A quality improvement initiative for COPD patients: A cost analysis.

Fred W Peyerl,Teofilo L Lee-Chiong,David Trout,Archita H Bhansali,Dushon D Riley,Christophe Leroyer

doi:10.1371/journal.pone.0235040

Abstract

The objective of this analysis was to evaluate and report on the economic impact of implementing an integrated, quality, and operational improvement program on chronic obstructive pulmonary disease (COPD) care from acute through post-acute care settings. This initiative was established in a cohort of 12 hospitals in Alabama and sought to address COPD readmission through improved workflows pertaining to early diagnosis, efficient care transitions, and patient visibility across the entire care episode. Implementation of the initiative was influenced by lean principles, particularly cross-functional agreement of workflows to improve COPD care delivery and outcomes. A budget impact model was developed to calculate cost savings directly from objective data collected during this initiative. The model estimated payer annual savings over 5 years. Patients were classified for analysis based on whether or not they received noninvasive ventilation. Scenario analyses calculated savings for payers covering different COPD cohort sizes. The base case revealed annual per patient savings of $11,263 for patients treated through the quality improvement program versus traditional care. The model projected cumulative savings of $52 million over a 5-year period. Clinical incorporation of non-invasive ventilation (NIV) resulted in $20,535 annual savings per patient and projected $91 million over 5 years. We conclude that an integrated management program for COPD patients across the care continuum is associated with substantial cost savings and significantly reduced hospital readmissions.

Highlights

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world [1]
A 3rd-party firm, IncreMedical1, engaged with hospital leadership and their home medical equipment (HME) partner through intensive cross-functional and cross-department discovery, followed by mutual adoption and agreement, order set creation, implementation, post-discharge data collection and transmission that was entered by the post-acute respiratory therapists into the hospital Electronic health record (EHR), and data aggregation and analysis based on event rates
To explore the effect on the Integrated Care Pathway (ICP), we retrospectively analyzed 30-day COPD readmissions, and 90-day all-cause hospitalizations and modeled economic outcomes based on Center for Medicare & Medicaid Services (CMS)-published values for hospitalization and readmission costs and reimbursements

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world [1]. A large part of the COPD burden of illness is due to disease exacerbations that require hospital admissions [2, 3], which can cost over $40,000 USD per hospitalization [3]. Recurrent hospitalizations for COPD patients may indicate poor long-term outcomes, such as end-stage lung disease, where hospital readmissions may not be in the best interest of the patient. Implementing innovative measures that can reduce hospitalizations among patients with COPD represents an important objective.

Methods

Results

Discussion

Conclusion