Chronic Obstructive Learning Collaborative

Transcription

1 Add your company logo here Chronic Obstructive Learning Collaborative Sponsored by AMGA and Boehringer Ingelheim Pharmaceuticals, Inc. July 24-26, 2013 Chicago, IL COPD Disease Management Program 1

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4 A COPD Disease Management Program run from A PCP Office VS A Pulmonary Clinic 4

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7 COPD Index What is COPD June 2004 Vol I No 1 Exacerbations Insurance Medications Nutrition Oxygen Physical Activity Pulmonary Function Test Sleep Apnea Smoking 7

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9 YEARS IN PROGRAM FEV1 AT ENROLLMENT % % % % 7.8 (Lived on 3 ppd and 7 beers) 39% % % % % % % % % % % % % 9

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11 Minimum length of time in the program One Month. Maximum length of time in the program 14.4 years Mean length of time in the program 4.6 years Median length of time in the program 4.3 years. 11

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18 COPD DMG Data Analysis Reliant Medical Group Worcester, MA

19 Data Collection Pulmonary Resident conducted manual review of Electronic Medical Record To identify COPD related utilization Only COPD related Utilization was included for this analysis All patients were alive for the four years during which they contributed person-time to the study.

20 Study Population and Methods 84 patients enrolled in the COPD DMG Electronic Medical Records Manual chart reviews Electronic data abstractions Data were gathered for year prior to enrollment and compared to three years after enrollment: Demographics ER Admissions Inpatient Admissions

21 Demographics Gender %, (n) 50% (42) female Age (mean, SD) 74.7 (8.4) Gold Stages 1 6% (5) 2 37% (31) 3 30% (25) 4 11% (9) *Normal FEV/FVC 16% (14) Smoking Status at Enrollment Former 85% (71) Current 13% (11) Never 2% (2) Using Oxygen 42% (35)

22 AMGA COPD Collaborative Measurement Report Reporting Period: 5/1/2011-5/31/2013 All RMG Patients with COPD Diagnosis Total Patients Met Criteria Patients Who Had Spirometry Test % of Patients Who Had Spirometry Test % Patients in the COPD program Total Patients Met Criteria Patients Who Had Spirometry Test % of Patients Who Had Spirometry Test % 22

23 Reporting Criteria for all RMG patients with COPD diagnosis: Numerator: All patients 18 years and older with COPD diagnosis made during ambulatory office visit within the past 24 months with spirometry performed. Denominator: All patients 18 years and older with COPD diagnosis made during ambulatory office visit within the past 24 months. Exclusions: 1. Patients with no ambulatory visit within previous 24 months. 2. Deceased patients. 3. Patients with only COPD diagnosis made in ED, inpatient, and/or Urgent Care visit. Reporting Criteria for patients in the COPD program: Numerator: All patients 18 years and older with COPD diagnosis made during ambulatory office visit within the past 24 months and are currently enrolled in the COPD program who have had Spirometry performed. Denominator: All patients 18 years and older with COPD diagnosis made during ambulatory office visit within the past 24 months and are currently enrolled in the COPD program. 23

24 Smoking Not many patients quit smoking after enrollment However patients who did smoke reported a reduction is the amount smoked Pre-Enrollment Packs Per Day: 1.27 Post-Enrollment Packs Per Day: 0.95

25 Emergency Room Admissions Parameter Percent Improvement Rate Ratio Confidence Limits P-Value Year 1 78% , Year 2 70% , Year 3 65% , *Estimate Results from Poisson Regression Analysis. Reference group for each year is the preenrollment year.

26 Inpatient Admissions Parameter Percent Improvement Rate Ratio Confidence Limits P-Value Year 1 75% , Year 2 70% , Year 3 75% , *Estimate Results from Poisson Regression Analysis. Reference group for each year is the preenrollment year.

27 Total Count Exacerbation and Utilization Summary Exacerbation & utilization before and after DMG enrollment (n=84) Exacerbations Inpatient Admissions ED Admissions Pre-Enrollment Year 1 Year 2 Year 3 Time Period

28 Conclusions Disease Management: Patients who smoke report fewer packs per day Significantly Reduces ER Admissions Significantly Reduces Inpatient Admissions Largest reduction for ER and INPT Admissions seen in first year after enrollment and this reduction remains relatively constant for years 2 and 3 post enrollment despite aging and disease progression.

29 Good to know you are there when I might need you. Knowing to talk to is that Margalit is so available huge there is no waiting for her to get back. The periodic phone calls to check up on us are very reassuring. The referral to quit smoking also a huge thanks. One year smoke free and counting! Thank you for being there! Margalit h as been very prompt returning my calls when I have questions or concerns. She makes m e feel at ease knowing she is always there if I need her. Knowing you are there at the other end of the phone call or always calling back, is great!. Just your patience and moral support are a gift. The fact that someone takes the time to listen to our concerns is a gift. 29

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