ONLINE DATA SUPPLEMENT - ASTHMA INTERVENTION PROGRAM PREVENTS READMISSIONS IN HIGH HEALTHCARE UTILIZERS
|
|
- Alvin Farmer
- 5 years ago
- Views:
Transcription
1 R2 (REVISED MANUSCRIPT BLUE OC) ONLINE DATA SUPPLEMENT - ASTHMA INTERVENTION PROGRAM PREVENTS READMISSIONS IN HIGH HEALTHCARE UTILIZERS Mario Castro, M.D., M.P.H. Nina A. Zimmermann R.N. Sue Crocker R.N. Joseph Bradley Charles Leven, Ph.D. Kenneth B. Schechtman, Ph.D. 1
2 METHODS - Extended Version Patients All patients admitted to Barnes-Jewish Hospital with the primary admitting diagnosis of asthma were screened for participation from September 1996 to July Patients were eligible for the study if they had a physician diagnosis of asthma of at least 12 months duration, were from years of age, and hospitalized at Barnes-Jewish Hospital. Patients were required to have a forced expiratory volume in one second (FEV 1 ) to forced vital capacity (FVC) ratio less than 80%. Patients who met these criteria and had a history of one or more hospitalization in the twelve months prior to evaluation were eligible. The criteria for exclusion from the study included: chronic bronchitis, emphysema, or congestive heart failure diagnosed by the primary physician; a terminal condition with anticipated survival of less than one year; dementia or serious psychiatric illness, such as schizophrenia or personality disorder; planned discharge to a long-term care facility, anticipated early discharge of less than 24 hours, not allowing enough time to complete the intervention, or refusal to participate by the patient or physician of record. The study was approved by the Human Studies Committee of Washington University School of Medicine. All patients gave informed consent before entry into the study. A total of 828 patients were admitted with a primary diagnosis of asthma during the period of enrollment. Of these, 732 were excluded for the following reasons: 230 were discharged in less than 24 hours, 201 had a diagnosis other than asthma, 122 had no previous hospitalization within the last twelve months, 29 patients were not mentally stable, and 28 patients refused to participate prior to randomization. An additional 122 2
3 patients were excluded if they left against medical advice, were under the care of one of the investigators, did not meet age criteria or unable to give consent, or the patient s primary physician refused to allow the patient to enroll or could not be contacted for approval. Therefore, 96 patients were eligible for randomization. Study Design and Intervention The study consisted of a randomized, controlled prospective trial investigating the use of an asthma nurse specialist to provide a multi-faceted approach to asthma care for high-risk inpatients who met the study criteria. Three consecutive nurses provided the intervention during the study. The study patients were randomly assigned to the intervention or usual care group in a blind selection procedure using a pre-randomized assignment in a sealed envelope. The patients and healthcare team were not blinded to treatment assignment due to the nature of the intervention. The usual care group received the normal care provided by their private primary care physician. Asthma education was provided to the usual care group by the hospital respiratory therapist and nurse including asthma medication dosing, action and side effects, as well as inhaler technique and peak flow monitoring. The usual care group received written discharge instructions from the hospital nurse stating the patient s discharge medications and physician follow-up information but did not include an asthma action or management plan. No nursing care was provided to the usual care group by the study nurses other than obtaining study data and the performance of baseline spirometry. The study intervention consisted of the following multi-faceted approach: 1) The asthma nurse specialist reviewed the individual treatment plans with the patients. The 3
4 nurse made suggestions to the primary physician regarding potential changes to the treatment plan, including simplification or consolidation, in accordance with the National Asthma Education and Prevention Program II[E1]. 2) Completion of a daily Asthma Care flow sheet while in the hospital which included a symptom score, pulmonary functions (including peak expiratory flow), current asthma medications, and any pertinent recommendations. The purpose of this Asthma Care flow sheet was to provide direct communication from the nurse specialist to the primary physician on the status of the patient. 3) Provision of asthma education appropriate to the patient s education, motivation, and cultural beliefs. This included individual instruction using tailored asthma education which included identifying triggers, early and late warning signs, medications and delivery technique, use of a spacer, peak flow monitoring, how to implement environmental control measures, assessing need for allergy skin testing, smoking cessation counseling, and importance of follow-up care. As many sessions as possible were provided to the patient until they were discharged (on average 2 sessions). 4) Provision of psychosocial support and screening patients for professional counseling. In the majority of cases, psychosocial support was provided by the asthma nurse specialist directly through verbal and written communication. If there was an important psychosocial issue that could interfere with asthma control and it was beyond the asthma nurse s expertise, the patient was referred to a social worker or psychiatric nurse specialist. 5) Establishing an individualized written Asthma Self-Management plan in conjunction with the treating physician. 6) Consultation with social service professionals when necessary to facilitate discharge planning. 7) Provision of outpatient follow-up through telephone contacts (on average 5.8 telephone contacts per patient, range 0-24) 4
