1996 OPEN FORUM Abstracts
ASTHMA AND COPD DISEASE MANAGEMENT PROGRAMS REDUCE HEALTHCARE UTILIZATION AND IMPROVE QUALITY OF LIFE.
Barbara Hendon, BA, RRT, Woody V. Kageler, MD, AccuLab Diagnostics, L.P., Dallas, TX.
Disease management programs (DMP) are designed to prolong the period of healthiness, reduce healthcare utilization (HU) and improve the overall quality of life (QOL). Asthma and COPD are chronic conditions with a high incidence of HU and increased morbidity, therefore Managed Care Organizations (MCO) have become increasingly interested in DMP for both diseases. Respiratory Care Practitioners (RCP) can be an integral part in DMP. METHOD: Customized DMP, adapted from the National Institute of Health's (NIH) guidelines for the management of asthma and Management of Chronic Obstructive Pulmonary Disease (Ferguson, et al, NEJM 328; April, 1993) for COPD, are delivered by RCP to MCO members. Outcome data are collected using instruments adapted from Health Outcomes Institute (HOI). Several weighted response questions and objective data determine the member's intervention level (IL). Each IL outlines a medication plan, action protocols and trigger control. The member monitors peak flow and symptoms and adjusts therapeutic treatment accordingly. Other weighted response questions determine the frequency for follow-up intervention by RCP. DMP enrollment period is for one year. Results: 57 individuals with either asthma or COPD have completed 6 months in the DMP. Ages: 4 to 78 years. Individuals vary in race and socio-economic background. Severity levels for asthma ranged from mild persistent to severe based on NIH classification. Pre-program intervention (PreP) is defined as HU 6 months prior to program enrollment and initial visit HOI collected information, and post-program (PostP) is HU and HOI 6 months following initial intervention. Statistical analysis by paired T-test. Results are presented as mean (SD).
Pre-P Post-P P value
Emergency room visits 1.75 (1.91) 0.32 (0.80) 0.0001
Hospitalizations 0.96 (1.21) 0.11 (0.56) 0.0001
Hospital days 5.12 (8.22) 0.44 (2.57) 0.0001
Lost productive days n=38 6.55 (11.82) 1.58 (3.55) 0.0051
EXPERIENCE: RCP can intervene proactively with members in the convenience of their homes to promote wellness. The RCP is the cornerstone in the process of developing a partnership with the member and PCP, who has final approval over IL, medication and action protocols. CONCLUSION: DMP offered to MCO for Asthma and COPD results in: 1) reduced HU, thereby reducing healthcare costs, 2) reduced lost productive days, 3) improved QOL, 4) expanded role for the RCP.