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High Levels of Medical Utilization By Ambulatory Patients with Vocal Cord Dysfunction as Compared to Age and Gender Matched Asthmatics

Walter Reed Army Medical Center, Washington, DC

PURPOSE: Patients admitted to the hospital for vocal cord dysfunction (VCD) have been shown to have high medical utilization. In our practice patients with VCD are aggressively diagnosed, have milder disease, and are rarely hospitalized for VCD. Medical utilization by ambulatory VCD patients has never been studied but is perceived to be high.

METHODS: We conducted a retrospective, case control study of healthcare resource utilization in patients with VCD between Jan 2002 and Feb 2004. The diagnosis of VCD was based on findings during laryngoscopy. Patients with VCD were matched for age (± 3 years) and gender to controls with moderate persistent asthma. Endpoints of interest included: total outpatient visits, evaluations by subspecialty physicians, urgent care evaluations, and hospitalizations. We also explored the number of prescriptions dispensed to individuals with VCD.

RESULTS: The VCD cohort included 25 patients (52% male, median age 41) and all were successfully matched to controls. As shown in the table

Health Care Measure VCD n=25 Asthma, n=25 p Total Physician Visits 475 267 0.005* Subspecialty Visits 277 118 0.007* Hospitalizations 7 5 0.590 Urgent Care Visits 45 20 0.141 Prescriptions 448 394 0.631

below, subjects with VCD were significant consumers of healthcare resources and required numerous evaluations by physicians. In fact, individuals with VCD required more frequent subspecialty consultations than asthmatic controls. VCD patients also required hospitalization.

CONCLUSION: Ambulatory VCD patients require significantly more physician and subspecialty care visits than moderate persistent asthmatics, a group known to have high medical utilization.

CLINICAL IMPLICATIONS: Aggressive diagnosis and management of ambulatory VCD patients may have a significant impact on healthcare utilization.

DISCLOSURE: J.A. Mikita, None.