5 and follow-up appointments with primary physician, as necessary. The patient s asthma control was assessed at these subsequent contacts and the primary physician was contacted if necessary. In some patients, a home visit (on average 0.4 home visits per patient, range 0-3) was necessary for patients who were unavailable by phone, to establish trust, and to evaluate for potential environmental or social factors which might be contributing to poor asthma control. Study endpoints All analysis was conducted with the intention-to-treat principle with the primary endpoint being readmission due to asthma within 360 days. Secondary endpoints included total readmissions, emergency department visits, quality of life, direct and indirect healthcare costs, lost school or work days, cumulative number of days of hospitalization, and the number of refills of asthma medications within 360 days. Data Collection Detailed data were collected at entry into the study by the asthma nurse specialist, including demographics, medical history, and information regarding the patients asthma history, including age at onset and diagnosis, previous hospitalizations, emergency department visits, environmental exposures and triggers, and medications. Spirometry was performed at enrollment, including measurement of FEV 1, FVC, and peak expiratory flow, in accordance with American Thoracic Society recommendations[e2]. The values expressed are reported in absolute values and as a percentage of the predicted normal values for each patient based on age, sex, height, and race. Predicted normal values were obtained from standard references[e3, 4]. Demographic, health care utilization, missed school/work days, and cost data were updated at 90 and 180 days based upon patient s 5
6 cost logs (described below). All hospitalizations, emergency department, and physicians visits were corroborated by the patient s medical records. Cost analysis Costs were estimated using cost logs which were collected contemporaneously by all patients during the 180 day enrollment period. The cost logs contained detailed information regarding health care utilization, medications, and hours spent by paid and unpaid healthcare givers. The cost logs were verified by the study nurse during follow up visits and the amount of time spent providing the intervention was documented (excluding time spent for research purposes). An hourly rate of $35 was chosen as the cost of nursing time and $15 for paid or unpaid caregiver time. The cost of a lost work day was calculated at $75 per day for both the patient and family caregiver. The cost for a physician visit was calculated at $40 per visit. The cost of allergy skin testing or immunotherapy was set at $400 each (prevailing rates in the St. Louis area). Costs for hospital admissions were based on allowed reimbursements according to standard codes for each diagnosis-related group (DRG). Direct medical costs included hospitalizations, emergency department visits, physician visits, nurse or paid caregiver home care, allergy skin tests/immunotherapy, and asthma medications. Indirect costs included the cost of lost work days by the patient or family caring for the patient, and nonprofessional or other paid help. All costs were adjusted to 1999 dollars. Quality of life Quality of life was measured using a disease-specific measure, the Asthma Quality of Life Questionnaire, at entry into the study and at 6 months following the initial hospitalization[e5]. This questionnaire contains 32 questions with four different domains: 6
7 activity limitation, asthma symptoms, emotional function, and environmental exposure. The activity domain is individualized to five different activities pertinent to that patient. Each question for recall of impairment during the previous two weeks using a 7- point scale. Overall quality of life score is estimated from the unweighted mean score of all the items. Previous studies have shown this questionnaire to be valid as an evaluative and discriminative instrument[e5, 6]. Statistical analysis T-tests and chi-square tests were used to compare variables between groups unless otherwise noted. However, because of the skewed nature of variables such as the number of days in the hospital and the number of emergency department visits, Wilcoxon's test was sometimes used as an alternative to the t-test. Stepwise logistic regression was used to identify variables that had an independent association with being readmitted at least two times within a year of the initial hospitalization. Variables entered into the model as potential predictors included the study group and all variables that were significantly associated with repeat hospitalization. These included the age of the patient, the duration of asthma, the number of hospitalizations in the previous 12 months, and FEV 1 (percent predicted). A logrank test was used to perform between group comparisons of the survival curves measuring time to the first readmission. Summary data on continuous variables are expressed as mean + standard deviation. All data analyses were performed using SAS software (SAS Institute, Cary, N.C.). 7
