{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T16:37:20Z","timestamp":1783528640718,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Chronic obstructive pulmonary disease (COPD) exacerbations are a major cause of hospitalization and healthcare utilization. The impact of inpatient specialty allocation on management practices remains unclear. This study examined variation in investigations and treatment practices among COPD patients admitted under respiratory medicine (RM) compared with internal medicine (IM), and evaluated clinical characteristics associated with RM admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of adults aged \u226540\u202fyears admitted for COPD exacerbations between January 2017 and March 2025. Patients were identified using ICD-10 COPD codes, excluding those admitted directly to ICUs or with asthma or bronchiectasis. Demographics, comorbidities, investigations, treatments, and hospitalization outcomes were analyzed. The primary outcome was variation in investigations and treatment practices between RM and IM admissions. The secondary outcome was identification of clinical characteristics associated with RM admission using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 6,277 COPD admissions, 3,211 (51.2%) were under RM and 3,066 (48.8%) under IM. Patients admitted under RM were younger (73.2\u202f\u00b1\u202f10.7 vs. 75.6\u202f\u00b1\u202f10.8\u202fyears,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and had fewer comorbidities, including ischemic heart disease (IHD), diabetes (DM), stroke, and chronic kidney disease (CKD). RM admissions underwent more respiratory-focused investigations, including chest radiography (54.2% vs. 43.5%), chest CT (8.4% vs. 5.6%), and ABG testing (23.1% vs. 8.2%). Non-invasive ventilation (17.7% vs. 4.2%) and invasive mechanical ventilation (18.2% vs. 4.3%) were more frequently used in RM admissions. Use of intravenous antibiotics, routine laboratory testing, allied health involvement, and palliative care services were more frequent in IM admissions. Descriptive differences in hospital outcomes were also observed, with RM admissions demonstrating lower in-hospital mortality (3.9% vs. 6.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and shorter hospitalization duration (5.85 vs. 6.93\u202fdays,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), while 30-day readmissions were similar. In multivariable analysis, older age (OR 0.97, 95% CI 0.96\u20130.99), male sex (OR 0.49), IHD (OR 1.60), stroke (OR 1.70), and CKD (OR 1.94 were associated with RM admission).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Variation in investigations and treatment practices was observed between RM and IM admissions for COPD exacerbations. These differences likely reflect variation in patient characteristics, illness severity, and clinical workflows rather than differences in quality of care attributable to specialty alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1720006","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T05:25:36Z","timestamp":1775107536000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Variation in inpatient investigations and treatment practices for COPD exacerbations between respiratory and internal medicine specialties: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Woon Hean Keenan","family":"Chong","sequence":"first","affiliation":[{"name":"Department of Respiratory and Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei Jun Dan","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy, Ng Teng Fong General Hospital, National University Health System","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronnie Voon Shiong","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Ng Teng Fong General Hospital, National University Health System","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching Yee","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Ng Teng Fong General Hospital, National University Health System","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel Stanley Wey Tut","family":"Tay","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Ng Teng Fong General Hospital, National University Health System","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian Ujin","family":"Yap","sequence":"additional","affiliation":[{"name":"Clinical Research Unit and Division of Dentistry, Ng Teng Fong General Hospital, National, University Health System","place":["Singapore, Singapore"]},{"name":"Faculty of Dentistry, National University of Singapore","place":["Singapore, Singapore"]},{"name":"Duke-14 NUS Medical School","place":["Singapore, Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.vhri.2019.02.002","article-title":"The economic burden of chronic obstructive pulmonary disease in the Asia-Pacific region: a systematic review","volume":"18","author":"Woo","year":"2019","journal-title":"Value Health Reg Issues"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1081\/COPD-120028702","article-title":"Trends and ethnic differences in COPD hospitalization and mortality in