Managing COPD Learning Collaborative

Transcription

1 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, MD, PhD 1

2 Team Composition Marlene Bannon Fred Bloom, M.D. Pamela Cook Jonathan Darer, M.D. Carolyn Houk, M.D. Mark Mossel Chris Seiler Paul Simonelli, M.D. Sanjay Udoshi, M.D. 2

3 COPD Project Goals Create system-wide registry for COPD Choose & implement best practice for COPD Develop continuum of care for COPD patients Address high-risk COPD patients 3

4 System-wide COPD Registry: Key Steps 1. Linkage of databases Identify patients who have provider-assigned diagnosis of COPD Link all PFT sites (>35) via common server Link EHR and PFT databases (CDIS) Identify all COPD patients who have had PFT's Fit GOLD criteria? Additional testing done? Generate site- and provider-specific lists of COPD without PFT's 4

5 Active Patients: Obstruction by Spirometry Measure # Pts % Pts Total active patients with Spirometry Total with FEV1/FVC < 70% % FEV1/FVC < 70%, COPD % FEV1/FVC < 70%, no COPD % 5

6 Difference in Age and Spirometry by Obstruction & COPD COPD FEV1/FVC < 0.70 Ave Age (years) Ave FVC (liters) Ave FEV1 (liters) FEV1/FVC (Ave) % < 40 years Number YES YES % 4.0% 2816 YES NO % 3.3% 1148 NO YES % 18.1% 3348 NO NO % 18.1%

7 COPD Registry: Key Steps 2. Pulmonary Function Testing Expansion of central PFT Lab capability "Outreach" PFT technician & testing (5 sites to date) Common protocols & standards Goal: 100% confirmation & stratification by PFT's 3. Education of Site-based Personnel In-lab training Webinars twice yearly CME courses 7

8 COPD Registry: Key Steps 4. Expansion of Registry Obstructive PFT's without a diagnosis of COPD Patient-based questionnaire* Site based administration (in pilot phase) Web-based (patient portal) Predictive modeling* Data warehouse-based comprehensive data * in development 8

9 Patient-Based Questionnaire 9

10 COPD: Best Practice 1. Align severity to GOLD criteria Internal EPIC-based diagnosis codes "Mild, Moderate, Severe, Very-severe" "severity to be determined Assign severity based on PFTs* * in development 10

11 Obstruction by Spirometry and COPD in PL: Difference by Diagnosis Description ICD9 # Pts % < 0.70 COPD Exacerbation % COPD w Emphysema % Asthma in COPD % COPD, Mild 496B 17 59% COPD, Moderate 496C 17 71% COPD, Severe 496D 20 90% COPD, Very Severe 496E 7 100% COPD, Severity to be Determined 496A % 11

12 COPD: Best Practice 2. Address other "phenotypes" of COPD* frequent exacerbation emphysema pulmonary hypertension chronic respiratory failure other co-morbidities * in development 12

13 COPD: Best Practice 3. Recommend therapy based on severity* Pharmacologic SABA for all LABA/ICS, LAMA for severe, exacerbator Consultation Pulmonary consults for Very Severe COPD * in development 13

14 COPD: Best Practice 4. Measure quality measures across population Smoking cessation Immunizations Appropriate Medications Advanced directives for severe COPD other? 14

15 COPD: Continuum of Care 1. Integration of sub-specialty care into the patientbased medical home On-going pilot projects: "Trigger" for sub-specialty management Management across the spectrum of disease Identify care teams Care Management 15

16 PCMH-Plus Care Team Model Patient with Severe COPD Primary Specialists Thoracic Medicine Primary Care Advanced Practitioner PCMH+ Primary Care Physician Care Manager Consultant Cardiology Advisor for COPD Population - Thoracic Medicine 16

17 COPD: Continuum of Care Ongoing Pilots: Improved physician & provider communication Ask a Doc chart review phone call video call (instant tele-medicine) New modes of patient management Telemedicine consultation 17

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19 COPD: Continuum of Care 2. Refine treatment protocols* Leverage expertise of primary care, hospitalists, subspecialists, and population-based researchers On-going QI Outcomes research * in development 19

20 COPD: High-risk Patients 1. Re-admission for COPD exacerbation In-hospital co-management by Hospitalists and Pulmonologists Enhanced short-term clinic follow-up by PCP and Pulmonologists Enhanced management for Medical Home and Case Managers 20

21 COPD: Readmission Rate GMC Total Patients* Re-admit <30 days Re-admit <90 days COPD 1 o Dx (15.7%) 44 (28.8%) COPD any Dx (15.9%) 445 (24.0%) GWV COPD 1 o Dx (20.3%) 60 (32.1%) COPD any Dx (16.8%) 326 (26.5%) *Patient level data, Quality manager, 11/1/09 10/31/10 21

22 COPD: High-risk Patients 2. Advanced Lung Disease program Conduit for advanced therapy Transplant LVRS Research protocols Address co-morbid conditions Pulmonary Hypertension program 22

23 COPD: High-risk Patients 3. Regional identification of patients at risk* - "Beacon project" - Regional sharing of radiology data * in development 23

24 Lessons Learned Definition of COPD challenging by EHR analysis Smoking cessation program development difficult 24

25 Future Steps Finish what we started! 25

26 Questions? 26