8 REFERENCES E1. National Asthma Education and Prevention Program: Expert Panel Report II: Guidelines for the diagnosis and management of asthma. National Institutes of Health; National Heart, Lung, and Blood Institute, E2. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis 1987; 136: 225. E3. Knudson RJ, Lebowitz MD, Holberg CJ, Burrows B. Changes in normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis 1983; 127: E4. Miller A. Pulmonary function tests in clinical and occupational lung disease. Orlando, Fla:: Grune and Stratton, 1986; E5. Juniper E, Guyatt G, Ferrie P, Griffith L. Measuring quality of life in asthma. Am Rev Respir Dis 1993; 147: E6. Juniper E, Guyatt G, Willan A, Griffith L. Determining a minimal important change in a disease-specific quality of life questionnaire. J Clin Epidemiol 1994; 47:
Asthma Intervention Program Prevents Readmissions in High Healthcare Users
Asthma Intervention Program Prevents Readmissions in High Healthcare Users Mario Castro, Nina A. Zimmermann, Sue Crocker, Joseph Bradley, Charles Leven, and Kenneth B. Schechtman Departments of Medicine
More information2017 Chronic Respiratory. Program Evaluation. Our mission is to improve the health and quality of life of our members
2017 Chronic Respiratory Program Evaluation Our mission is to improve the health and quality of life of our members 2017 Chronic Respiratory Program Evaluation Program Title: Chronic Respiratory Program
More informationAsthma: Evaluate and Improve Your Practice
Potential Barriers and Suggested Ideas for Change Key Activity: Initial assessment and management Rationale: The history and physical examination obtained from the patient and family interviews form the
More informationTARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS
TARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS Recommendation PULMONARY FUNCTION TESTING (SPIROMETRY) Conditional: The Expert Panel that spirometry measurements FEV1,
More informationReducing COPD Exacerbation Readmissions in a Community-Based Teaching Hospital
Reducing COPD Exacerbation Readmissions in a Community-Based Teaching Hospital Dawn Waddell, PharmD, BCPS Clinical Pharmacy Manager Lisa Kingdon, PharmD, BCPS Clinical Pharmacy Specialist Dawn Waddell
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationClinical Practice Guideline: Asthma
Clinical Practice Guideline: Asthma INTRODUCTION A critical aspect of the diagnosis and management of asthma is the precise and periodic measurement of lung function both before and after bronchodilator
More informationMeenu Singh, Joseph L. Mathew, Prabhjot Malhi, B.R. Srinivas and Lata Kumar
Comparison of Improvement in Quality of Life Score with Objective Parameters of Pulmonary Function in Indian Asthmatic Children Receiving Inhaled Corticosteroid Therapy Meenu Singh, Joseph L. Mathew, Prabhjot
More informationSupplementary Online Content
Supplementary Online Content Regan EA, Lynch DA, Curran-Everett D, et al; Genetic Epidemiology of COPD (COPDGene) Investigators. Clinical and radiologic disease in smokers with normal spirometry. Published
More informationCommissioning for Better Outcomes in COPD
Commissioning for Better Outcomes in COPD Dr Matt Kearney Primary Care & Public Health Advisor Respiratory Programme, Department of Health General Practitioner, Runcorn November 2011 What are the Commissioning
More information2012 Chronic Respiratory. Program Evaluation. Our mission is to improve the health and quality of life of our members
2012 Chronic Respiratory Program Evaluation Our mission is to improve the health and quality of life of our members 2012 Chronic Respiratory Program Evaluation Program Title: Chronic Respiratory Program
More informationAsthma Coding Fact Sheet for Primary Care Pediatricians
01/01/2017 Asthma Coding Fact Sheet for Primary Care Pediatricians Physician Evaluation & Management Services Outpatient 99201 99202 99203 99204 99205 Office or other outpatient visit, new patient; self
More information6- Lung Volumes and Pulmonary Function Tests
6- Lung Volumes and Pulmonary Function Tests s (PFTs) are noninvasive diagnostic tests that provide measurable feedback about the function of the lungs. By assessing lung volumes, capacities, rates of
More informationNicotine Replacement Therapy and Brief Motivational Interview for Emergency Department Smokers with Asthma
Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 3-4-2008 Nicotine Replacement Therapy and Brief Motivational Interview
More information2013 Chronic Respiratory. Program Description. Our mission is to improve the health and quality of life of our members
2013 Chronic Respiratory Program Description Our mission is to improve the health and quality of life of our members Chronic Respiratory Program Description I. Purpose Care Coordination promotes the Plan
More informationThis clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.
