Adjusted for healthcare use, comorbidities and sociodemographics, outpatient care factors associated with lower numbers of next-year hospitalisations were fees indicating interaction between providers (7% reduction), spirometry with GP or specialist (7%), continuity of care with GP (15%), and GP follow-up (8%) or rehabilitation (18%) within 30 days vs. later following any current year hospitalisations. For 90-day readmissions results were less evident, and most variables were non-significant.
CONCLUSIONS: As increased use of outpatient care was strongly associated with future hospitalisations, this further stresses the need for good communication between providers when coordinating care for COPD patients. The results indicated possible benefits of care continuity within and interaction between providers.
摘要：
背景：尽管慢性阻塞性肺疾病（COPD）的入院给医院带来了沉重负担，大多数与卫生服务机构接触的患者都是在门诊治疗。传统上,在以人群为基础的样本中,很难捕获门诊护理.在这项研究中，我们描述了COPD患者的门诊服务使用情况，并评估了门诊护理（接触频率和特定因素）与明年COPD住院或90天再入院之间的关联。
方法：在2009-2018年期间接触时居住在奥斯陆或特隆赫姆的40岁以上的患者从挪威患者登记处（医院内和门诊接触者，康复)和KUHR登记册(与全科医生联系，合同专家和物理治疗师)。这些被链接到普通全科医生注册表（GP实践的特征），长期护理数据(家庭和机构护理，需要帮助)，来自挪威统计局的社会经济和人口统计数据和死因登记。负二项模型用于研究门诊护理组合之间的关联，具体的护理因素和下一年COPD住院和90天再入院。样本由24,074个人组成。
结果：用于呼吸诊断的门诊服务使用的频率和组合差异很大（GP，急诊室,物理治疗,合同专家和门诊医院联系人)很明显。GP和门诊医院接触频率与明年住院人数的增加密切相关（当没有门诊医院接触时，GP频率增加了1.2-3.2倍，与门诊医院接触者组合的2.4-5倍）。针对医疗保健用途进行了调整，合并症和社会人口统计学，与明年住院人数减少相关的门诊护理因素是表明提供者之间相互作用的费用(减少7%)，与全科医生或专家进行肺活量测定（7%），与全科医生的护理连续性（15%），和GP随访（8％）或康复（18％）在30天内与在任何本年度住院后的晚些时候。对于90天的再入院结果不太明显，大多数变量无显著性。
结论：由于门诊护理的使用增加与未来的住院密切相关，这进一步强调,在协调COPD患者的护理时,提供者之间需要良好的沟通.结果表明，提供者内部的护理连续性和提供者之间的互动可能带来好处。
方法：在2009-2018年期间接触时居住在奥斯陆或特隆赫姆的40岁以上的患者从挪威患者登记处（医院内和门诊接触者，康复)和KUHR登记册(与全科医生联系，合同专家和物理治疗师)。这些被链接到普通全科医生注册表（GP实践的特征），长期护理数据(家庭和机构护理，需要帮助)，来自挪威统计局的社会经济和人口统计数据和死因登记。负二项模型用于研究门诊护理组合之间的关联，具体的护理因素和下一年COPD住院和90天再入院。样本由24,074个人组成。
结果：用于呼吸诊断的门诊服务使用的频率和组合差异很大（GP，急诊室,物理治疗,合同专家和门诊医院联系人)很明显。GP和门诊医院接触频率与明年住院人数的增加密切相关（当没有门诊医院接触时，GP频率增加了1.2-3.2倍，与门诊医院接触者组合的2.4-5倍）。针对医疗保健用途进行了调整，合并症和社会人口统计学，与明年住院人数减少相关的门诊护理因素是表明提供者之间相互作用的费用(减少7%)，与全科医生或专家进行肺活量测定（7%），与全科医生的护理连续性（15%），和GP随访（8％）或康复（18％）在30天内与在任何本年度住院后的晚些时候。对于90天的再入院结果不太明显，大多数变量无显著性。
结论：由于门诊护理的使用增加与未来的住院密切相关，这进一步强调,在协调COPD患者的护理时,提供者之间需要良好的沟通.结果表明，提供者内部的护理连续性和提供者之间的互动可能带来好处。
