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Castaneda JM, Leonhard A, Spece LJ, Duan KI, Palen BN, Chen JA, Li YI, Zeliadt S, Josey K, Feemster LC, Au DH, Donovan LM. Incidence and Predictors of Long-Term Hypnotic Receipt among Patients with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2025; 22:863-871. [PMID: 39938075 DOI: 10.1513/annalsats.202407-798oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 02/11/2025] [Indexed: 02/14/2025] Open
Abstract
Rationale: Many patients with chronic obstructive pulmonary disease (COPD) receive hypnotic prescriptions to mitigate insomnia symptoms. Although clinical practice guidelines advise short-term use, patients often receive these medications on a long-term basis. Because patients with COPD may be more susceptible to adverse effects of hypnotic medication, it is critical that we better understand the incidence and potential influences of this practice. Objectives: To characterize the incidence and predictors of guideline-discordant long-term receipt of hypnotic medications among patients with COPD. Methods: Using nationwide Veterans Health Administration data, we identified patients with clinically diagnosed COPD from 2010 to 2019 without prior hypnotic medication receipt in the previous 1 year. To identify individuals with new hypnotic agent use, we restricted this sample to those who received at least 30 total days of zolpidem, melatonin, trazodone, and/or doxepin within a 90-day period. We defined long-term hypnotic medication receipt as continued availability of one of these hypnotic medications for ≥30 days within the subsequent 90-day period. We then used a mixed-effects logistic regression model to assess patient and site-level associations with long-term receipt. Results: Among 4,262 patients with COPD and new hypnotic medication receipt, 55.6% (n = 2,371) continued to receive hypnotic medications on a long-term basis. Long-term receipt was positively associated with short-acting β-agonist receipt (for every 10% increase in days with short-acting β-agonist availability, odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05), maintenance inhaler prescriptions (monotherapy, OR, 1.35; 95% CI, 1.10-1.68; dual therapy, OR, 1.43; 95% CI, 1.20-1.70; triple therapy, OR, 1.54; 95% CI, 1.24-1.91), posttraumatic stress disorder (OR, 1.21; 95% CI, 1.02-1.44), major depressive disorder (OR, 1.24; 95% CI, 1.07-1.44), anxiety disorder (OR, 1.21; 95% CI, 1.03-1.44), and more frequent primary care visits (more than five visits in the past 12 mo, OR, 1.86; 95% CI, 1.19-2.90). Long-term receipt was negatively associated with initial receipt of melatonin (OR, 0.70; 95% CI, 0.55-0.91) and more than one pulmonary visit in the previous 12 months (OR, 0.74; 95% CI, 0.56-0.97). Conclusions: Despite guideline recommendations, long-term hypnotic medication receipt is common among patients with COPD. Future work to prevent long-term hypnotic prescriptions should consider the role that respiratory symptoms and mental health comorbidities may have in driving this practice.
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Affiliation(s)
- Jason M Castaneda
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Aristotle Leonhard
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Laura J Spece
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Kevin I Duan
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian N Palen
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Veterans Affairs Center for Care and Payment Innovation, Washington, DC; and
| | - Jessica A Chen
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Y Irina Li
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Steve Zeliadt
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Kevin Josey
- Veterans Affairs Center for Care and Payment Innovation, Washington, DC; and
- Department of Biostatistics and Informatics, University of Colorado, Aurora, Colorado
| | - Laura C Feemster
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - David H Au
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Veterans Affairs Center for Care and Payment Innovation, Washington, DC; and
| | - Lucas M Donovan
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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Picazo F, Duan KI, Hee Wai T, Hayes S, Leonhard AG, Fonseca GA, Plumley R, Beaver KA, Donovan LM, Au DH, Feemster LC. Rural Residence Associated with Receipt of Recommended Postdischarge Chronic Obstructive Pulmonary Disease Care among a Cohort of U.S. Veterans. Ann Am Thorac Soc 2025; 22:515-522. [PMID: 39513986 DOI: 10.1513/annalsats.202405-493oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 11/07/2024] [Indexed: 11/16/2024] Open
Abstract
