Effectiveness of chronic obstructive pulmonary disease (COPD) management program at the University of Louisville.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease of the respiratory system characterized by airflow limitation that is not completely reversible and is associated with systemic effects especially of the cardiovascular system. COPD is frequently complicated by acute exacerbations that contribute to physical impairment and increased health care use. As COPD is a chronic lung disease with significant systemic manifestations, it is important to have chronic disease management programs specifically targeting individuals with COPD designed to improve their overall quality of life, reduce the burden of disease and decrease the impact of COPD on daily life. Chronic disease management encompasses a multidisciplinary approach designed to enhance the quality and cost-effectiveness of health care for chronic conditions and has been defined as “an approach to patient care that emphasizes coordinated, comprehensive care along the continuum of disease and across health care delivery systems”. The purpose of this present study is to evaluate the effectiveness of a chronic obstructive pulmonary disease management program implemented at the University of Louisville in 2011. Methods: We conducted a retrospective observational cohort study of COPD subjects using clinical data from medical records and cost data from a claims dataset. Respiratory health was assessed by pulmonary function testing, St. George Respiratory questionnaire, COPD Assessment Test (CAT), 6 minute walk test (6MWT), Modified Medical Research Council (mMRC) dyspnea scale, and BODE index. General measures include Duke Profile for assessing overall health and Patient Health Questionnaire (PHQ-9) for assessing depression. At baseline, chi-square test for categorical variable and t-test for continuous variable was used to check for any difference between the two groups. To check for any longitudinal significant change in quality of life measures like SGRQ, CAT score, mMRC scale, BODE index, six minute walk distance and PFT measures from baseline paired t-test was performed. For each subject, the baseline probability of participation in the disease management program was calculated by the propensity score method using logistic regression analysis. Multiple linear regression analysis was performed to assess the rate of deterioration of various clinical parameters like FEV1 and FVC between two groups. Cost analysis was done by comparing the cost related to COPD among subjects in DMP group versus those under usual care. These costs includes total COPD cost, and also sub-categories of cost like office visit cost, in-patient hospitalization (IPH) cost, out-patient hospitalization (OPH) cost, pharmacy cost, cost related to home care and laboratory cost. Results: A total of 52 subjects were enrolled in the disease management program between February 1st 2011 and December 31st 2013: 37 in 2011, 11 in 2012 and 4 in 2013. The usual care group consists of 662 subjects diagnosed with COPD. There is a significant difference in average age of subjects…