Association of early suspected acute exacerbations of idiopathic pulmonary fibrosis with subsequent clinical outcomes and healthcare resource utilization.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) may be complicated by episodes of acute exacerbation. This study quantified the association between occurrence of suspected acute exacerbations of IPF (AEx-IPF) in the 6 months post-IPF diagnosis with clinical outcomes and IPF-related healthcare resource utilization (HRU). METHODS: U.S. pulmonologists participated in a retrospective chart review of IPF patients. Patient eligibility criteria included: 1) ≥40 years of age and a confirmed date of first IPF diagnosis with HRCT and/or lung biopsy between January 2011-June 2013; 2) 2 separate FVC results recorded around first diagnosis and 6 months post-diagnosis. Patients with a suspected AEx-IPF within 6 months post-diagnosis were categorized as "early AEx-IPF." Subsequent clinical outcomes and IPF-related HRU were assessed from 6 months post-diagnosis until the latest physician contact date. RESULTS: The sample included 490 IPF patients from 168 pulmonologists; 72 (15%) patients had a suspected early AEx-IPF. At IPF diagnosis, the mean (SD) age was 61 (11) years, 68% were male, and the mean FVC percent predicted was 60% (26%). Compared to patients without a suspected early AEx-IPF, patients with an early AEx-IPF had higher mortality risk (HR = 2.87, p < 0.001) and higher rates of subsequent suspected AEx-IPF (IRR = 3.87, p < 0.001), outpatient visits (IRR = 1.46, p < 0.001), ER visits (IRR = 4.39, p < 0.001), hospitalizations (IRR = 7.96, p < 0.001), and ICU stays (IRR = 9.74, p < 0.001). CONCLUSIONS: Using a large sample of IPF patients from varied practice settings, we found a strong relationship between suspected early AEx-IPF and worse subsequent clinical outcomes and increased IPF-related HRU. This relationship was particularly pronounced for acute resource use.

Impact of a telehealth and care management program for patients with chronic obstructive pulmonary disease.

RATIONALE: Improving outcomes and health resource use for patients with chronic obstructive pulmonary disease (COPD) care is a priority for health systems. The Health Buddy Program, a content-driven telehealth system coupled with care management, is designed to enhance patient education, self-management, and timely access to care. OBJECTIVES: To examine the effects of the Health Buddy Program on resource use among Medicare patients with COPD who participated in a Centers for Medicare and Medicaid Services demonstration project from 2006 to 2010. METHODS: Medicare fee-for-service beneficiaries with COPD who enrolled in the intervention at two participating clinics were propensity-score matched to similar patients with COPD identified from a 5% random sample of Medicare patients. Difference-in-difference analyses descriptively compared the program's effect on quarterly healthcare resource use over the 3-year study period compared with baseline. Negative binomial models estimated the association of the program with healthcare resource outcomes adjusting for significant (P<0.05) baseline differences post matching. MEASUREMENTS AND MAIN RESULTS: The effect of the Health Buddy Program on quarterly all-cause and respiratory-related hospital admissions, hospital admissions for COPD exacerbations, and all-cause emergency department use was assessed after matching. Intervention (n=619) and matched control subjects (n=619) had similar baseline characteristics after matching. The Health Buddy Program was associated with 23% lower quarterly all-cause hospital admissions and 40% lower quarterly respiratory-related hospital admissions compared with baseline for intervention beneficiaries versus control subjects. In subgroup analyses, patients who engaged in the intervention during the study period (n=247) demonstrated significantly lower quarterly hospital admissions for COPD exacerbations. The Health Buddy Program was not associated with reductions in quarterly emergency department use. Results were robust in analyses that adjusted for significant differences in baseline characteristics after matching. CONCLUSIONS: A content-driven telehealth system combined with care management has the potential to improve health outcomes in Medicare beneficiaries with COPD.

Effects of care management and telehealth: a longitudinal analysis using medicare data.

OBJECTIVES: To evaluate mortality and healthcare utilization effects of an intervention that combined care management and telehealth, targeting individuals with congestive heart failure, chronic obstructive pulmonary disease, or diabetes mellitus. DESIGN: Retrospective matched cohort study. SETTING: Northwest United States. PARTICIPANTS: High-cost Medicare fee-for-service beneficiaries (N = 1,767) enrolled in two Centers for Medicare and Medicaid Services demonstration participating clinics and a propensity-score matched control group. INTERVENTION: The Health Buddy Program, which integrates a content-driven telehealth system with care management. MEASUREMENTS: Mortality, inpatient admissions, hospital days, and emergency department (ED) visits during the 2-year study period were measured. Cox-proportional hazard models and negative binomial regression models were used to assess the relationship between the intervention and survival and utilization, controlling for demographic and health characteristics that were statistically different between groups after matching. RESULTS: At 2 years, participants offered the Health Buddy Program had 15% lower risk-adjusted all-cause mortality (hazard ratio (HR) = 0.85, 95% confidence interval (CI) = 0.74-0.98; P = .03) and had reductions in the number of quarterly inpatient admissions from baseline to the study period that were 18% greater than those of matched controls during this same time period (-0.035 vs -0.003; difference-in-differences = -0.032, 95% CI = -0.054 to -0.010, P = .005). No relationship was found between the Health Buddy Program and ED use or number of hospital days for participants who were hospitalized. The Health Buddy Program was most strongly associated with fewer admissions for individuals with chronic obstructive pulmonary disease and mortality for those with congestive heart failure. CONCLUSION: Care management coupled with content-driven telehealth technology has potential to improve health outcomes in high-cost Medicare beneficiaries.