How different combinations of comorbidities affect healthcare use by elderly patients with obstructive lung disease.

Previous research had shown the number of comorbidities is a major factor influencing the burden of care for elderly patients with obstructive lung disease (OLD). This retrospective cohort study on a large population of elderly patients (age > 65 years) with OLD in northern Italy measures the use of healthcare resources associated with the most frequent combinations of comorbidities and investigates the most common reasons for hospitalization. Total health costs, pharmacy costs, emergency department (ED) visits, outpatient visits, and hospital admissions are assessed for every subject. The most common causes of hospitalization by a number of comorbidities and the most common sets of three comorbidities are identified. For each comorbidity group, we rank a list of the most frequent causes of hospitalization, both overall and avoidable with effective ambulatory care. A small group of patients suffering from major comorbidities accounts for the use of most healthcare resources. The most frequent causes of hospitalization are respiratory failure, heart failure, chronic bronchitis, and bronchopneumonia. The most common conditions manageable with ambulatory care among causes of hospitalizations are heart failure, bacterial pneumonia, and COPD. The set of three comorbidities responsible for the highest average total costs, and the highest average number of hospitalizations and outpatient visits comprised hypertension, cardiac arrhythmias, and heart failure. The main reasons for hospitalization proved to remain linked to heart failure and acute respiratory disease, regardless of specific combinations of comorbidities. Based on these findings, specific public health interventions among patients with OLD cannot be advised on the basis of specific sets of comorbidities only.

The Choosing Wisely campaign - don't throw the baby out with the bathwater.

The goal of the Choosing Wisely campaign launched in 2009 by the American Board of Internal Medicine (ABIM) Foundation is to promote dialog on avoiding wasteful or unnecessary medical tests, treatments and procedures. Originating in 2009, the Choosing Wisely initiative involved three primary care specialties in a project aiming to develop "Top Five" lists, which were to be "specialty-specific enumerations of achievable practice changes to improve patient health through better treatment choices, reduced risks and reduced costs. The initiative soon became global, many specialty societies outside the US joining. Some time later, however, data collected demonstrated that a reduction had been achieved only for a few low-value tests and procedures, thus highlighting the need for a more evidence-based approach for identifying low-value practices and for evaluating the efficacy of this initiative over time.