149 research outputs found
Predicting the costs of managing patients with chronic obstructive pulmonary disease
SummaryThe economic consequences of chronic obstructive pulmonary disease (COPD) are considerable, although the factors that best predict costs are largely unknown. This study used a population-based cohort to identify the clinical factors during an index year that were most predictive of increased direct medical costs in the subsequent year, and to develop a predictive model that described the cost variations in COPD.The medical records of 2116 patients enrolled in one regional health system who had COPD and healthcare resource utilisation data for 1998 and 1999, were abstracted for information about symptoms, smoking history, chronic illnesses, and pulmonary function data. All inpatient, outpatient and pharmacy utilisation data for each subject for 1999 were extracted from the database. Total costs for each individual were transformed to a log scale. Potential causes of cost variability (predictor variables) were defined and classified into sets (or domains). Multiple linear regression models were fitted for each domain.The study demonstrated that severity of airflow obstruction, as assessed by FEV1% predicted, is a significant but weak predictor of future healthcare resource utilisationâprior hospitalisation and home oxygen use, the presence of comorbid conditions and symptoms of dyspnoea are better predictors of costs. Those interested in the economic benefits of new COPD treatments and disease management programs need to carefully account for these factors
The validity of using ICD-9 codes and pharmacy records to identify patients with chronic obstructive pulmonary disease
Background: Administrative data is often used to identify patients with chronic obstructive pulmonary disease (COPD), yet the validity of this approach is unclear. We sought to develop a predictive model utilizing administrative data to accurately identify patients with COPD.
Methods: Sequential logistic regression models were constructed using 9573 patients with postbronchodilator spirometry at two Veterans Affairs medical centers (2003-2007). COPD was defined as: 1) FEV1/FVC <0.70, and 2) FEV1/FVC < lower limits of normal. Model inputs included age, outpatient or inpatient COPD-related ICD-9 codes, and the number of metered does inhalers (MDI) prescribed over the one year prior to and one year post spirometry. Model performance was assessed using standard criteria.
Results: 4564 of 9573 patients (47.7%) had an FEV1/FVC < 0.70. The presence of â„1 outpatient COPD visit had a sensitivity of 76% and specificity of 67%; the AUC was 0.75 (95% CI 0.74-0.76). Adding the use of albuterol MDI increased the AUC of this model to 0.76 (95% CI 0.75-0.77) while the addition of ipratropium bromide MDI increased the AUC to 0.77 (95% CI 0.76-0.78). The best performing model included: â„6 albuterol MDI, â„3 ipratropium MDI, â„1 outpatient ICD-9 code, â„1 inpatient ICD-9 code, and age, achieving an AUC of 0.79 (95% CI 0.78-0.80).
Conclusion: Commonly used definitions of COPD in observational studies misclassify the majority of patients as having COPD. Using multiple diagnostic codes in combination with pharmacy data improves the ability to accurately identify patients with COPD.Department of Veterans Affairs, Health Services Research and Development (DHA), American Lung Association (CI- 51755-N) awarded to DHA, the American Thoracic Society Fellow Career Development AwardPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/84155/1/Cooke - ICD9 validity in COPD.pd
Overcoming the Challenges Associated with Image-based Mapping of Small Bodies in Preparation for the OSIRIS-REx Mission to (101955) Bennu
The OSIRIS-REx Asteroid Sample Return Mission is the third mission in NASA's
New Frontiers Program and is the first U.S. mission to return samples from an
asteroid to Earth. The most important decision ahead of the OSIRIS-REx team is
the selection of a prime sample-site on the surface of asteroid (101955) Bennu.
