Abstract
Multidisciplinary community coordinated care programs are widely adopted to optimise care of chronic disease patients, but there is a need for further evaluation in the setting of COPD. This observational study evaluated 147 patients with severe or very severe COPD who were enrolled in a multidisciplinary community respiratory coordinated care program (RCCP) from 2007 to 2012. Comparison was made of hospitalisation rates and length of stay for 12 months prior to joining the program, and the first 12 months after joining the program. This data was used to inform a cost analysis. Enrolment into RCCP halved the annual hospital admission rate from 1.18 to 0.57 admissions per year (relative risk reduction 51.4%, p < 0.001), and annual total length of stay was reduced from 8.06 to 3.59 days per patient per year (p < 0.001). Hospital admissions were reduced from 5.05 days to 2.00 days (p < 0.001). Accounting for the program’s costs, these changes resulted in a $US 906.94 ($AUD 972.80) cost saving per patient per year. A RCCP program can reduce patient hospitalisation and overall costs in the COPD setting.
Highlights
Chronic Obstructive Pulmonary Disease (COPD) is a significant cause of global morbidity and mortality (Vestbo, How to cite this paper: Aslam, S., Man, J., Behary, J., Riskallah, J., Ansary, S. and CH Kwan, B. (2016) Outcomes and Cost Effectiveness of a Respiratory Coordinated Care Program in Patients with Severe or Very Severe COPD
Patients with chronic respiratory disease residing in the catchment area of two hospital sites (St George Hospital, Sydney, Australia; The Sutherland Hospital, Sydney, Australia) were enrolled into a multidisciplinary respiratory coordinated care program (RCCP) between January 2007 and December 2012
We believe that hospital admission rates can be used as a surrogate marker for health care outcomes for these patients, suggesting improved health outcomes in these patients as well
Summary
Chronic Obstructive Pulmonary Disease (COPD) is a significant cause of global morbidity and mortality (Vestbo, How to cite this paper: Aslam, S., Man, J., Behary, J., Riskallah, J., Ansary, S. and CH Kwan, B. (2016) Outcomes and Cost Effectiveness of a Respiratory Coordinated Care Program in Patients with Severe or Very Severe COPD. (2016) Outcomes and Cost Effectiveness of a Respiratory Coordinated Care Program in Patients with Severe or Very Severe COPD. In the United States, the financial burden of COPD is estimated to be $50 billion US dollars (USD), $30 billion in direct health care expenditure and $20 billion in indirect expenditure, with the mean cost of hospital admission at $7,100 [4]. In Australia, the annual disease cost in 2012 was estimated at greater than $900 million Australian dollars ($839 million USD) contributing to the largest share of national health spending and the second highest rate of avoidable hospital admissions [6]. The goal is to improve patient health outcomes, reduce hospitalization, and reduce health care costs through the use of a well coordinated multidisciplinary team [7] with an emphasis on early prevention, early access to specialist advice, self management, and chronic as well as acute care. A key part of the service is to prevent late reporting of exacerbation symptoms [8] by regular health professional review and treat exacerbations early when it is still safe to do so in an outpatient setting, benefiting both the patient and the hospital system [9]
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