abcd Clinical Study Synopsis for Public Disclosure This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data. The synopsis
More informationCenter for Respiratory and Sleep Medicine COPD Chronic Disease Management Program
Center for Respiratory and Sleep Medicine COPD Chronic Disease Management Program Cristina Ashworth, NP Khalil Diab,MD Center for Respiratory and Sleep Medicine Subgroup of Indiana Internal Medicine Consultants
More informationCenterstone Research Institute
American Addiction Centers Outcomes Study 12 month post discharge outcomes among a randomly selected sample of residential addiction treatment clients Centerstone Research Institute 2018 1 AAC Outcomes
More informationDifference Between The Slow Vital Capacity And Forced Vital Capacity: Predictor Of Hyperinflation In Patients With Airflow Obstruction
ISPUB.COM The Internet Journal of Pulmonary Medicine Volume 4 Number 2 Difference Between The Slow Vital Capacity And Forced Vital Capacity: Predictor Of Hyperinflation In Patients With Airflow Obstruction
More informationTACKLING COPD READMISSIONS. Wendy Presley RN
TACKLING COPD READMISSIONS Wendy Presley RN WHY START WITH COPD? HIGH VOLUME PROBLEM PRONE COSTLY And you just can t resist a challenge Chronic Obstructive Pulmonary Disease (COPD) is a preventable and
More informationPEDIATRIC ASTHMA INPATIENT CARE MAP
DATE PATIENT PEDIATRIC ASTHMA INPATIENT CARE MAP DOB HSC NO. PHIN Approved by the Winnipeg Regional Health Authority This Care Map is to be used as a guideline and in no way replaces sound clinical judgment
More informationType of intervention Treatment. Economic study type Cost-effectiveness analysis.
Cost-effectiveness of salmeterol/fluticasone propionate combination product 50/250 micro g twice daily and budesonide 800 micro g twice daily in the treatment of adults and adolescents with asthma Lundback
More informationDouglas W. Mapel MD, MPH, Melissa Roberts PhD
Original Article Spirometry, the St. George s Respiratory Questionnaire, and other clinical measures as predictors of medical costs and COPD exacerbation events in a prospective cohort Douglas W. Mapel
More informationKnowledge and Practice of Medical Doctors on Chronic Obstructive Pulmonary Disease: A Preliminary Survey from a State Hospital
ORIGINAL ARTICLE Knowledge and Practice of Medical Doctors on Chronic Obstructive Pulmonary Disease: A Preliminary Survey from a State Hospital ARM Fauzi, MRCP Kulliyah of Medicine, International Islamic
More informationNational Learning Objectives for Asthma Educators
National Learning Objectives for Asthma Educators National Learning Objectives for Asthma Educators The Asthma Educator will be able to achieve the following objectives. Performance objectives, denoted
More informationIndian Journal of Basic & Applied Medical Research; September 2013: Issue-8, Vol.-2, P
Original article: Study of pulmonary function in different age groups Dr.Geeta J Jagia*,Dr.Lalita Chandan Department of Physiology, Seth GS Medical College, Mumbai, India *Author for correspondence: drgrhegde@gmail.com
More informationFact. Objectives 1/6/2016. Reducing Hospital Readmissions for Chronic Obstructive Pulmonary Disease (COPD)
Reducing Hospital Readmissions for Chronic Obstructive Pulmonary Disease (COPD) Jin S. Oh, PharmD Larkin Community Hospital January 10, 2016 Fact COPD is the third leading cause of death in the United
More informationSYNOPSIS A two-stage randomized, open-label, parallel group, phase III, multicenter, 7-month study to assess the efficacy and safety of SYMBICORT
Drug product: Drug substance(s): Edition No.: Study code: SYMBICORT pmdi 160/4.5 g Budesonide/formoterol D5896C00005 Date: 8 May 2006 SYNOPSIS A two-stage randomized, open-label, parallel group, phase
More informationArkansas Health Care Payment Improvement Initiative COPD Algorithm Summary
Arkansas Health Care Payment Improvement Initiative COPD Algorithm Summary Chronic Obstructive Pulmonary Disease (COPD) Algorithm Summary v1.6 Page 2 of 6 Triggers PAP Assignment Exclusions Episode Time
More informationA Randomized Controlled Trial of Follow-up of Patients Discharged From the Hospital Following Acute Asthma*
Original Research ASTHMA A Randomized Controlled Trial of Follow-up of Patients Discharged From the Hospital Following Acute Asthma* Best Performed by Specialist Nurse or Doctor? James A. Nathan, MRCP;
More informationPulmonary Rehabilitation. Palmetto GBA, Jurisdiction 11 MAC Provider Outreach and Education
Pulmonary Rehabilitation Palmetto GBA, Jurisdiction 11 MAC Provider Outreach and Education Pulmonary Rehabilitation Pulmonary Rehabilitation is a multi-disciplinary program of care for patients with chronic
More informationMEDICAL ASSISTANCE BULLETIN
ISSUE DATE January 6, 2016 SUBJECT EFFECTIVE DATE January 20, 2016 MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of COPD Agents Pharmacy Service Leesa M. Allen, Deputy Secretary