Mission success hinges on identifying a site that is safe and has regolith that
can readily be ingested by the spacecraft's sampling mechanism. To inform this
mission-critical decision, the surface of Bennu is mapped using the OSIRIS-REx
Camera Suite and the images are used to develop several foundational data
products. Acquiring the necessary inputs to these data products requires
observational strategies that are defined specifically to overcome the
challenges associated with mapping a small irregular body. We present these
strategies in the context of assessing candidate sample-sites at Bennu
according to a framework of decisions regarding the relative safety,
sampleability, and scientific value across the asteroid's surface. To create
data products that aid these assessments, we describe the best practices
developed by the OSIRIS-REx team for image-based mapping of irregular small
bodies. We emphasize the importance of using 3D shape models and the ability to
work in body-fixed rectangular coordinates when dealing with planetary surfaces
that cannot be uniquely addressed by body-fixed latitude and longitude.Comment: 31 pages, 10 figures, 2 table
The natural history of chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the USA, and it remains one of the few diseases that continues to increase its numbers. The development and progression of COPD can vary dramatically between individuals. A low level of lung function remains the cornerstone of COPD diagnosis and is a key predictor of prognosis. Lung function, however, is not the only factor in determining morbidity and mortality related to COPD, with factors such as body mass index, exercise capability and comorbid disease being important predictors of poor outcomes. Exacerbations of COPD are additional important indicators of both quality of life and outcomes in COPD patients. Definitions of exacerbations can vary, ranging from an increase in symptoms to COPD-related hospitalisations and death. COPD exacerbations are more common in patients with lower levels of lung function and may lead to more rapid declines in lung function. Better understanding of the natural history of COPD may lead to better definitions of specific COPD phenotypes, better interventions and improved outcomes
External validation of a COPD prediction model using population-based primary care data: a nested case-control study
Emerging models for predicting risk of chronic obstructive pulmonary disease (COPD) require external validation in order to assess their clinical value. We validated a previous model for predicting new onset COPD in a different database. We randomly drew 38,597 case-control pairs (total Nâ=â77,194) of individuals aged â„35 years and matched for sex, age, and general practice from the United Kingdom Clinical Practice Research Datalink database. We assessed accuracy of the model to discriminate between COPD cases and non-cases by calculating area under the receiver operator characteristic (ROC(AUC)) for the prediction scores. Analogous to the development model, ever smoking (OR 6.70; 95%CI 6.41â6.99), prior asthma (OR 6.43; 95%CI 5.85â7.07), and higher socioeconomic deprivation (OR 2.90; 95%CI 2.72â3.09 for highest vs. lowest quintile) increased the risk of COPD. The validated prediction scores ranged from 0â5.71 (ROC(AUC) 0.66; 95%CI 0.65â0.66) for males and 0â5.95 (ROC(AUC) 0.71; 95%CI 0.70â0.71) for females. We have confirmed that smoking, prior asthma, and socioeconomic deprivation are key risk factors for new onset COPD. Our model seems externally valid at identifying patients at risk of developing COPD. An impact assessment now needs to be undertaken to assess whether this prediction model can be applied in clinical care settings
Introducing the national COPD resources and outcomes project
<p>Abstract</p> <p>Background</p> <p>We report baseline data on the organisation of COPD care in UK NHS hospitals participating in the National COPD Resources and Outcomes Project (NCROP).</p> <p>Methods</p> <p>We undertook an initial survey of participating hospitals in 2007, looking at organisation and performance indicators in relation to general aspects of care, provision of non-invasive ventilation (NIV), pulmonary rehabilitation, early discharge schemes, and oxygen. We compare, where possible, against the national 2003 audit.</p> <p>Results</p> <p>100 hospitals participated. These were typically larger sized Units. Many aspects of COPD care had improved since 2003. Areas for further improvement include organisation of acute care, staff training, end-of-life care, organisation of oxygen services and continuation of pulmonary rehabilitation.</p> <p>Conclusion</p> <p>Key Points: positive change occurs over time and repeated audit seems to deliver some improvement in services. It is necessary to assess interventions such as the Peer Review used in the NCROP to achieve more comprehensive and rapid change.</p
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Overcoming the Challenges Associated with Image-Based Mapping of Small Bodies in Preparation for the OSIRIS-REx Mission to (101955) Bennu
The OSIRISâREx Asteroid Sample Return Mission is the third mission in National Aeronautics and Space Administration (NASA)'s New Frontiers Program and is the first U.S. mission to return samples from an asteroid to Earth. The most important decision ahead of the OSIRISâREx team is the selection of a prime sampleâsite on the surface of asteroid (101955) Bennu. Mission success hinges on identifying a site that is safe and has regolith that can readily be ingested by the spacecraft's sampling mechanism. To inform this missionâcritical decision, the surface of Bennu is mapped using the OSIRISâREx Camera Suite and the images are used to develop several foundational data products. Acquiring the necessary inputs to these data products requires observational strategies that are defined specifically to overcome the challenges associated with mapping a small irregular body. We present these strategies in the context of assessing candidate sample sites at Bennu according to a framework of decisions regarding the relative safety, sampleability, and scientific value across the asteroid's surface. To create data products that aid these assessments, we describe the best practices developed by the OSIRISâREx team for imageâbased mapping of irregular small bodies. We emphasize the importance of using 3âD shape models and the ability to work in bodyâfixed rectangular coordinates when dealing with planetary surfaces that cannot be uniquely addressed by bodyâfixed latitude and longitude.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]
REVISITING THE APOLLO PHOTOGRAMMETRIC MAPPING SYSTEM
The integrated photogrammetric mapping system flown on the last three Apollo lunar missions (AS15, AS16, and AS17) in 1971 and 1972 incorporated a Metric (mapping) Camera, a high-resolution Panoramic Camera, and a star camera and laser altimeter. The U.S. Geological Surveyâs Astrogeology Science Center, the Intelligent Robotics Group of the NASA Ames Research Center, and Arizona State University are working together in an ongoing collaboration to achieve the most complete cartographic development of Apollo mapping system data into versatile digital map products. These will enable a variety of scientific/engineering uses of the data including mission planning, geologic mapping, geophysical process modelling, slope dependent correction of spectral data, and change detection. After a brief discussion of the origins of the mapping system, we describe the Metric and Panoramic cameras, processing of the associated image and support data, work to photogrammetrically control the Metric Camera images, and future plans
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