Homelessness as a Positive Influence on Pulmonary Health in COPD

Abstract

SESSION TITLE: Pulmonary Rehabilitation SESSION TYPE: Original Investigation Slide PRESENTED ON: Monday, October 30, 2017 at 07:30 AM - 08:30 AM PURPOSE: Homelessness is a growing problem in the United States that may significantly impair physical health. The homeless have a high prevalence of cigarette smoking, poor nutrition, and adverse environmental exposures, which could contribute to obstructive lung disease. Under our COPD Access To Community Health (CATCH), a CMS Innovations grant, we bring a team of physicians, nurses, nurse case managers to affect the population health of Ventura County California. We have aggressively recruited over 2000 adults from all social strata. They complete spirometry, have a medical home identified, data entered into the CATCH registry, enrolled in smoking cessation, enrolled in cellphone based education, and are presented at multi-disciplinary weekly conference. We have spent over two years lobbying for inclusion of pulmonary rehabilitation coverage by our MediCaid managed care plan. Patients may be met at coffee houses rather than encampments to maintain a safe environment where spirometry and registry data are obtained METHODS: Registry data includes Ethnicity, City, Postal Code, Language, Benefit Plan Name, Text Message, Types Of Care Messages, Smoker, Pack Years. Referred to Smoking Cessation, If Not Referred, Quit Date, Newly Diagnosed, Date of 1st PFT, Initial Stage, Initial Severity, FEV, 1Session Quality, Oxygen (Y/N)If yes, O2 machine name, and Level of Activity were collected in all CATCH Registry patients. At time of case review specific behavioral screening, GOLD Staging, nutrition screening, smoking cessation opportunities, identification of cases needing intensification of case management including fall prevention and hospice care are reviewed and entered into the electronic health care record or information provided to the primary care physician if in another system of care. RESULTS: Although subvariate analysis is ongoing and a genomic subgroup may be responsible, what emerged is a group of male patients ranging in age from 30 to 72 years who qualified as homeless, and as a consequence of the lack of transportation system available to them walked or bicycled more than three miles daily for social and other needs. Patients were identified by pack years smoking and enforced transportation and exercise activity. 45 pack years Bicycles; 25 pack years Surfer/ hiker;60 pack years Walks/ bikes; 7 pack years Walking 3 miles a day; 2 pack years Walks 3-4 miles a day; 60 pack years Walks and bikes; 26 Pack years Walks; 10 pack years Walk 4 miles a day; Former smoker 25 pack years Mountain bikes/ cuts wood; and 30 pack years Walks. All patients were GOLD 0 with no bronchodilator response. CONCLUSIONS: Rates of diagnosed respiratory health conditions and lung disease are generally dramatically higher than the general population due to the high rates of smoking tobacco and illicit substances. The importance of establishing the amounts of weekly exercise and increasing that amount, appears to result in unexpected protention of lung health. CLINICAL IMPLICATIONS: Increasing activity for all Americans is a clearly designated health goal and one that, in this population of male homeless patients, has resulted in startling outcome. DISCLOSURE: The following authors have nothing to disclose: Chris Landon No Product/Research Disclosure Information