Patient Perceptions of Their Doctors and Hospitalization among Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease

Suyuan Zhang, Purdue University

Abstract

The objectives for this study were to determine one-year incidence of ambulatory care-sensitive hospitalizations for Chronic Obstructive Pulmonary Disease (COPD) in a Medicare population, to assess association between patient perceptions of their doctors and COPD ambulatory care-sensitive hospitalization, and to assess association between patient perceptions of their doctors and COPD-related hospitalization. An observational, retrospective cohort study was conducted using data from the 2007 to 2012 Medicare Current Beneficiary Survey (MCBS). Patient perceptions of their doctor and hospitalization were assessed during the study period, defined as 12 months following the year in which COPD diagnosis was identified. Individuals were included if they had a diagnosis of COPD, had continuous coverage in Medicare Part A and Medicare Part B during the 12-month study period and the preceding year, and had identified a usual source of care. Individuals were excluded if they had any missing data on items used to create the patient perceptions of doctors index, had a proxy responder, or had a diagnosis of Alzheimer’s disease or dementia. Among 2,306 Medicare beneficiaries who met study criteria, 52 percent were 75 years or older, 54 percent were women, and 86 percent were White. A patient perception of their doctors index was created using MCBS survey items. Individuals with an overall score for the patient perceptions of their doctors scale greater or equal to the median value were categorized as having positive perceptions of their doctors, while those with an overall score below the median value were categorized as having less than positive perceptions of their doctors. One-year incidence of COPD ambulatory care-sensitive hospitalizations was 4.1 percent (95% CI=3.3% to 4.9%). Association between patient perceptions of their doctors and COPD ambulatory care-sensitive hospitalization risk was assessed using multivariate logistic regression models, adjusted for covariates selected from stepwise procedure. The associations between patient perceptions of their doctors and number of COPD ambulatory care-sensitive hospitalizations, COPD ambulatory care-sensitive hospital days, or COPD ambulatory care-sensitive hospitalization expenditures were assessed using multivariate generalized linear models, adjusted for covariates selected from stepwise procedure. Similar models were developed to assess associations between patient perceptions of their doctors and COPD-related hospitalization outcomes. No association was found between patient perceptions of their doctors and COPD ambulatory care-sensitive hospitalization outcomes. However, multivariate models revealed that oxygen users who had less than positive perceptions of their doctors were more likely to have a COPD-related hospitalization (odds ratio=1.73, p=0.010) and had more COPD-related hospitalizations (average marginal effect=0.155, p=0.028) as compared to those who had positive perceptions of their doctors.

Degree

Ph.D.

Advisors

Thomas, Purdue University.

Subject Area

Health care management

COinS