Association of Guideline-Recommended COPD Inhaler Regimens With Mortality, Respiratory Exacerbations, and Quality of Life

Keller, Thomas L.; Spece, Laura J; Donovan, Lucas M.; Udris, Edmunds M.; Coggeshall, Scott; Griffith, Matthew; Bryant, A.; Casaburi, Richard; Cooper, John A.; Criner, Gerard J.; Diaz, Phillip; Fuhlbrigge, Anne L.; Kanner, Richard E.; Martínez, Fernando J.; Panos, Ralph J.; Shade, David M.; Sternberg, Alice L.; Stibolt, Thomas B.; Stoller, James K.; Tonascia, James; Wise, Robert A.; Yusen, Roger D.; Au, David H.; Feemster, Laura C.

doi:10.1016/j.chest.2020.02.073

Cited by 8 publications

(9 citation statements)

References 33 publications

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“…Secondly, although COPD is treatable, it is not curable, leaving us to wonder if patient outcomes improved in the long term. Although these results are indicative of better acute care, we do not know if this translates into better aggregate outcomes over time [25]. We believe that extending the benefits of QualityIQ engagement to PCPs would improve COPD care and extend the benefits beyond the acute care setting, building on the latest research showing that the QualityIQ tool is effective in the primary care setting [16].…”

Section: Discussionmentioning

confidence: 99%

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Initiative to Improve Evidence-Based Chronic Obstructive Pulmonary Disease Hospitalist Care Using a Novel On-Line Gamification Patient Simulation Tool: A Prospective Study

Strong

Weems

Burgon³

et al. 2021

Healthcare

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Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality. Much of the disease burden comes from exacerbations requiring hospitalization. Unwarranted care variation and divergence from evidence-based COPD management guidelines among hospitalists is a leading driver of the poor outcomes and excess costs associated with COPD-related hospitalizations. We engaged with Novant Health hospitalists to determine if measurement and feedback using fixed-choice simulated patients improves evidence-based care delivery and reduces costs. We created a series of gamified acute-care COPD case simulations with real-time feedback over 16 weeks then performed a year-over-year analytic comparison of the cost, length of stay (LOS), and revisits over the six months prior to the introduction of the simulated patients, the four months while caring for the simulated patients, and the six months after. In total, 245 hospitalists from 15 facilities at Novant Health participated. At baseline, the overall quality-of-care was measured as 58.4% + 12.3%, with providers correctly identifying COPD exacerbation in 92.4% of cases but only identifying the grade and group in 61.9% and 49.5% of cases, respectively. By the study end, the quality-of-care had improved 10.5% (p < 0.001), including improvements in identifying the grade (+9.7%, p = 0.044) and group (+8.4%, p = 0.098). These improvements correlated with changes in real-world performance data, including a 19% reduction in COPD-related pharmacy costs. Overall, the annualized impact of COPD improvements led to 233 fewer inpatient days, 371 fewer revisit days, and inpatient savings totaling nearly $1 million. Engaging practicing providers with patient simulation-based serial measurements and gamified evidence-based feedback potentially reduces inpatient costs while simultaneously reducing patient LOS and revisit rates.

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Section: Discussionmentioning

confidence: 99%

“…CPVs have been validated against actual clinical care and in numerous clinical settings [21][22][23]. CPV-driven initiatives have also been shown to reduce the cost of care (projected as $5 to $6.2M) and improve patient outcomes, such as length of stay and mortality [24,25].…”

Section: Qualityiq Patient Simulation Casesmentioning

confidence: 99%

Initiative to Improve Evidence-Based Chronic Obstructive Pulmonary Disease Hospitalist Care Using a Novel On-Line Gamification Patient Simulation Tool: A Prospective Study

Strong

Weems

Burgon³

et al. 2021

Healthcare

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“…The HrQoL experienced by patients with LTOT has previously been reported by a small number of studies, which have generally presented poor scores ( 18 – 22 ). To our knowledge, no study has investigated the potential associations between HrQoL and modifiable factors such as adverse effects, alcohol consumption or smoking.…”

mentioning

confidence: 84%

“…(17) The HrQoL experienced by patients with LTOT has previously been reported by a small number of studies which have generally presented poor scores. (18)(19)(20)(21)(22) To our knowledge, no study has investigated the potential associations between HrQoL and modifiable factors such as adverse effects, alcohol consumption or smoking as well as their relations to HrQoL. Elucidating the prevalence of adverse effects, alcohol consumption and smoking in patients treated with LTOT could contribute to improvements in care for those affected, and could potentially contribute to enhancing patient adherence, which is currently known to be suboptimal among many patients.…”

Section: Word Count For Abstract: 308mentioning

confidence: 99%

Adverse Effects, Smoking, Alcohol Consumption, and Quality of Life during Long-Term Oxygen Therapy: A Nationwide Study

Björklund

Ekström

2022

Annals ATS

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Author contributions: F.B. and M.E. take joint responsibility for the content of the manuscript, including the data and analysis. F.B. and M.E. both made substantial contributions to the study concept and design; F.B. performed data acquisition and F.B. and M.E. performed data analysis and interpretation. Both authors contributed significantly to manuscript writing and critical revisions for important intellectual content, and both authors read and approved the final version of the manuscript. Study sponsors had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.

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“…23,24 In addition, many patients with COPD use inhaled treatment regimens that depart from guideline-recommended indications. 18,25,26 Notably, fewer than 5% of patients attend pulmonary rehabilitation despite strong evidence supporting its use. [27][28][29] Identifying factors associated with the achievement of high-quality outpatient COPD care represents an important first step toward the design of effective interventions to improve care quality.…”

Section: Introductionmentioning

confidence: 99%

Association of Patient and Primary Care Provider Factors with Outpatient COPD Care Quality

et al. 2022

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Association of Guideline-Recommended COPD Inhaler Regimens With Mortality, Respiratory Exacerbations, and Quality of Life

Cited by 8 publications

References 33 publications

Initiative to Improve Evidence-Based Chronic Obstructive Pulmonary Disease Hospitalist Care Using a Novel On-Line Gamification Patient Simulation Tool: A Prospective Study

Initiative to Improve Evidence-Based Chronic Obstructive Pulmonary Disease Hospitalist Care Using a Novel On-Line Gamification Patient Simulation Tool: A Prospective Study

Adverse Effects, Smoking, Alcohol Consumption, and Quality of Life during Long-Term Oxygen Therapy: A Nationwide Study

Association of Patient and Primary Care Provider Factors with Outpatient COPD Care Quality

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