Fig. 1

Schematic of Markov model. The orange cycling arrows reflect that an individual can remain within a health state at the end of an individual cycle (1 year). The unidirectional orange arrows reflect that an individual can transition to a worsening GOLD state in a non-recursive fashion (e.g., a patient cannot transition from GOLD III to II, but can transition from GOLD II to III) (i.e., P(Transition GOLD X to GOLD X + 1)). The unidirectional purple arrows reflect that an individual can die in any GOLD classification at the end of the cycle (i.e., P(Death | GOLD)), as well as die after experiencing an exacerbation and hospitalization (i.e., P(Death | Exacerbation & Hospitalization | GOLD)); death is an absorbing state. The purple bi-directional arrows between GOLD classification and Exacerbation reflect the P(Exacerbation | GOLD). The purple bi-directional arrows between Exacerbation and Urgent Care, ER Visit, and Hospitalization reflect the P(Specific Health Service Utilization | Exacerbation | GOLD).