{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:32:58Z","timestamp":1784043178227,"version":"3.55.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2018,9,1]],"date-time":"2018-09-01T00:00:00Z","timestamp":1535760000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Hospital readmissions are an important cause of morbidity and mortality among patients with chronic obstructive pulmonary disease (COPD). Although comorbidities are associated with outcomes in COPD, it is unknown how they affect treatment choices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We sought to examine whether comorbidity was associated with readmission, mortality, and delivery of in-hospital treatment for COPD exacerbations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a cohort study of veterans hospitalized with a COPD exacerbation to six Veterans Affairs hospitals between 2005 and 2011. We collected comorbidities in the year before hospitalization. We defined our primary outcome as readmission and\/or mortality within 30 days of discharge, and treatment quality as receipt of systemic corticosteroids and respiratory antibiotics during the index hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2,391 patients were included. Each one-point increase in Charlson index was associated with greater odds of readmission or death (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.18\u20131.30) and reduced odds of receiving treatment with steroids and antibiotics (aOR, 0.90; 95% CI, 0.85\u20130.95), in adjusted analyses. Patients with comorbid congestive heart failure (aOR, 0.64; 95% CI, 0.52\u20130.79), coronary artery disease (aOR, 0.73; 95% CI, 0.60\u20130.89), and chronic kidney disease (aOR, 0.74; 95% CI, 0.55\u20130.99) were less likely to receive corticosteroids and antibiotic treatment than patients without those comorbidities. We did not identify any comorbidity that was associated with increased odds of receiving appropriate therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Comorbidity was associated with 30-day readmission and mortality, and with delivery of fewer treatments known to be beneficial among patients with COPD exacerbation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.201804-255oc","type":"journal-article","created":{"date-parts":[[2018,8,4]],"date-time":"2018-08-04T14:05:58Z","timestamp":1533391558000},"page":"1033-1038","source":"Crossref","is-referenced-by-count":41,"title":["Role of Comorbidities in Treatment and Outcomes after Chronic Obstructive Pulmonary Disease Exacerbations"],"prefix":"10.1093","volume":"15","author":[{"given":"Laura J.","family":"Spece","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington and"},{"name":"Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric M.","family":"Epler","sequence":"additional","affiliation":[{"name":"Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8187-2641","authenticated-orcid":false,"given":"Lucas M.","family":"Donovan","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington and"},{"name":"Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew F.","family":"Griffith","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington and"},{"name":"Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret P.","family":"Collins","sequence":"additional","affiliation":[{"name":"Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura C.","family":"Feemster","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington and"},{"name":"Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Au","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington and"},{"name":"Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,9,1]]},"reference":[{"key":"2026020502190261900_bib1","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1056\/NEJMsa0803563","article-title":"Rehospitalizations among patients in the Medicare fee-for-service program","volume":"360","author":"Jencks","year":"2009","journal-title":"N Engl J Med"},{"key":"2026020502190261900_bib2","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1378\/chest.14-0972","article-title":"Total and state-specific medical and absenteeism costs of COPD among adults aged \u2265 18 years in the United States for 2010 and projections through 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