More informationAnyone who smokes and/or has shortness of breath and sputum production could have COPD
COPD DIAGNOSIS AND MANAGEMENT CHECKLIST Anyone who smokes and/or has shortness of breath and sputum production could have COPD Confirm Diagnosis Presence and history of symptoms: Shortness of breath Cough
More informationDATE: 09 December 2009 CONTEXT AND POLICY ISSUES:
TITLE: Tiotropium Compared with Ipratropium for Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease: A Review of the Clinical Effectiveness DATE: 09 December 2009 CONTEXT AND POLICY
More informationPREDICTION EQUATIONS FOR LUNG FUNCTION IN HEALTHY, LIFE TIME NEVER-SMOKING MALAYSIAN POPULATION
Prediction Equations for Lung Function in Healthy, Non-smoking Malaysian Population PREDICTION EQUATIONS FOR LUNG FUNCTION IN HEALTHY, LIFE TIME NEVER-SMOKING MALAYSIAN POPULATION Justin Gnanou, Brinnell
More information*GERIATRIC FELLOWSHIP COMPETENCY CHECKLIST EDUCATIONAL GOALS:
*GERIATRIC FELLOWSHIP COMPETENCY CHECKLIST EDUCATIONAL GOALS: The goal of geriatric fellowship training is to prepare fellows for competency in the following core areas: Check and record date completed
More informationSGRQ Questionnaire assessing respiratory disease-specific quality of life. Questionnaire assessing general quality of life
SUPPLEMENTARY MATERIAL e-table 1: Outcomes studied in present analysis. Outcome Abbreviation Definition Nature of data, direction indicating adverse effect (continuous only) Clinical outcomes- subjective
More informationTOBACCO TREATMENT INPATIENT QUALITY MEASURES. Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: December 2015
TOBACCO TREATMENT INPATIENT QUALITY MEASURES Kathy Wonderly RN, MSEd, CPHQ Consultant Developed: December 2015 The Joint Commission has included a tobacco treatment measure set in their National Hospital
More informationCARE OF THE ADULT COPD PATIENT
CARE OF THE ADULT COPD PATIENT Target Audience: The target audience for this clinical guideline is all MultiCare providers and staff including those associated with our Clinically Integrated Network. The
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Donaldson SH, Bennett WD, Zeman KL, et al. Mucus clearance
More informationSPIROMETRY. Marijke Currie (CRFS) Care Medical Ltd Phone: Copyright CARE Medical ltd
SPIROMETRY Marijke Currie (CRFS) Care Medical Ltd Phone: 0800 333 808 Email: sales@caremed.co.nz What is spirometry Spirometry is a physiological test that measures the volume of air an individual can
More informationCare Bundle. Adult patients with COPD
Care Bundle Adult patients with COPD Version 2 July 2014 What is a care bundle? A care bundle is a set of interventions that, when used together, significantly improve patient outcomes. The measures chosen
More informationOMICS International Conferences
About OMICS Group OMICS Group is an amalgamation of Open Access Publications and worldwide international science conferences and events. Established in the year 2007 with the sole aim of making the information
More informationOptimal Asthma Control Data Specifications
Optimal Asthma Control Data Specifications Final Version December 2009: Updated for Population Identification April 2010 MNCM Measure Description Methodology Rationale Composite measure of the percentage
More informationThe clinical trial information provided in this public disclosure synopsis is supplied for informational purposes only.
The clinical trial information provided in this public disclosure synopsis is supplied for informational purposes only. Please note that the results reported in any single trial may not reflect the overall
More informationRHCs in Accountable Care Organizations (ACOs)
RHCs in Accountable Care Organizations (ACOs) Judith Ortiz, Ph.D., Thomas Wan, Ph.D. Richard Hofler, Ph.D., Angeline Bushy, Ph.D., R.N. Yi ling Lin, Ph.D., Celeste Boor, B.S., Jackie Ong Rural Health Research
More informationPregnancy Smoking Intervention in NE Tennessee: Effectiveness Data from the First Two Years of TIPS
Pregnancy Smoking Intervention in NE Tennessee: Effectiveness Data from the First Two Years of TIPS Beth A. Bailey, PhD Associate Professor of Family Medicine Director, Tennessee Intervention for Pregnant
More informationSpirometry in primary care
Spirometry in primary care Wednesday 13 th July 2016 Dr Rukhsana Hussain What is spirometry? A method of assessing lung function Measures volume of air a patient can expel after a full inspiration Recorded
More informationPulmonary Rehabilitation
Pulmonary Rehabilitation New Benefit The enactment of HR 6331, the Medicare Improvements for Patients and Providers Act of 2008, established a specific Medicare benefit for pulmonary rehabilitation. The
More informationOutline FEF Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications?
Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications? Fernando Holguin MD MPH Director, Asthma Clinical & Research Program Center for lungs and Breathing University of Colorado
More informationSupplementary Online Content
Supplementary Online Content Lee JS, Nsa W, Hausmann LRM, et al. Quality of care for elderly patients hospitalized for pneumonia in the United States, 2006 to 2010. JAMA Intern Med. Published online September
More informationOffice Based Spirometry
Osteopathic Family Physician (2014)1, 14-18 Scott Klosterman, DO; Woodson Crenshaw, OMS4 Spartanburg Regional Family Medicine Residency Program; Edward Via College of Osteopathic Medicine - Virginia Campus
More informationChronic obstructive pulmonary disease
0 Chronic obstructive pulmonary disease Implementing NICE guidance June 2010 NICE clinical guideline 101 What this presentation covers Background Scope Key priorities for implementation Discussion Find
More informationUMEC/VI vs. UMEC in subjects who responded to UMEC UMEC/VI vs. VI in subjects who responded to VI
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationMinimum Competencies for Asthma Care in Schools: School Nurse
Minimum Competencies for Asthma Care in Schools: School Nurse Area I. Pathophysiology 1. Explain using simple language and appropriate educational aids the following concepts: a. Normal lung anatomy and
More informationPOLICIES AND PROCEDURE MANUAL
POLICIES AND PROCEDURE MANUAL Policy: MP230 Section: Medical Benefit Policy Subject: Outpatient Pulmonary Rehabilitation I. Policy: Outpatient Pulmonary Rehabilitation II. Purpose/Objective: To provide
More informationSpirometry Training Courses. Spirometry for. Thoracic Society of Australia and New Zealand. June Developed in partnership with
Standards for Spirometry Training Courses Companion Document to Standards for the Delivery of Spirometry for Coal Mine Workers Thoracic Society of Australia and New Zealand June 2017 Developed in partnership
More informationC.S. HAWORTH 1, A. WANNER 2, J. FROEHLICH 3, T. O'NEAL 3, A. DAVIS 4, I. GONDA 3, A. O'DONNELL 5
Inhaled Liposomal Ciprofloxacin in Patients With Non-Cystic Fibrosis Bronchiectasis and Chronic Pseudomonas aeruginosa: Results From Two Parallel Phase III Trials (ORBIT-3 and -4) C.S. HAWORTH 1, A. WANNER
More informationClinical and radiographic predictors of GOLD-Unclassified smokers in COPDGene
Clinical and radiographic predictors of GOLD-Unclassified smokers in COPDGene Emily S. Wan, John E. Hokanson, James R. Murphy, Elizabeth A. Regan, Barry J. Make, David A. Lynch, James D. Crapo, Edwin K.
More informationSCREENING AND PREVENTION
These protocols are designed to implement standard guidelines, based on the best evidence, that provide a consistent clinical experience for AHC II Integrated Clinical Delivery Network patients and allow
More informationArkansas Health Care Payment Improvement Initiative Congestive Heart Failure Algorithm Summary
Arkansas Health Care Payment Improvement Initiative Congestive Heart Failure Algorithm Summary Congestive Heart Failure Algorithm Summary v1.2 (1/5) Triggers PAP assignment Exclusions Episode time window
More information7.Integrating quit lines into health systems
7.Integrating quit lines into health systems Why should quit-line planners, promoters and service providers consider how their quit line could be integrated into health-care delivery systems in their country?
More informationBlood Eosinophils and Response to Maintenance COPD Treatment: Data from the FLAME Trial. Online Data Supplement
Blood Eosinophils and Response to Maintenance COPD Treatment: Data from the FLAME Trial Nicolas Roche, Kenneth R. Chapman, Claus F. Vogelmeier, Felix JF Herth, Chau Thach, Robert Fogel, Petter Olsson,
More informationOutpatient Pulmonary Rehabilitation
Outpatient Pulmonary Rehabilitation Policy Number: 8.03.05 Last Review: 7/2017 Origination: 7/1995 Next Review: 7/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for
More informationThe Value of Engagement in Substance Use Disorder (SUD) Treatment
The Value of Engagement in Substance Use Disorder (SUD) Treatment A Report from Allegheny HealthChoices, Inc. June 2016 Introduction When considering substance use disorder (SUD) treatment, the length
More informationDaclizumab improves asthma control in patients with moderate to. severe persistent asthma: A randomized, controlled trial
Daclizumab improves asthma control in patients with moderate to severe persistent asthma: A randomized, controlled trial William W. Busse, MD, Elliot Israel, MD, Harold S. Nelson, MD, James W. Baker, MD,
More informationAsthma Pharmacotherapy Adherence Interventions for Adult African-Americans: A Systematic Review. Isaretta L. Riley, MD
Asthma Pharmacotherapy Adherence Interventions for Adult African-Americans: A Systematic Review By Isaretta L. Riley, MD A Master s Paper submitted to the faculty of the University of North Carolina at
More informationThis is a cross-sectional analysis of the National Health and Nutrition Examination
SUPPLEMENTAL METHODS Study Design and Setting This is a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data 2007-2008, 2009-2010, and 2011-2012. The NHANES is
More informationCambia Palliative Care Metrics: Where are we and where are we going?