Rationale: Individuals with chronic obstructive pulmonary disease (COPD) in rural areas experience inequitable access to care. Objectives: To assess whether rural residence is associated with receipt of recommended postdischarge COPD care. Methods: We conducted a cohort study of all U.S. veterans discharged from a Veterans Affairs medical center after COPD hospitalization from 2010 to 2019. Rural residence was defined by rural-urban commuting area classification. Our primary outcome was the proportion of recommended care received within 90 days of hospital discharge, including smoking cessation therapy, appropriate management of supplemental oxygen, appropriate prescription of inhaled therapy, and pulmonary rehabilitation. We conducted multivariable linear regression between rural residence and the proportion of recommended care received, adjusting for age, sex, race, ethnicity, comorbidities, and primary care facility type. We tested multivariable linear probability models for each of the recommended therapies. Results: Of 67,649 patients, 7,370 (10.8%) resided in rural areas and 2,000 (3.0%) in highly rural areas. Overall, the proportion of recommended COPD treatments received was low (mean, 15.0%; standard deviation, 21.0%). Compared with urban residence, patients with rural and highly rural residence received fewer recommended COPD care treatments (rural estimate [adjusted percentage difference (95% confidence interval)], -1.1 [-1.6, -0.6]; highly rural estimate, -1.2 [-2.1, -0.3]). Rural and highly rural residence were associated with lower likelihood of receiving appropriate inhaled therapy escalation (rural estimate, -4.0 [-5.1, -3.0]; highly rural estimate, -3.0 [-5.0, -1.1]) and pulmonary rehabilitation referral (rural estimate, -1.2 [-1.6, -0.9]; highly rural estimate, -2.1 [-2.7, -1.4]) but a higher likelihood of receiving smoking cessation therapy (rural estimate, 5.4 [3.3, 7.5]; highly rural estimate, 7.2 [3.3, 11.2]). There was no significant difference in appropriate oxygen management (rural estimate, -1.0 [-2.8, 0.9]; highly rural estimate, 3.1 [-0.7, 6.9]). Conclusions: Patients across the rural-urban spectrum received few recommended postdischarge COPD treatments. Health systems approaches are needed to address widespread underuse of evidence-based COPD care.
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Affiliation(s)
- Fernando Picazo
- Center of Innovation for Veteran-Centered and Value-Drive Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Kevin I Duan
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Travis Hee Wai
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada; and
| | - Sophia Hayes
- Center of Innovation for Veteran-Centered and Value-Drive Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Aristotle G Leonhard
- Center of Innovation for Veteran-Centered and Value-Drive Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Giuseppe A Fonseca
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Robert Plumley
- Center of Innovation for Veteran-Centered and Value-Drive Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Kristine A Beaver
- Center of Innovation for Veteran-Centered and Value-Drive Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Lucas M Donovan
- Center of Innovation for Veteran-Centered and Value-Drive Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - David H Au
- Center of Innovation for Veteran-Centered and Value-Drive Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
- Center for Care and Payment Innovation, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Laura C Feemster
- Center of Innovation for Veteran-Centered and Value-Drive Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
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Chunyang L, Yijia S. Analysis of the effects of group progressive resistance training on inflammatory markers, cardiovascular fitness parameters, and respiratory function in elderly patients with chronic obstructive pulmonary disease. J Med Biochem 2025; 44:112-118. [PMID: 39991166 PMCID: PMC11846646 DOI: 10.5937/jomb0-52323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/26/2024] [Indexed: 02/25/2025] Open
Abstract
Background To investigate the effects of implementing group progressive resistance training on Maximal Oxygen consumption (VO2max), Maximum Ventilation per minute (VEmax), Maximal Oxygen pulse (O2pulsemax), Maximum Heart Rate (HRmax), and Modified Medical Research Council dyspnea scale (mMRC) in elderly patients with chronic obstructive pulmonary disease. Methods A total number of 114 elderly patients with chronic obstructive pulmonary disease treated in the hospital from May 2022 to May 2024 were collected and divided into two groups based on different training methods. The conventional group (n=57) received routine rehabilitation training, while the organization group (n=57) received group progressive resistance training. Cardio - pulmonary Exercise Testing (CPET) parameters, serum inflammatory factors, lung function indicators, and mMRC score were compared between two groups before training, 2 weeks of training, and 4 weeks of training. Results Before training, there was no significant difference between the two groups regarding training compliance, CPET parameters, inflammatory factors, and mMRC score. After 2-4 weeks of training, both groups showed improvements in training frequency, intensity, autonomous training, and increases in VO2MAX, VEmax, O2pulsemax, and HRmax. However, the organization group had higher scores in these areas and lower levels of inflammatory factors (IL-8, IL-18, IL-6, IL-12) and mMRC scores compared to the conventional group, with statistically significant differences (P<0.05). Conclusions Group progressive resistance training can help improve the compliance of elderly patients with chronic obstructive pulmonary disease with training, reduce the body's inflammatory response, improve VO2MAX, VEmax, O2pulsemax, and HRmax levels, and alleviate breathing difficulties.
