title: Impact of an integrated disease management program in reducing exacerbations in patients with severe asthma and COPD.
abstract: BACKGROUND
  Conflicting data exists on the effectiveness of integrated programs in reducing recurrent exacerbations and hospitalizations in patients with Asthma and chronic obstructive lung disease (COPD). We developed a Pulmonologist-led Chronic Lung Disease Program (CLDP) for patients with severe asthma and COPD and analyzed its impact on healthcare utilization and predictors of its effectiveness.
  
  
  METHODS
  CLDP elements included clinical evaluation, onsite pulmonary function testing, health education, and self-management action plan along with close scheduled and on-demand follow-up. Patients with ≥2 asthma or COPD exacerbations requiring emergency room visit or hospitalization within the prior year were enrolled, and followed for respiratory related ER visits (RER) and hospitalizations (RHA) over the year (357 ± 43 days) after CLDP interventions.
  
  
  RESULTS
  A total of 106 patients were enrolled, and 104 patients were subject to analyses. During the year of follow-up after CLDP enrollment, there was a significant decrease in mean RER (0.56 ± 1.48 versus 2.62 ± 2.81, p < 0.0001), mean RHA (0.39 ± 0.08 versus 1.1 ± 1.62, p < 0.0001), and 30 day rehospitalizations (0.05 ± 0.02 versus 0.28 ± 0.07, p < 0.0001). Reduction of healthcare utilization was strongly associated with GERD and sinusitis therapy, and was independent of pulmonary rehabilitation. Direct variable cost analyses estimated annual savings at $1.17 million. Multivariate logistic regression analysis revealed lack of spirometry utilization as an independent risk factor for severe exacerbations.
  
  
  CONCLUSIONS
  A Pulmonologist-led disease management program integrating key elements of care is cost effective and significantly decreases severe exacerbations. Integrated programs should be encouraged for care of frequent exacerbators of asthma and COPD.
authors.affiliation: Division of Pulmonary and Critical Care, University of California San Francisco, Fresno, CA, 93701, USA. Electronic address: vjain@fresno.ucsf.edu.
authors.forename: Vipul V
authors.initials: VV
authors.lastname: Jain
authors.affiliation: Division of Pulmonary and Critical Care, University of California San Francisco, Fresno, CA, 93701, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Allison
authors.affiliation: Community Regional Medical Center, Fresno, CA, USA.
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Beck
authors.affiliation: Department of Internal Medicine, University of California San Francisco, Fresno, CA, 93701, USA.
authors.forename: Ratnali
authors.initials: R
authors.lastname: Jain
authors.affiliation: Department of Internal Medicine, University of California San Francisco, Fresno, CA, 93701, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Mills
authors.affiliation: Community Regional Medical Center, Fresno, CA, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: McCurley
authors.affiliation: Division of Pulmonary and Critical Care, University of California San Francisco, Fresno, CA, 93701, USA.
authors.forename: Karl P
authors.initials: KP
authors.lastname: Van Gundy
authors.affiliation: Division of Pulmonary and Critical Care, University of California San Francisco, Fresno, CA, 93701, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Peterson
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D002140:California; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000379:methods*; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D012648:Self Care / Q000191:economics / Q000379:methods; D016896:Treatment Outcome
keywords: Asthma; COPD; Disease management program; Exacerbations; Healthcare utilization; Spirometry