Cambia Palliative Care Metrics: Where are we and where are we going? J. Randall Curtis, MD, MPH Director, Cambia Palliative Care Center of Excellence www.uwpalliativecarecenter.com Overview of System-Wide
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Bucholz EM, Butala NM, Ma S, Normand S-LT, Krumholz HM. Life
More informationDiabetes Quality Improvement Initiative
Diabetes Quality Improvement Initiative Community Care of North Carolina 2300 Rexwoods Drive, Ste. 100 Raleigh, NC 27607 (919) 745-2350 www.communitycarenc.org 2007 Background The Clinical Directors of
More informationA preliminary assessment of nurses asthma education needs and the effect of a training. programme in an urban tertiary healthcare facility.
A preliminary assessment of nurses asthma education needs and the effect of a training programme in an urban tertiary healthcare facility O O Adeyeye, Y A Kuyinu, R T Bamisile, and C I Oghama Abstract
More informationSYNOPSIS. First subject enrolled 15 August 2003 Therapeutic confirmatory (III) Last subject completed 03 February 2005
Drug product: SYMBICORT pmdi 160/4.5 μg Drug substance(s): Budesonide/formoterol Study code: SD-039-0728 Edition No.: FINAL Date: 27 February 2006 SYNOPSIS A 52-week, randomized, double-blind, single-dummy,
More informationAppendix Identification of Study Cohorts
Appendix Identification of Study Cohorts Because the models were run with the 2010 SAS Packs from Centers for Medicare and Medicaid Services (CMS)/Yale, the eligibility criteria described in "2010 Measures
More informationUSAID Health Care Improvement Project
IMPROVEMENT OBJECTIVE: Decrease asthma/copd morbidity and mortalityin affected adults and children through improved quality of asthma/copd case-management (ambulatory & hospital) Cross-cutting ambulatory
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationChronic Obstructive Pulmonary Disease (COPD).
Chronic Obstructive Pulmonary Disease (COPD). Linde: Living healthcare 02 03 Chronic Obstructive Pulmonary Disease (COPD). A pocket guide for healthcare professionals. COPD the facts Moderate to severe
More informationPURPOSE OF THE SELF-ASSESSMENT TOOLS:
Pulmonary Rehab s Framework Self-Assessment Tool Inpatient Rehab Survey for Pulmonary Rehab INTRODUCTION: In response to a changing rehab landscape in which rehabilitation is offered in many different
More informationTORCH: Salmeterol and Fluticasone Propionate and Survival in COPD
TORCH: and Propionate and Survival in COPD April 19, 2007 Justin Lee Pharmacy Resident University Health Network Outline Overview of COPD Pathophysiology Pharmacological Treatment Overview of the TORCH
More informationCHAPTER 7 SECTION 24.1 PHASE I, PHASE II, AND PHASE III CANCER CLINICAL TRIALS TRICARE POLICY MANUAL M, AUGUST 1, 2002 MEDICINE
MEDICINE CHAPTER 7 SECTION 24.1 ISSUE DATE: AUTHORITY: 32 CFR 199.4(e)(26) I. DESCRIPTION The Department of Defense (DoD) Cancer Prevention and Treatment Clinical Trials Demonstration was conducted from
More informationYorkshire & Humber Respiratory Programme Report
2013 NHS Harrogate & Rural District Clinical Commissioning Group Yorkshire & Humber Respiratory Programme Report This report has been produced by the Yorkshire & Humber Respiratory Team. It highlights
More informationCase-Compare Impact Report
Case-Compare Impact Report October 8, 20 For CME Activity: Developed through an independent educational grant from Genentech: Moderate to Severe Persistent Asthma: A Case-Based Panel Discussion (March
More information5/3/2012 PRESENTATION GOALS RESPIRATORY THERAPISTS ROLE IN END OF LIFE CARE FOR THE PULMONARY PATIENT
RESPIRATORY THERAPISTS ROLE IN END OF LIFE CARE FOR THE PULMONARY PATIENT Presented by Carrie Black Bourassa, LRT, RRT PRESENTATION GOALS Define palliative care Define hospice care Discuss pulmonary hospice
More informationTWIN VALLEY BEHAVIORAL HEALTHCARE CLINICAL GUIDELINES FOR MANAGEMENT OF SMOKING CESSATION
Appendix G PHASE OF MANAGEMENT NOTIFICATION ASSESSMENT TWIN VALLEY BEHAVIORAL HEALTHCARE CLINICAL GUIDELINES FOR MANAGEMENT OF SMOKING CESSATION ACTIONS All patients will be advised on admission that :
More informationThe links between physical health in mental health
The links between physical health in mental health A holistic approach to managing mental and physical health is needed. Physical and mental health are inextricably linked 1 What is the problem? It is
More informationIn order to diagnose lung diseases doctors
