Characteristics associated with cystic fibrosis-related pulmonary exacerbation treatment location

Laura S Gold; Ryan N Hansen; Sonya L Heltshe; Patrick A Flume; Christopher H Goss; Natalie E West; Don B Sanders; Larry Kessler

doi:10.1016/j.jcf.2023.10.004

Characteristics associated with cystic fibrosis-related pulmonary exacerbation treatment location

J Cyst Fibros. 2023 Oct 5:S1569-1993(23)00926-8. doi: 10.1016/j.jcf.2023.10.004. Online ahead of print.

Authors

Laura S Gold¹, Ryan N Hansen², Sonya L Heltshe³, Patrick A Flume⁴, Christopher H Goss⁵, Natalie E West⁶, Don B Sanders⁷, Larry Kessler⁸

Affiliations

¹ Department of Radiology, University of Washington, O1-140-6 UW Tower, 4333 Brooklyn Ave NE, Box 359558, Seattle, WA 98195-9558, United States. Electronic address: goldl@uw.edu.
² School of Pharmacy, University of Washington, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States.
³ Department of Pediatrics, University of Washington, Seattle, WA, United States; Cystic Fibrosis Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, WA, United States.
⁴ Departments of Medicine and Pediatrics, Medical University of South Carolina, Charleston, SC, United States.
⁵ Department of Pediatrics, University of Washington, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States.
⁶ Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
⁷ Department of Pediatrics, Indiana University, Indianapolis, IN, United States.
⁸ Department of Health Services, University of Washington, Seattle, WA, United States.

PMID: 37805355
PMCID: PMC10995101 (available on 2025-04-05)
DOI: 10.1016/j.jcf.2023.10.004

Abstract

Previous studies indicate that hospital rather than home treatment of pulmonary exacerbations (PEx) in people with cystic fibrosis (CF) can improve outcomes. We evaluated characteristics of adult participants from the Standardized Treatment of Pulmonary Exacerbations (STOP2) trial with two separate comparisons: (1) those who were treated initially in hospital (N = 768) to those treated initially at home (N = 214) and (2) those treated only in hospital (N = 328) to those who were treated only at home or both at home and in hospital (N = 654). Participants who had Medicaid insurance, were treated for shorter duration, and traveled longer to reach treatment centers were more likely to have been treated initially in the hospital. Having Medicaid insurance, being treated for a shorter duration, and being male were associated with being treated only in the hospital. This analysis suggests decisions about the location of treatment are based on pragmatic factors rather than on clinical characteristics.

Keywords: Cystic fibrosis; Home intravenous treatment; Hospitalization; Insurance; Pulmonary exacerbation; Sex.

Abstract

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