Abstract
Objective: to present the results of our 1-year, telephonic disease management interventions for 349 patients with mild to severe chronic obstructive pulmonary disease (COPD).
Methods: parameters measuring utilization of medical services, days lost from work, and quality-of-life measurements (utilizing the St. George’s Questionnaire) were determined for the 12-month period prior to enrollment of patients and compared with those observed during the 12-month participation in the program.
Results: there was a statistically significant reduction in all utilization measurements and a statistically significant improvement in quality of life. Emergency room (ER) visits decreased by 57% (p < 0.001), hospitalizations by 53% (p < 0.001), intensive care unit admissions by 66% (p = 0.001), unscheduled office visits by 67% (p < 0.001), and oral antibacterial bursts by 48% (p < 0.001). Of the 114 employed patients, days missed from work were reduced by 77% (p < 0.001). The total saving from reduction in hospitalizations and ER visits was $US672 000. This was against an approximate cost of the program of $US223 500 (average of $US635 per enrollee). Costs associated with medications and physician visits were not obtained.
Conclusions: these outcomes suggest that, with ongoing patient support, the provision of physical rehabilitation, and improved communication between those engaged in the healing process, it is possible to reduce utilization and overall healthcare expenditures and improve the quality of life for a population of patients with moderate to severe COPD. This intervention was both cost effective and medically effective. Our experience suggests that further trials of COPD disease management are warranted.
Similar content being viewed by others
References
Murray CJ, Lopez AD. Evidence-based health policy: lessons from the Global Burden of Disease Study. Science 1996; 274: 740–3.
Petty TL, Weinmann GG. Building a national strategy for the prevention and management of and research in chronic obstructive pulmonary disease. JAMA 1997 Jan 15; 277 (3): 246–53.
Ward MM, Javitz HS, Smith WM, et al. Direct medical cost of chronic obstructive pulmonary disease in the USA. Respir Med 2000; 94: 1123–9.
World Health Organization. Full report: world health 1999 [online] Available from URL: http://www.who.int/whr/1999/en/report. [Accessed 2002 Jul 29].
Islam SS, Schottenfeld D. Declining FEV1 and chronic productive cough in cigarette smokers: a 25-year prospective study of lung cancer incidence in Tecumseh, Michigan. Cancer Epidemiol Biomarkers Prev 1994; 3: 289–98.
Tockman MS, Pearson JD, Fleg JL, et al. Rapid decline in FEV1: a new risk factor for coronary heart disease mortality. Am J Respir Crit Care Med 1995; 151: 390–8.
Kannel WB, Lew EA, Hubert H. Vital capacity as a predictor of cardiovascular disease: the Framingham Study. Am Heart J 1983; 105: 311–5.
ICD-9-CM: International classification of diseases. Ninth rev. 4th ed. Los Angeles (CA): PMIC, 1993.
Wickstrom G. The “Hawthorne effect”: what did the original Hawthorne studies actually show? Scand J Work Envir Health 2000; 26 (4): 363–7.
Lacasse Y, Wong E, Guyatt GH, et al. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet 1996; 348: 1115–9.
Finnerty JP, Keeping I, Bullough I, et al. The effectiveness of outpatient pulmonary rehabilitation in chronic lung disease. Chest 2001; 119: 1705–10.
Hernandez MTE, Rubio TM, Ruiz FO, et al. Results of a home based training program for patients with COPD. Chest 2000; 118: 106–14.
Clini E, Foglio K, Bianchi L, et al. In-hospital short-term training program for patients with chronic airway obstruction. Chest 2001; 120: 1500–5.
Pulmonary Rehabilitation 1999 Official Statement of the American Thoracic Society. Am J Respir Crit Care Med 1999 May; 159 (5): 1666–82.
O’Neill BM, Johnston D, Burrell N, et al. Effect of once weekly pulmonary rehabilitation on exercise tolerance in patients with chronic lung disease. Ir J Med Sci 2001; 170 (4): 231–2.
Jones PW, Quirk FH, Baveystock CM, et al. A self-completed measure for chronic airflow limitation: the St George’s Respiratory Questionnaire. Am Rev Respir Dis 1992; 145: 1321–7.
Jones PW, Bosh TK. Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med 1997; 155: 1283–9.
Spencer S, Calverley MA, Burge S, et al. Health status deterioration in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 163: 122–8.
