From Clinic to Comfort: The Impact of Frequent Pulmonary Clinic Visits on Advanced COPD Hospitalizations - A Retrospective Case-Control Study of Two University Hospitals.

Abstract

Introduction: About 25% of chronic obstructive pulmonary disease (COPD) patients have advanced disease that cause severe exacerbations that lead to hospitalizations and increase mortality. While outpatient visits are known to reduce COPD exacerbations, their impact on advanced COPD-related hospitalizations is less known. This study examines whether frequent outpatient pulmonary clinic visits help prevent hospitalizations and reduce inpatient mortality.

Methods: We identified COPD patients admitted in 2019 with acute COPD exacerbation using billing codes at two university hospitals (N=1200). Home oxygen and FEV1 greater than 50% were used to identify advanced COPD patients (N=486). Retrospective data over 3 years for outpatient pulmonary visits was used to subdivide patients into frequent pulmonary clinic visitors in one calendar year and infrequent visitors (IFV).

Results: Among our cohort, 46% were IFV and 54% were FV with a comparable mean age seen (FV: 64.8 vs. IFV: 63.3 years; p = 0.37). FV had 49% lower odds of advanced COPD-related hospitalization (aOR: 0.51, p = 0.004) and receive guideline-directed management (56.1% vs. 35.3%), all of which were statistically significant. Similarly, FV had higher rates of flu vaccination (87.1% vs. 79.8%; p = 0.051. The Charlson Comorbidity Index was higher in hospitalized patients (1.82 vs. 1.49; p = 0.024). While FV were 28% less likely to die (OR = 0.72, p = 0.124), this was not statistically significant. Hospitalization was a strong predictor of inpatient mortality (OR = 3.12).

Conclusions: Our study suggests that frequent outpatient pulmonary clinic visits in patients with advanced COPD significantly reduce COPD-related hospitalizations, improve guideline-directed management, and enhance preventive care. While a direct mortality benefit was not statistically significant, the reduction in hospitalizations rate suggests potential indirect survival benefit. Further controlled studies are needed to validate these findings and inform future COPD-related healthcare policies.