title: Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective.
abstract: The burden of chronic obstructive pulmonary disease (COPD) in the USA continues to grow. Although progress has been made in the the development of diagnostics, therapeutics, and care guidelines, whether patients' quality of life is improved will ultimately depend on the actual implementation of care and an individual patient's access to that care. In this Commission, we summarise expert opinion from key stakeholders-patients, caregivers, and medical professionals, as well as representatives from health systems, insurance companies, and industry-to understand barriers to care delivery and propose potential solutions. Health care in the USA is delivered through a patchwork of provider networks, with a wide variation in access to care depending on a patient's insurance, geographical location, and socioeconomic status. Furthermore, Medicare's complicated coverage and reimbursement structure pose unique challenges for patients with chronic respiratory disease who might need access to several types of services. Throughout this Commission, recurring themes include poor guideline implementation among health-care providers and poor patient access to key treatments such as affordable maintenance drugs and pulmonary rehabilitation. Although much attention has recently been focused on the reduction of hospital readmissions for COPD exacerbations, health systems in the USA struggle to meet these goals, and methods to reduce readmissions have not been proven. There are no easy solutions, but engaging patients and innovative thinkers in the development of solutions is crucial. Financial incentives might be important in raising engagement of providers and health systems. Lowering co-pays for maintenance drugs could result in improved adherence and, ultimately, decreased overall health-care spending. Given the substantial geographical diversity, health systems will need to find their own solutions to improve care coordination and integration, until better data for interventions that are universally effective become available.
authors.affiliation: Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA. Electronic address: mrking@umich.edu.
authors.forename: MeiLan K
authors.initials: MK
authors.lastname: Han
authors.affiliation: Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Martinez
authors.affiliation: Center of Innovation for Veteran-Centered and Value-Driven Care, and VA Puget Sound Health Care System, US Department of Veteran Affairs, Seattle, WA, USA; Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.affiliation: McGill University Health Centre, McGill University, Montreal, QC, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Bourbeau
authors.affiliation: Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
authors.affiliation: Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Branson
authors.affiliation: Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Criner
authors.affiliation: Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Kalhan
authors.affiliation: American Association for Respiratory Care, Dallas, TX, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kallstrom
authors.affiliation: Mobile Medical Homecare, Leo, IN, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: King
authors.affiliation: University of Illinois Hospital & Health Sciences System, University of Illinois, Chicago, IL, USA.
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Krishnan
authors.affiliation: University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Lareau
authors.affiliation: Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Lee
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lindell
authors.affiliation: Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, KY, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Mannino
authors.affiliation: Department of Internal Medicine, Weill Cornell School of Medicine, New York, NY, USA.
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Martinez
authors.affiliation: Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Meldrum
authors.affiliation: Section of Hospital Medicine, University of Chicago Medicine, Chicago, IL, USA.
authors.forename: Valerie G
authors.initials: VG
authors.lastname: Press
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Byron
authors.initials: B
authors.lastname: Thomashow
authors.affiliation: Palliative and Supportive Institute, Pittsburgh, PA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Tycon
authors.affiliation: COPD Foundation, Washington, DC, USA.
authors.forename: Jamie Lamson
authors.initials: JL
authors.lastname: Sullivan
authors.affiliation: COPD Foundation, Miami, FL, USA.
authors.forename: John
authors.initials: J
authors.lastname: Walsh
authors.affiliation: Boston University School of Medicine, Boston, MA, USA; American Thoracic Society, New York, NY, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Wilson
authors.affiliation: Carolinas HealthCare System, Charlotte, NC, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Wright
authors.affiliation: Family and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Yawn
authors.affiliation: Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois, Chicago, IL, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Zueger
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Surya P
authors.initials: SP
authors.lastname: Bhatt
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Dransfield
mesh_terms: D026683:Advisory Committees; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000639:trends*; D019983:Guideline Adherence / Q000639:trends; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D014481:United States