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Affiliation(s)
- Li Chunyang
- Zhejiang Hospital, Intensive Care Unit, Hangzhou, China
| | - Sun Yijia
- Zhejiang Hospital, Respiratory Department, Hangzhou, China
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Weissman GE, Silvestri JA, Lapite F, Mullen IS, Bishop NS, Kmiec T, Summer A, Sims MW, Ahya VN, Kangovi S, Klaiman TA, Szymczak JE, Hart JL. A Qualitative Study Identifying the Potential Risk Mechanisms Leading to Hospitalization for Patients With Chronic Lung Disease. CHEST PULMONARY 2024; 2:100060. [PMID: 39391571 PMCID: PMC11465817 DOI: 10.1016/j.chpulm.2024.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
BACKGROUND Care management programs for chronic lung disease attempt to reduce hospitalizations, yet have not reliably achieved this goal. A key limitation of many programs is that they target patients with characteristics associated with hospitalization risk, but do not specifically modify the mechanisms that lead to hospitalization. RESEARCH QUESTION What are the common mechanisms underlying known patient-level risk characteristics leading to hospitalizations for acute exacerbations of chronic lung disease? STUDY DESIGN AND METHODS We conducted a qualitative study of patients admitted to the University of Pennsylvania Health System with acute exacerbations of chronic lung disease between January and September 2019. We interviewed patients, their family caregivers, and their inpatient and outpatient clinicians about experiences leading up to the hospitalization. We analyzed the interview transcripts using triangulation and abductive analytic methods. RESULTS We conducted 69 interviews focused on the admission of 22 patients with a median age of 66 years (interquartile range, 60-70 years), of whom 16 patients (73%) were female and 14 patients (64%) were Black. We interviewed 22 patients, 14 caregivers, 19 inpatient clinicians, and 14 outpatient clinicians. We triangulated the available interview data for each patient admission and identified the underlying mechanisms of how several known patient characteristics associated with risk actually led to hospitalization. These mechanisms included limited capacity for home management of acute symptom changes, barriers to accessing care, chronic functional limitations, and comorbid behavioral health disorders. Importantly, many of the clinical, social, and behavioral mechanisms underlying hospitalizations were present for months or years before the symptoms that prompted inpatient care. INTERPRETATION Care management programs should be built to target specific clinical, social, and behavioral mechanisms that directly lead to hospitalization. Upstream interventions that reduce hospitalization risk are possible given that many contributory mechanisms are present for months or years before the onset of acute exacerbations.
