title: Evaluation of a disease management program for COPD using propensity matched control group.
abstract: BACKGROUND
  Disease management programs (DMPs) have proliferated recently as a means of improving the quality and efficiency of care for patients with chronic illness. These programs include education about disease, optimization of evidence-based medications, information and support from case managers, and institution of self-management principles. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in Singapore and worldwide. DMP aims to reduce mortality, hospitalizations, and average length of stay in such patients. This study assesses the outcomes of the DMP, comparing the propensity score matched DMP patients with controls.
  
  
  METHODS
  DMP patients were compared with the controls, who were COPD patients fulfilling the DMP's inclusion criteria but not included in the program. Control patients were identified from Operations Data Store (ODS) database. The outcomes of interest were average length of stay, number of days admitted to hospital per 100 person days, readmission, and mortality rates per person year. The risk of death and readmission was estimated using Cox, and competing risk regression respectively. Propensity score was estimated to identify the predictors of DMP enrolment. DMP patients and controls were matched on their propensity score.
  
  
  RESULTS
  There were 170 matched DMP patients and control patients having 287 and 207 hospitalizations respectively. Program patient had lower mortality than the controls (0.12 vs. 0.27 per person year); cumulative 1-year survival was 91% among program patient and 76% among the control patients. Readmission, and hospital days per 100 person-days was higher for the program patients (0.36 vs. 0.17 per person year), and (2.19 vs. 1.88 per person year) respectively.
  
  
  CONCLUSIONS
  Participation in "DMP" was associated with lower all-cause mortality when compared to the controls. This survival gain in the program patients was paradoxically associated with an increase in readmission rate and total hospital days.
authors: Health Services & Outcomes Research (HSOR), National Healthcare Group HQ, Singapore ;
authors: Pradeep Paul
authors: PP
authors: George
authors: Health Services & Outcomes Research (HSOR), National Healthcare Group HQ, Singapore ;
authors: Bee Hoon
authors: BH
authors: Heng
authors: Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore ;
authors: Tow Keang
authors: TK
authors: Lim
authors: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore ;
authors: John
authors: J
authors: Abisheganaden
authors: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore ;
authors: Alan Wei Keong
authors: AW
authors: Ng
authors: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore ;
authors: Akash
authors: A
authors: Verma
authors: ;
authors: Fong Seng
authors: FS
authors: Lim
keywords: Pulmonary disease; case management; chronic obstructive; disease management program (DMP); mortality; readmission