The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

OUTCOMES OF AN ASTHMA/COPD CASE MANAGEMENT PROGRAM

Joe Dwan, MS, RRT, Kaiser Permanente, Portland, Oregon.

Background: Following positive results of a RCT pilot project, our case management program concluded the first year in 2001. Four ER?s were target for outreach to asthma & COPD patients, along with physician referrals. Two trained RCPs were utilized for 1.5 FTEs. The interventions include phone contact, PFTs, office visits with the RCP case manager. Plus follow up with the patient and primary care provider (PCP). Our goal was to optimize management of patients with adult asthma and COPD according to the KPNW Regional Clinical Practice Guidelines by improving our patients? state of health, well being and satisfaction and to efficiently utilize resources.

Method: Program evaluation included reviewing entry and exclusion criteria, procedures for screening & managing patients, discharge criteria, outcomes measures, PCP & patient surveys, cost measures, and learning?s & systems barriers. Utilization data was retrieved from our electronic medical record (EMR). Utilization data includes hospitalization, ER and urgent care/unscheduled visits, plus doctor office visits. Cost measures utilized national average costs for ER and hospitalizations.

Results: A total of 901 patients were screened with 450 receiving outreach interventions. Enrolled patients totaled 319 with 164 asthmatics and 155 COPD. Patient satisfaction and PCP surveys showed positive feedback. ER utilization decreased 56%, hospitalizations decreased 39%, urgent care visits decreased 52%, and doctor office visits decreased 32%. Cost savings calculated at $106,874.

Respiratory Utilization & Costs before and after enrollment in RCP Case Management
  Enrolled ER before ER after hospital before hospital after UCC before UCC after
Asthma
164
122
32
13
5
31
18
COPD
155
183
102
81
52
25
9
total:
319
305
134
94
57
56
27
Asthma costs
$25,620
$6,720
$35,503
$13,655
$2,573
$1,494
 
COPD costs
$53,802
$29,988
$291,762
$187,304
$2,075
$747
 

Savings
difference before and af ter case ma nagement
Asthma =
$47,527
$18,900
$21,848
$1,079
 
COPD =
$134,410
$23,814
$104,458
$1,328
Total =
$181,957
Wage & Benefits =
$75,083
Program Savings =
$106,874
Assumes AsthmaER AsthmaHosp
COPD ER
COPD Hos Clinic visit UCC
Costs =
$210
$2,731
$294
$3,602
$65
$83

Conclusions: Adult asthma and COPD case management provided by respiratory care practitioners is both effective in improving self-management and care satisfaction by patients and in decreasing utilization of scheduled and unscheduled healthcare visits. Measuring outcomes of both customer satisfaction and cost savings are strong motivation to health care systems to provide case management for this population.

OF-02-120

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