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Affiliation(s)
- Gary E Weissman
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA; Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Jasmine A Silvestri
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA
| | | | - Isabelle S Mullen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nicholas S Bishop
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA
| | - Tyler Kmiec
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA
| | - Amy Summer
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA
| | - Michael W Sims
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA
| | - Vivek N Ahya
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA
| | - Shreya Kangovi
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA; Penn Center for Community Health Workers, University of Pennsylvania, Philadelphia, PA
| | - Tamar A Klaiman
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA
| | - Julia E Szymczak
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Joanna L Hart
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA; Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA
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5
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Chokkara S, Rojas JC, Zhu M, Lindenauer PK, Press VG. Evaluating Quality of Care for Patients with Asthma in the Readmission Penalty Era. Ann Am Thorac Soc 2024; 21:1166-1175. [PMID: 38748912 PMCID: PMC11298984 DOI: 10.1513/annalsats.202311-928oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/15/2024] [Indexed: 08/02/2024] Open
Abstract
Rationale: Asthma poses a significant burden for U.S. patients and health systems, yet inpatient care quality is understudied. National chronic obstructive lung disease (COPD) readmission policies may affect inpatient asthma care through hospital responses to these policies because of imprecise diagnosis and identification of patients with COPD and asthma. Objectives: Evaluate inpatient care quality for patients hospitalized with asthma and potential collateral effects of the Medicare COPD Hospital Readmissions Reduction Program (HRRP). Methods: This was a retrospective cohort study of patients aged 18-54 years hospitalized for asthma across 924 U.S. hospitals (Premier Healthcare Database). Results: Care quality for patients with asthma was evaluated before HRRP implementation (n = 20,820; January 2010-September 2014) and after HRRP implementation (n = 26,885; October 2014-December 2018) using adherence to inpatient care guidelines (recommended, nonrecommended, and "ideal care" [all recommended with no nonrecommended care]). Between 2010 and 2018, at least 80% of patients received recommended care annually. Recommended care decreased similarly (rate of 0.02%/mo) after versus before HRRP (P = 0.8). Nonrecommended care decreased more rapidly after HRRP (rate of 0.29%/mo) versus before HRRP (rate of 0.17%/mo; P < 0.001), with changes driven largely by decreased antibiotic prescribing. Ideal care increased more rapidly after HRRP (rate of 0.25%/mo) versus before HRRP (rate of 0.17%/mo; P = 0.02), with changes driven largely by nonrecommended care improvements. Conclusions: Post-HRRP trends suggest asthma care improved with increased rates of guideline concordance in nonrecommended and ideal care. Although federal policies (e.g., HRRP) may have had positive collateral effects, such as with asthma care, parallel care efforts, including antibiotic stewardship, likely contributed to these improvements.
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Affiliation(s)
| | - Juan C. Rojas
- Department of Medicine, Rush University, Chicago, Illinois; and
| | - Mengqi Zhu
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School–Baystate, Springfield, Massachusetts
| | - Valerie G. Press
- Department of Medicine, University of Chicago, Chicago, Illinois
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Waltman A, Konetzka RT, Chia S, Ghani A, Wan W, White SR, Krishnamurthy R, Press VG. Effectiveness of a Bundled Payments for Care Improvement Program for Chronic Obstructive Pulmonary Disease. J Gen Intern Med 2023; 38:2662-2670. [PMID: 37340256 PMCID: PMC10506991 DOI: 10.1007/s11606-023-08249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/18/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND The Medicare Bundled Payments for Care Improvement (BPCI) program reimburses 90-day care episodes post-hospitalization. COPD is a leading cause of early readmissions making it a target for value-based payment reform. OBJECTIVE Evaluate the financial impact of a COPD BPCI program. DESIGN, PARTICIPANTS, INTERVENTIONS A single-site retrospective observational study evaluated the impact of an evidence-based transitions of care program on episode costs and readmission rates, comparing patients hospitalized for COPD exacerbations who received versus those who did not receive the intervention. MAIN MEASURES Mean episode costs and readmissions. KEY RESULTS Between October 2015 and September 2018, 132 received and 161 did not receive the program, respectively. Mean episode costs were below target for six out of eleven quarters for the intervention group, as opposed to only one out of twelve quarters for the control group. Overall, there were non-significant mean savings of $2551 (95% CI: - $811 to $5795) in episode costs relative to target costs for the intervention group, though results varied by index admission diagnosis-related group (DRG); there were additional costs of $4184 per episode for the least-complicated cohort (DRG 192), but savings of $1897 and $1753 for the most complicated index admissions (DRGs 191 and 190, respectively). A significant mean decrease of 0.24 readmissions per episode was observed in 90-day readmission rates for intervention relative to control. Readmissions and hospital discharges to skilled nursing facilities were factors of higher costs (mean increases of $9098 and $17,095 per episode respectively). CONCLUSIONS Our COPD BPCI program had a non-significant cost-saving effect, although sample size limited study power. The differential impact of the intervention by DRG suggests that targeting interventions to more clinically complex patients could increase the financial impact of the program. Further evaluations are needed to determine if our BPCI program decreased care variation and improved quality of care. PRIMARY SOURCE OF FUNDING This research was supported by NIH NIA grant #5T35AG029795-12.