Jones PW. Interpreting thresholds for a clinically significant change in health status in asthma and COPD. Eur Respir J 2002; 19 (3): 398–404.
Osman LM, Godden DJ, Friend JAR, et al. Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease. Thorax 1997; 52: 67–71.
Wilson L, Devine EB, So K. Direct medical costs of COPD: chronic bronchitis and emphysema. Respir Med 2000; 94: 204–13.
Niederman MS, McCombs JS, Unger AN, et al. Treatment cost of acute exacerbations of chronic bronchitis. Clin Ther 1999 Mar; 21 (3): 576–91.
Fletcher CM, Peto R. The natural history of chronic airflow obstruction. BMJ 1977; 1: 1645–8.
Nocturnal Oxygen Therapy Trial Group. Continuous and nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med 1980 Sep; 93 (3): 391–8.
Sullivan SD, Strassels SA, Smith DH. Characterization of the costs of COPD in the US [abstract]. Eur Respir J 1996; 9 Suppl. 23: 421S.
Murray CJL, Lopez AD. Leading causes of disability-adjusted life years. Science 1999; 274: 740–3.
Corsello PR. Selection and assessment of the chronic respiratory disease patient for pulmonary rehabilitation. In: Hodgkin JE, Celli BR, Connors GL, editors. Pulmonary rehabilitation: guidelines to success. Philadelphia (PA): Lippincott Williams & Wilkins, 2000: 31–40.
Heaton RK, Grant I, McSweeney AJ, et al. Psychologic effects of continuous and nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med 1983; 143: 1941–7.
ATS standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995; 152: S77-S120.
Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease. NHLBI/WHO Workshop Report — National Institutes of Health (NIH) National Heart, Lung, and Blood Institute. Publication Number 2701: 2001 Apr.
Gross NJ. Extrapulmonary effects of chronic obstructive lung disease. Curr Opin Pulm Med 2001 Mar; 7 (2): 84–92.
Jiang W, Alexander J, Christopher E, et al. Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med 2001; 161: 1849–56.
Felker B, Katon W, Hedrick SC, et al. The association between depressive symptoms and health status in patients with chronic pulmonary disease. Gen Hosp Psychiatry 2001 Mar–Apr; 23 (2): 56–61.
Guyatt GH, Feeny DH, Patrick DL. Measuring health related quality of life. Ann Intern Med 1993; 118: 622–9.
Griffith DE, Kronenberg RS. Psychologic, neuropsychologic and social aspects of COPD. In: Cherniack NS, editor. Chronic obstructive pulmonary disease. Philadelphia (PA): WB Saunders Company, 1991: 568–75.
Engstrom CP, Persson LO, Larsson S, et al. Functional status and well being in chronic obstructive pulmonary disease with regard to clinical parameters and smoking: a descriptive and comparative study. Thorax 1996; 51: 825–30.
Platt FW, Gaspar DL, Coulehan JL, et al. “Tell me about yourself”: the patientcentered interview. Ann Intern Med 2001; 134: 1079–85.
Sullivan SD, Ramsey SD, Todd AL. The economic burden of COPD. Chest 2000; 117 (2 Suppl.):5S–9S.
Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the medical outcomes study. JAMA 1989; 262: 907–13.
Strassels SA, Smith DH, Sullivan SD, et al. The costs of treating COPD in the United States. Chest 2001; 119: 344–52.
National Institutes of Health. Division of Epidemiology, National Heart, Lung, and Blood Institute, 1996. Available from URL: http://www.nih.gov [Accessed 2001 Dec 12].
National Medical Expenditure Survey — 1987. Chicago (IL): The Center for Health Administration Studies: University of Chicago, 1987.
Grasso ME, Weiler WE, Shaffer TJ, et al. Capitation, managed care and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 158: 133–8.
Acknowledgements
No outside sources of funding were used to conduct this study. There are no potential conflicts of interest relevant to the contents of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tinkelman, D., Corsello, P., McClure, D. et al. One-Year Outcomes from a Disease Management Program for Chronic Obstructive Pulmonary Disease. Dis-Manage-Health-Outcomes 11, 49–59 (2003). https://doi.org/10.2165/00115677-200311010-00007
Published:
Issue Date:
DOI: https://doi.org/10.2165/00115677-200311010-00007