The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

PREDICTING PROGNOSIS IN OUTPATIENTS WITH ADVANCED COPD

Jamie Vaccaro, BS. RRT. Herbert Patrick. MD. Susan Haywood. AS. RRT. John Schrogie. MD. Vijay Nadipelli, MS. Departments of Respiratory Care and Health Policy/Clinical Outcomes. Thomas Jefferson University Hospital Inc., Philadelphia. PA

Introduction and Hypothesis: Hospice programs offer a cost effective alternative method of care for terminally ill patients with approximately six months to live. We initiated a project to determine which parameters identify short term prognosis. i.e., six months, for outpatients with advanced COPD. Method: We selected fifteen COPD patients with severe COPD by FEV_{1} and with past medical records available for a minimum of two years. Data was obtained by both a retrospective chart analysis using hospital and office records and a prospective study lasting six months from March to August 1995. The patients were divided into two groups according to whether they were living or expired by the prospective study cutoff date. Patients received a SF- 36 (quality of life) questionnaire and Karnofsky Scoring Scale (0-100: 100 is normal daily function) with the prospective clinical observation.

Variable Living Expired p Value*

n 8 7

Age. yrs 73.5 ± 8.6 69.1 ± 10.6 0.20

Sex. n Male 3 Female 5 Male 4 Female 3

Racc. n Cau 2 Cau 3 Cau 3 Cau 2

Afr Am 1 Afr Am 2 Afr Am 1 Arf Amcr 1

Oxygen Usage 3 5 0.20

FEV % 38.9±20.3 27.6±5.4 0.09

Inpt. Adm/yr. 2.0±1.60 8.71±5.31 0.007

Outpt. Visits/yr 19.5±10.5 15.1±11.4 0.23

ER Visits/yr. 2.4±2.9 8.4±6.1 0.02

Diuretic Usage 1.88±1.80 1.29±1.38 0.22

Digitalis Usage 0.63±1.76 0.29±0.48 0.31

Antibiotic Usage 1.88±1.46 1.29±1.38 0.22

Karnofsky 62.5 ± 15.6 76.3±14.9 0.18

* 1-Test except oxygen usage from Fisher exact, p < 0.05 is significant.

Results: Patients are divided by clinical status group with data shown as mean ± S.D. Three patients expired before initiating the prospective study and four patients expired during the prospective study. The FEV_{1} and oxygen usage was not significantly different in patients who expired. The SF-36 testing disclosed no significant difference between the two groups, although both were below U.S. population norms. The mean number of inpatient admissions/yr (p < .007) and Emergency Room visits/yr (p < .02) were significantly greater in patients who expired. Conclusion: The increased use of hospital services and not the physiologic variables such as FEV_{1} and oxygen usage offers a predictor of six month terminal status. A larger study is indicated to better define six month prognostic factors in COPD patients. As frequent hospitalizations or emergency care begin to occur, more cost effective supportive care alternatives such as hospice care may need to be considered.

Sponsored in part by Vitas Healthcare Corporation.

Reference: OF-96-146

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