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Affiliation(s)
- Amelia Waltman
- Pritzker School of Medicine, University of Chicago, Chicago, USA
| | - R Tamara Konetzka
- Department of Public Health Sciences, University of Chicago, Chicago, USA
| | - Stephanie Chia
- Center for Transformative Care, University of Chicago Medicine, Chicago, USA
| | - Assad Ghani
- Center for Transformative Care, University of Chicago Medicine, Chicago, USA
| | - Wen Wan
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, USA
| | - Steven R White
- Section of Pulmonary/Critical Care, Department of Medicine, University of Chicago, Chicago, USA
| | | | - Valerie G Press
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, USA.
- Section of Academic Pediatrics, Department of Pediatrics, University of Chicago, 5841 S Maryland, MC 2007, Chicago, USA.
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Kerr M, Tarabichi Y, Evans A, Mapel D, Pace W, Carter V, Couper A, Drummond MB, Feigler N, Federman A, Gandhi H, Hanania NA, Kaplan A, Kostikas K, Kruszyk M, van Melle M, Müllerová H, Murray R, Ohar J, Pollack M, Pullen R, Williams D, Wisnivesky J, Han MK, Meldrum C, Price D. Patterns of care in the management of high-risk COPD in the US (2011-2019): an observational study for the CONQUEST quality improvement program. LANCET REGIONAL HEALTH. AMERICAS 2023; 24:100546. [PMID: 37545746 PMCID: PMC10400879 DOI: 10.1016/j.lana.2023.100546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 08/08/2023]
Abstract
Background In this study, we compare management of patients with high-risk chronic obstructive pulmonary disease (COPD) in the United States to national and international guidelines and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). Methods Patients were identified from the DARTNet Practice Performance Registry and categorized into three high-risk cohorts in each year from 2011 to 2019: newly diagnosed (≤12 months after diagnosis), already diagnosed, and patients with potential undiagnosed COPD. Patients were considered high-risk if they had a history of exacerbations or likely exacerbations (respiratory consult with prescribed medication). Descriptive statistics for 2019 are reported, along with annual trends. Findings In 2019, 10% (n = 16,610/167,197) of patients met high-risk criteria. Evidence of spirometry for diagnosis was low; in 2019, 81% (n = 1228/1523) of patients newly diagnosed at high-risk had no record of spirometry/peak expiratory flow in the 12 months pre- or post-diagnosis and 43% (n = 651/1523) had no record of COPD symptom review. Among those newly and already diagnosed at high-risk, 52% (n = 4830/9350) had no evidence of COPD medication. Interpretation Findings suggest inconsistent adherence to evidence-based guidelines, and opportunities to improve identification, documentation of services, assessment, therapeutic intervention, and follow-up of patients with COPD. Funding This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.
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Affiliation(s)
- Margee Kerr
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Yasir Tarabichi
- Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH, USA
| | | | - Douglas Mapel
- University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Wilson Pace
- DARTNet Institute, Aurora, USA
- University of Colorado, Denver, CO, USA
| | | | - Amy Couper
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - M. Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Norbert Feigler
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | - Alex Federman
- General Internal Medicine, Mount Sinai, New York, NY, USA
| | - Hitesh Gandhi
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | - Nicola A. Hanania
- Section of Pulmonary and Critical Care Medicine, and Director of the Airways Clinical Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Alan Kaplan
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Family Physician Airways Group of Canada, Stouffville, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Maja Kruszyk
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Queensland, Australia
| | - Marije van Melle
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Connecting Medical Dots BV, Utrecht, the Netherlands
- ORTEC, Zoetermeer, the Netherlands
| | | | | | - Jill Ohar
- Department of Internal Medicine, WakeForest University, Winston-Salem, NC, USA
| | - Michael Pollack
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA
| | - Rachel Pullen
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Dennis Williams
- UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
- Allergy and Asthma Network, Vienna, VA, USA
| | | | | | - Catherine Meldrum
- Division of Pulmonary & Critical Care at University of Michigan Hospital, Ann Arbor, MI, USA
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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