Southern Medical Journal · 1983 · 11 citations · 0 references
MedicineClinical SciencesInternal MedicineContinuity Of CareHospital MedicinePulmonologyChronic Obstructive Pulmonary DiseaseChronic Obstructive Pulmonary Disease CareContinuing CareInpatient CareObstructive Lung DiseaseRespiratory DiseaseArterial Blood Gas AssessmentArterial Blood Gas MonitoringArterial Blood Gas SamplingChronic Obstructive Pulmonary Disease AssessmentChronic Obstructive Pulmonary Disease EpidemiologyChronic Obstructive Pulmonary Disease PathophysiologyLaboratory Data AcquisitionRespiratory Disease Management
Over a two-year period, the management of patients with chronic obstructive lung disease was observed in the walk-in clinic of a Veterans Administration Medical Center. Of 794 visits, 279 (35%) resulted in immediate hospitalization. Of 515 patients sent home, 229 (44%) relapsed, and of these, 165 (72%) eventually required admission. The clinical and laboratory data routinely obtained, including arterial blood gas values in 69% of the visits, could not distinguish the inappropriate discharges unless acidosis or severe hypoxemia was present. About 10% of the patients accounted for 30% of the admissions. Severity of disease, especially the development of cor pulmonale, accounted only partially for high demand by a subset of patients. Psychosocial factors and inadequacy of facilities for continuing home care play an essential, though poorly defined, role in precipitating hospital admissions.