Predictors, Healthcare Utilization and Costs Related to Short-Term Stays in Patients with COPD: A Registry-Based Analysis in Norway

Tron Anders Moger,1 Jon Helgheim Holte,1 Olav Amundsen,2 Silje Bjørnsen Haavaag,2 Øystein Døhl,3,4 Line Kildal Bragstad,5 Ragnhild Hellesø,2 Trond Tjerbo,1 Nina Køpke Vøllestad2 1Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway; 2Department of Public Health Science and Interdisciplinary Science, Institute of Health and Society, University of Oslo, Oslo, Norway; 3Department of Finance, Municipality of Trondheim, Trondheim, Norway; 4Department of Neuromedicine and Movement Science, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; 5Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, NorwayCorrespondence: Tron Anders Moger, Email tronmo@medisin.uio.noBackground: Chronic obstructive pulmonary disease (COPD) incurs significant healthcare costs, often accompanied by multimorbidity. Advanced patients may need short-term stays for rehabilitation, treatment, or respite to maintain home living.Aim: To identify predictors for a first short-term stay and study the healthcare utilization and costs compared with similar patients without a short-term stay.Patients and Methods: Data on COPD patients in the cities Oslo and Trondheim 2010– 2019 and including information on specialist, primary and long-term care, diagnoses, sociodemographics and -economics were collected from national and municipal registries, resulting in a sample of 24,613 patients. Using discrete time survival models, we identified predictors for a short-term stay. We described the costs before and after admission, and the duration of living at home, compared to non-recipients matched on age, comorbidities and healthcare use.Results: Depression, anxiety, mental disorders, alcoholism, prior hospitalization and reception of home care were associated with higher odds of short-term stays. One to two GP visits for respiratory diseases, being in the top quartile for GP visits for non-respiratory diseases, visits to specialists, and physiotherapist visits for non-respiratory issues were significantly associated with lower odds of short-term institutional stay. Patients admitted to short-term stays incurred markedly higher costs both in the year before admission and during subsequent years compared to matched non-recipients, primarily due to increased use of inpatient and home care services.Conclusion: Prior receipt of home care, unlike standard outpatient services, was linked to a higher likelihood of short-term stays. This suggests that some outpatient services may delay the need for such stays, or that patients already in municipal services are more readily admitted. Additionally, patients with psychosocial issues may have greater care needs, indicating that resource allocation aligns with these needs. The findings suggest that by the time short-term stays are required, health deterioration has already become considerable.Keywords: home-based services, COPD, registry data, healthcare utilization, long-term care, healthcare costs

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