Singapore","volume":"1","author":"Ng","year":"2004","journal-title":"COPD"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1046\/j.1440-1843.2003.00460.x","article-title":"COPD prevalence in 12 Asia-Pacific countries and regions: projections based on the COPD prevalence estimation model","volume":"8","year":"2003","journal-title":"Respirol Carlton Vic"},{"key":"ref4","year":"2024"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e072571","DOI":"10.1136\/bmjopen-2023-072571","article-title":"Year-to-year trajectories of hospital utilisation rates among patients with COPD: a real-world, single-Centre, retrospective cohort study","volume":"13","author":"Yii","year":"2023","journal-title":"BMJ Open"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1111\/j.1440-1843.2006.00819.x","article-title":"Frequent hospital readmissions for acute exacerbation of COPD and their associated factors","volume":"11","author":"Cao","year":"2006","journal-title":"Respirol Carlton Vic."},{"key":"ref7","year":""},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e7","DOI":"10.1016\/S2213-2600(24)00413-2","article-title":"GOLD COPD report: 2025 update","volume":"13","author":"Venkatesan","year":"2025","journal-title":"Lancet Respir Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"101","DOI":"10.2147\/COPD.S27887","article-title":"Guideline-based survey of outpatient COPD management by pulmonary specialists in Germany","volume":"7","author":"Glaab","year":"2012","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/j.ejim.2013.08.005","article-title":"The practice of internal medicine in Europe: organisation, clinical conditions and procedures","volume":"24","author":"Cranston","year":"2013","journal-title":"Eur J Intern Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"9","DOI":"10.21037\/jtd-2025-aw-2374","article-title":"Specialty-led inpatient chronic obstructive pulmonary disease management and mortality: a propensity-weighted cohort study","volume":"18","author":"Chong","year":"2026","journal-title":"J Thorac Dis"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"7595","DOI":"10.3390\/jcm12247595","article-title":"The clinical profile of patients with COPD is conditioned by age","volume":"12","author":"Morena","year":"2023","journal-title":"J Clin Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"759","DOI":"10.2147\/COPD.S81267","article-title":"Comparative study on 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and gender specific life expectancies of the Singapore population, 1965 to 2009 - converging, or diverging?","volume":"13","author":"Lim","year":"2013","journal-title":"BMC Public Health"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"326","DOI":"10.47102\/annals-acadmedsg.V44N9p326","article-title":"Health screening behaviour among Singaporeans","volume":"44","author":"Wong","year":"2015","journal-title":"Ann Acad Med Singap"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s00508-019-1441-5","article-title":"The European COPD audit: adherence to guidelines, readmission risk and hospital care for acute exacerbations in Austria","volume":"131","author":"Breyer-Kohansal","year":"2019","journal-title":"Wien Klin Wochenschr"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1528","DOI":"10.1007\/s11606-018-4406-x","article-title":"The impact of care specialty on survival-adjusted medical costs of COPD patients after a hospitalization: a longitudinal analysis","volume":"33","author":"Chen","year":"2018","journal-title":"J Gen Intern Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1183\/09031936.06.00063205","article-title":"Integrated care prevents hospitalisations for exacerbations in COPD patients","volume":"28","author":"Casas","year":"2006","journal-title":"Eur Respir J"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"106152","DOI":"10.1016\/j.rmed.2020.106152","article-title":"The clinical effectiveness of the COPDnet integrated care model","volume":"172","author":"Koolen","year":"2020","journal-title":"Respir Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1136\/thoraxjnl-2016-208396","article-title":"Comprehensive care programme for patients with chronic obstructive pulmonary disease: a randomised controlled trial","volume":"72","author":"Ko","year":"2017","journal-title":"Thorax"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1378\/chest.14-1123","article-title":"Predischarge bundle for patients with acute exacerbations of COPD to reduce readmissions and ED visits: a randomized controlled trial","volume":"147","author":"Jennings","year":"2015","journal-title":"Chest"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e0116187","DOI":"10.1371\/journal.pone.0116187","article-title":"Impact of a COPD discharge care bundle on readmissions following admission with acute exacerbation: interrupted time series analysis","volume":"10","author":"Laverty","year":"2015","journal-title":"PLoS One"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e000265","DOI":"10.1136\/bmjresp-2017-000265","article-title":"Development of a patient-centred, evidence-based and consensus-based discharge care bundle for patients with acute exacerbation of chronic 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