Beyond the Next Breath: Controlling Costs and Maximizing COPD Outcomes Edith Haage, PT, GCS NewCourtland Senior Services 10/21/2015 NEWCOURTLAND.org 1-888-530-4913
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Objectives Understand the general pathology of common chronic pulmonary impairments and their impact on health, quality of life and cost of care in older adults. Appreciate the role of medical, pharmacological and rehabilitative management on pulmonary system conditions Recognize the pivotal role of active client participation in disease management, hospitalization rates and minimization of emergency department visits Discuss the relationship between comprehensive interdisciplinary COPD management programming and effective cost containment strategies within a PACE model
COPD Facts At present, the NIH estimates there are over 12 million people diagnosed with COPD An additional 12 million likely have COPD and don't even know it COPD causes significant long term disability and increased risk for early death * http://www.nhlbi.nih.gov/health/educational/copd/index.htm
COPD: Reality Check COPD is the 3 rd leading cause of death in the US While other major causes of death have been decreasing, COPD mortality has continued to rise. COPD kills more than 120,000 Americans each year http://www.nhlbi.nih.gov/health/educational/copd/health-careprofessionals/index.htm
Counting the Cost In 2010, total national medical costs attributable to COPD and its sequelae were estimated at $32.1 billion Of the medical costs, 18% was paid for by private insurance, 51% by Medicare, and 25% by Medicaid. National medical costs are projected to increase from $32.1 billion in 2010 to $49.0 billion in 2020. Total state-specific costs in 2010 ranged from $49.1 million in Wyoming to $2.8 billion in California: medical costs ranged from $42.5 million in Alaska to $2.5 billion in Florida. Total and State-Specific Medical and Absenteism Costs of COPD Amond Adults Aged >18 years in the United States for 2010 and Projections Through 2020. Earl S. Ford, MD, MPH; Louise B. Murphy, PhD; Olga Khavjou, MA; Wayne H Giles, MD; James B. Holt, PhD; Janet B Croft, PhD. Chest. 2015;147(1):31-45
Don t Say It: Hospitalizations In 2008, there were about 822,500 hospital stays for (COPD) among adults age 40 years and older. COPD stays coded as an acute exacerbation accounted for 514,000 (62.5 %) of all COPD stays. Nearly 1 out of every 5 patients 40 years or older in U.S. hospitals has a diagnosis of COPD.
Germantown Life Utilization 25 20 15 10 Qtr 4 2014 Qtr 4 2015 5 0 ER Visits Qtr 4 Hospital Days Skilled NH Days
http://www.thoracic.org/copd-guidelines/for-patients/anatomy-and-function-of-thenormal-lung.php
Defining COPD Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease state characterized by progressive airflow limitation that is not fully reversible. Associated with cigarette smoking. Although COPD affects the lungs, it also produces significant systemic consequences. http://www.thoracic.org/copd-guidelines/resources/copddoc.pdf
What s the Difference? Chronic Bronchitis Tend to be younger Productive cough Frequent infections Often overweight and cyanotic Blue Bloaters. Emphesema Tend to be leaner Appear barrel chested Have more shortness of breath Faster respiratory rate Pink Puffers.
Bottom Line Functionally, patients with either emphysema or chronic bronchitis have limitations in expiratory flow. Staging of COPD severity is based on the degree of impairment in Forced Expiratory Volume Expiratory flow is decreased, making it more difficult to get air out of the lungs; this difficulty results in air trapping The Aging Pulmonary System. John D. Lowman
Implications Health Chronic cough and phlegm Chest tightness Susceptibility to infection SOB Impaired sleep Fall Risk Postural changes -> Musculoskeletal issues Quality of Life Limited Stamina Low energy Depression Anxiety Social Isolation Dependence Impaired ADL s
GlaxoSmithKline is the copyright owner of the COPD Assessment Test (CAT).
NPA COPD Model Practice In 2012 NPA established a COPD practice model to provide relevant diagnostic and treatment recommendations to PACE primary care providers (PCPs). Specifically designed for PACE participants Founded on published evidence-based guidelines for older adults Focused on shared decision-making between individual PCPs and participants/caregivers as optimal practice. NPA Primary Care Committee 2012 Chronic Obstructive Lung Disease Model Practice
Disease Management Considerations
SMOKING CESSATION Smoking cessation still most effective and cost effective way to stop progression Recommended Annually http://thedesigninspiration.com/category/photos
Pharmacological Interventions Inhalers Oral Medications Vaccinations
Respiratory Interventions Supplemental Oxygen if PO2 < 88% BiPAP (Bilevel Positive Airway Pressure) as Non- Invasive Positive Pressure Ventilation
Additional Interventions Pt/Family Education about Disease, maintenance Tx, and Tx of exacerbations Nutritional Counseling Present and Advance Directive Review
Physical Rehabilitation NPA Model Practice recommends a course of pulmonary rehabilitation of a minimum 6 weeks for those classified as high risk for exacerbations if the participant is able to tolerate it. At New Courtland LIFE Germantown, we strongly encourage COPD participants of all acuities to participate in Wellness programming for breathing exercises, strengthening, stamina and functional mobility to facilitate health and quality of life.
Comprehensive Management OT RT PT CHIROPRACTIC RN RD PCP PARTICIPANT SW
Bibliography The Aging Pulmonary System. John D. Lowman. Focus: Physical Therapist Practice in Geriatrics. 2011; 4: 1-32. Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease 2008 update Highlights for Primary Care. Denis E O Donnell, MD, Paul Hernandez, MD, Alan Kaplan, MD, Shawn Aaron, MD, Jean Bourbeau, MD, Darcy Marciniuk, MD, Meyer Balter, MD, Gordon Ford, MD, Andre Gervais, MD, Yves Lacasse, MD, Francois Maltais, MD, Jeremy Road, MD, Graeme Rocker, MD, Don Sin, MD, Tasmin Sinuff, MD, and Nha Voduc, MD. Can Respir J. 2008 Jan-Feb; 15 (Suppl A): 1A 8A Chronic bronchitis, asthma and pulmonary emphysema: a statement by the Committee on Diagnostic Standards for Nontuberculous Respiratory Diseases. Am Rev Respir Dis 1962; 85: 762 768. The Definition of Emphysema: Report of a National Heart, Lung and Blood Institute, Division of Lung Diseases, Workshop. Snider GL, Kleinerman J, Thurlbeck WM, Bengali ZK. Am Rev Respir Dis 1985; 132: 182 185. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease. Pawels R, Sonia Buist A, Calverley P, Jenkins C, Hurd S. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD). Workshop summary. Am J Respir Crit Care Med 2001; 163: 1256 1276. Living Well with COPD. Grace Ann Koppel. NIH Medline Plus Volume 9 Number 3 Fall 2014: 2-9 Pulmonary Rehabilitation for Management of Chronic Obstructive Pulmonary Disease. Richard Casaburi, Ph.D., M.D., and Richard ZuWallack, M.D. N Engl J Med 2009; 360:1329-1335 Total and State-Specific Medical and Absenteism Costs of COPD Amond Adults Aged >18 years in the United States for 2010 and Projections Through 2020. Earl S. Ford, MD, MPH; Louise B. Murphy, PhD; Olga Khavjou, MA; Wayne H Giles, MD; James B. Holt, PhD; Janet B Croft, PhD. Chest. 2015;147(1):31-45