Applying Statistical Models to Health Outcomes For Australian Patients with Bronchiectasis

Kingkam, Pitchaya

Applying Statistical Models to Health Outcomes For Australian Patients with Bronchiectasis

Kingkam, Pitchaya

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Publication Type:: Thesis
Issue Date:: 2021

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Field	Value	Language
dc.contributor.author	Kingkam, Pitchaya
dc.date.accessioned	2021-10-01T03:01:52Z
dc.date.available	2021-10-01T03:01:52Z
dc.date.issued	2021
dc.identifier.uri	http://hdl.handle.net/10453/150773
dc.description	University of Technology Sydney. Faculty of Science.	en_US.UTF-8
dc.description.abstract	Bronchiectasis is a common disease caused by chronic infection in the small airways of the lungs. Patients often carry a heavy burden of symptoms. Unfortunately, little is known about the impact of bronchiectasis on Australians or on our healthcare system. For many years, bronchiectasis was considered as another Chronic Obstructive Pulmonary Disease and was bundled (for costing purposes) with COPD or other pulmonary infections, without recognition that the condition was associated with significant, particular clinical features that required longer and more complex admissions to hospital than COPD. Prior to July 2018, there was no disease specific code within the system that allocates hospital funding and consequently, episodes of care for patients with bronchiectasis were assigned into other respiratory illness in the AR-DRG system. This misallocation is likely to have affected hospital funding which is calculated based on ALOS associated with the AR-DRG group of diseases. The main purpose of this thesis was to explore the factors contributing to the length of stay and hospital readmission for patients with bronchiectasis in Australia in three parts; i) An evaluation of the effect of a specific AR-DRG on funding of length of hospital stay for bronchiectasis patients and a comparison of the actual length of stay in hospital (LOS) with the average length of stay (ALOS) based on the assigned AR-DRG. We found that the AR-DRG system consistently underestimated the LOS and costs for acute hospital admissions due to bronchiectasis. ii) An investigation of the effect of seasonality of presentation and patient characteristics (sex, age, smoking status, ABR registry status) on hospital LOS and ALOS. The cohort in this study included 299 patients who were diagnosed as bronchiectasis with 505 admissions of >24 hours to Concord Hospital, NSW between July 2011-June 2018. The results were showing significance (p<0.05) between the non ABR-registry and the response lnALOS. This implied that bronchiectasis patients who participated with ABR tend to have length of stay in hospital shorter than patients who did not register in the ABR. iii) An analysis of the time between episodes of care of bronchiectasis patients using longitudinal data analysis and multilevel models. Patients who were smokers and hospital LOS, were statistically significant risk factors for readmission. LOS was negatively correlated with time to readmission suggesting that longer stays in hospital can reduce readmission risk. In addition, patients who were smokers had a significantly higher readmission rate than patients who were not smokers.	en_US.UTF-8
dc.format	Thesis (PhD)
dc.language.iso	en_US	en_US.UTF-8
dc.relation	https://opus.lib.uts.edu.au/bitstream/10453/150773/2/02whole.pdf
dc.rights	The author owns the copyright in this thesis including all reproduction and reuse rights for the work. The work may not be altered without the permission of the copyright owner. Attribution is essential when quoting or paraphrasing from this thesis.
dc.rights	au.edu.uts.lib/ppc
dc.rights	info:eu-repo/semantics/openAccess
dc.title	Applying Statistical Models to Health Outcomes For Australian Patients with Bronchiectasis	en_US.UTF-8
dc.type	Thesis
utslib.copyright.status	open_access	*

Abstract:

Bronchiectasis is a common disease caused by chronic infection in the small airways of the lungs. Patients often carry a heavy burden of symptoms. Unfortunately, little is known about the impact of bronchiectasis on Australians or on our healthcare system. For many years, bronchiectasis was considered as another Chronic Obstructive Pulmonary Disease and was bundled (for costing purposes) with COPD or other pulmonary infections, without recognition that the condition was associated with significant, particular clinical features that required longer and more complex admissions to hospital than COPD. Prior to July 2018, there was no disease specific code within the system that allocates hospital funding and consequently, episodes of care for patients with bronchiectasis were assigned into other respiratory illness in the AR-DRG system. This misallocation is likely to have affected hospital funding which is calculated based on ALOS associated with the AR-DRG group of diseases. The main purpose of this thesis was to explore the factors contributing to the length of stay and hospital readmission for patients with bronchiectasis in Australia in three parts; i) An evaluation of the effect of a specific AR-DRG on funding of length of hospital stay for bronchiectasis patients and a comparison of the actual length of stay in hospital (LOS) with the average length of stay (ALOS) based on the assigned AR-DRG. We found that the AR-DRG system consistently underestimated the LOS and costs for acute hospital admissions due to bronchiectasis. ii) An investigation of the effect of seasonality of presentation and patient characteristics (sex, age, smoking status, ABR registry status) on hospital LOS and ALOS. The cohort in this study included 299 patients who were diagnosed as bronchiectasis with 505 admissions of >24 hours to Concord Hospital, NSW between July 2011-June 2018. The results were showing significance (p<0.05) between the non ABR-registry and the response lnALOS. This implied that bronchiectasis patients who participated with ABR tend to have length of stay in hospital shorter than patients who did not register in the ABR. iii) An analysis of the time between episodes of care of bronchiectasis patients using longitudinal data analysis and multilevel models. Patients who were smokers and hospital LOS, were statistically significant risk factors for readmission. LOS was negatively correlated with time to readmission suggesting that longer stays in hospital can reduce readmission risk. In addition, patients who were smokers had a significantly higher readmission rate than patients who were not smokers.

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