You Take My Breath Away Activity 5C NOTE: This activity is designed to follow You Really Are Full of Hot Air! Activity Objectives: After completing You Really Are Full of Hot Air! Activity 5B, students
More informationS P I R O M E T R Y. Objectives. Objectives 3/12/2018
S P I R O M E T R Y Dewey Hahlbohm, PA-C, AE-C Objectives To understand the uses and importance of spirometry testing To perform spirometry testing including reversibility testing To identify normal and
More informationBEHAVIORAL H E A L T H T R E A T M E N T. for a bright future
BEHAVIORAL H E A L T H T R E A T M E N T Hope for a bright future Providing a comprehensive mental health and addiction treatment continuum for senior adults, adults and adolescents Offering a Comprehensive
More informationQuality Outcomes and Financial Benefits of Nutrition Intervention. Tracy R. Smith, PhD, RD, LD Senior Clinical Manager, Abbott Nutrition
Quality Outcomes and Financial Benefits of Nutrition Intervention Tracy R. Smith, PhD, RD, LD Senior Clinical Manager, Abbott Nutrition January 28, 2016 SHIFTING MARKET DYNAMICS PROVIDE AN OPPORTUNITY
More informationCLINICAL PATHWAY. Acute Medicine. Chronic Obstructive Pulmonary Disease
CLINICAL PATHWAY Acute Medicine Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Table of Contents (tap to jump to page) INTRODUCTION 1 Scope of this Pathway 1 Pathway Contacts
More informationPeak Expiratory Flow Rate (PEFR) for ED Management of Acute Asthma Exacerbation
Peak Expiratory Flow Rate (PEFR) for ED Management of Acute Asthma Exacerbation PI: Brian Driver, MD Checklist Reviewed Inclusion and Exclusion Criteria Confirm pertinent exclusion criteria with PMP Engage
More information2015 Chronic Respiratory. Program Evaluation. Our mission is to improve the health and quality of life of our members
2015 Chronic Respiratory Program Evaluation Our mission is to improve the health and quality of life of our members 2015 Chronic Respiratory Program Evaluation Program Title: Chronic Respiratory Program
More informationManaging COPD Learning Collaborative
Managing COPD Learning Collaborative November 2-4, 2011 San Antonio, TX Sponsored by AMGA and Boehringer Ingelheim Pharmaceuticals, Inc. Geisinger Health System Carolyn C. Houk, MD FACP Paul Simonelli,
More informationExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full Report 2007
Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full Report 2007 TARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS Selecting Initial Therapy
More informationTeacher : Dorota Marczuk Krynicka, MD., PhD. Coll. Anatomicum, Święcicki Street no. 6, Dept. of Physiology
Title: Spirometry Teacher : Dorota Marczuk Krynicka, MD., PhD. Coll. Anatomicum, Święcicki Street no. 6, Dept. of Physiology I. Measurements of Ventilation Spirometry A. Pulmonary Volumes 1. The tidal
More informationProductivity losses in chronic obstructive pulmonary disease a population-based survey.
Online supplement to Productivity losses in chronic obstructive pulmonary disease a population-based survey. Running head: Productivity losses in COPD. Authors: Marta Erdal, Department of Thoracic Medicine,
More informationGRADE Tables and Summary of Findings for the recommendations of Rehabilitation in health systems
GRADE Tables and Summary of Findings for the recommendations of Rehabilitation in health systems REHABILITATION SERVICE DELIVERY For the following PICO questions, Population includes any person who requires
More informationdiagnosis and initial treatment at one of the 27 collaborating CCSS institutions;
Peer-delivered smoking counseling for childhood cancer survivors increases rate of cessation: the Partnership for Health Study Emmons K M, Puleo E, Park E, Gritz E R, Butterfield R M, Weeks J C, Mertens
More informationModule 6. Pharmacy Based Respiratory Therapy Services. Scott K. Stolte, Pharm.D. Pre-Assessment Exercise
Module 6 Pharmacy Based Respiratory Therapy Services Scott K. Stolte, Pharm.D. Pre-Assessment Exercise 1 Question #1 Which of the following is NOT a role for the pharmacist recommended by NAEPP? a. Educate
More informationA comparison of global questions versus health status questionnaires as measures of the severity and impact of asthma
Eur Respir J 1999; 1: 591±596 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 1999 European Respiratory Journal ISSN 93-1936 A comparison of global questions versus health status questionnaires
More information