Abstract Purpose Hypercapnic respiratory failure (RF) is a common problem managed by pulmonologists. Dedicated RF clinic for individual tailored patient management is a relatively novel approach. This retrospective study explores the utilization of this model affected healthcare utilization and mortality. Methods We included 711 patients from Geisinger Medical Center from 8/22/2023 - 12/31/2024 with pCO2 ≥ 50 and pH 7.4. Intervention arm included patients followed in RF clinic (N = 30). The Kruskal-Wallis and Chi-Square test were used for continuous and categorical variables respectively to compare differences between groups. We had 496 complete records. Negative binomial regression analysis (both univariate and multivariate) was used. In multivariate analysis, the covariates pCO2, pH, BMI, and bilevel use were included in the model. Results The pCO2, BMI, and bilevel use was significantly higher in intervention group compared to control group with p values 0.0001, 0.0045, 0.001 respectively. Univariate analysis showed that the number of hospitalizations was significantly higher in the intervention group compared to the control group, with a parameter estimate of -0.6235 and a p-value of 0.0002. In the multivariate regression, after adjusting for pco2, pH, BMI, and bilevel use, the parameter estimates for the intervention group remained significant at -0.5449 (p = 0.0027), indicating a persistently higher number of hospitalizations in the intervention group. The intervention group had higher ED (6.67%, 2/30) and ICU visit rates (6.67%, 2/30) compared to the control group (ED: 0.27%, 2/741; ICU: 1.08%, 8/741). The Fisher’s exact p-values were 0.0084 and 0.0543, respectively. The mortality rate was significantly different between the groups (p = 0.0420), with the intervention group showing a lower mortality rate (13.33%, 4/30) compared to the control group (31.58%, 234/741). Conclusion Chronic hypercapnic RF carries high mortality, close to 40 % in studies. The fact that our control group approaches that mortality rate and intervention group shows significant improvement from that rate suggests the utility of RF clinic in optimizing this. More aggressive monitoring may contribute to improved survival, despite increased healthcare utilization. Due to a higher burden of baseline respiratory disease, patients enrolled within the dedicated hypercapnic respiratory failure clinic had a higher healthcare utilization rate including ED visits, inpatient and ICU admissions possibly due to sicker cohort. This abstract presents preliminary data for this ongoing project. Future iterations will include a much larger intervention and control group for analysis. This abstract is funded by: Geisinger
Mittal et al. (Fri,) studied this question.