title: Impact of a telehealth and care management program for patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  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.
authors: 1 Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors: David H
authors: DH
authors: Au
authors: Dendy S
authors: DS
authors: Macaulay
authors: John L
authors: JL
authors: Jarvis
authors: Urvi S
authors: US
authors: Desai
authors: Howard G
authors: HG
authors: Birnbaum
mesh_terms: D000368:Aged; D003695:Delivery of Health Care / Q000379:methods*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000628:therapy*; D012189:Retrospective Studies; D017216:Telemedicine / Q000379:methods*; D014481:United States
keywords: Medicare; chronic obstructive pulmonary disease; telemedicine