Quantifying sustained health system benefits of primary care-based integrated disease management for COPD: a 6-year interrupted time series study.

IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Thorax Pub Date : 2024-07-16 DOI:10.1136/thorax-2023-221211
Christopher Licskai, Anna Hussey, Véronique Rowley, Madonna Ferrone, Zihang Lu, Kimball Zhang, Emilie Terebessy, Andrew Scarffe, Shannon Sibbald, Cathy Faulds, Tim O'Callahan, Teresa To
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Abstract

Background: Severe exacerbation of chronic obstructive pulmonary disease (COPD) is a trajectory-changing life event for patients and a major contributor to health system costs. This study evaluates the real-world impact of a primary care, integrated disease management (IDM) programme on acute health service utilisation (HSU) in the Canadian health system.

Methods: Interrupted time series analysis using retrospective health administrative data, comparing monthly HSU event rates 3 years prior to and 3 years following the implementation of COPD IDM. Primary outcomes were COPD-related hospitalisation and emergency department (ED) visits. Secondary outcomes included hospital bed days and all-cause HSU.

Results: There were 2451 participants. COPD-related and all-cause HSU rates increased in the 3 years prior to IDM implementation. With implementation, there was an immediate decrease (month 1) in COPD-related hospitalisation and ED visit rates of -4.6 (95% CI: -7.76 to -1.39) and -6.2 (95% CI: -11.88, -0.48) per 1000 participants per month, respectively, compared with the counterfactual control group. After 12 months, COPD-related hospitalisation rates decreased: -9.1 events per 1000 participants per month (95% CI: -12.72, -5.44) and ED visits -19.0 (95% CI: -25.50, -12.46). This difference nearly doubled by 36 months. All-cause HSU also demonstrated rate reductions at 12 months, hospitalisation was -10.2 events per 1000 participants per month (95% CI: -15.79, -4.44) and ED visits were -30.4 (95% CI: -41.95, -18.78).

Conclusions: Implementation of COPD IDM in a primary care setting was associated with a changed trajectory of COPD-related and all-cause HSU from an increasing year-on-year trend to sustained long-term reductions. This highlights a substantial real-world opportunity that may improve health system performance and patient outcomes.

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量化基于初级保健的慢性阻塞性肺病综合疾病管理对医疗系统的持续益处:一项为期 6 年的间断时间序列研究。
背景:慢性阻塞性肺病(COPD)的严重恶化是改变患者生活轨迹的事件,也是医疗系统成本的主要来源。本研究评估了初级保健、综合疾病管理(IDM)计划对加拿大医疗系统中急性医疗服务利用率(HSU)的实际影响:方法:使用回顾性健康管理数据进行间断时间序列分析,比较慢性阻塞性肺病综合疾病管理计划实施前 3 年和实施后 3 年的每月医疗服务使用率。主要结果是慢性阻塞性肺病相关的住院和急诊就诊。次要结果包括住院天数和全因 HSU:共有 2451 名参与者。在实施 IDM 之前的 3 年中,慢性阻塞性肺病相关住院率和全因 HSU 率均有所上升。与反事实对照组相比,实施 IDM 后,慢性阻塞性肺病相关住院率和急诊室就诊率立即下降(第 1 个月),分别为每月每 1000 名参与者-4.6(95% CI:-7.76 至-1.39)和-6.2(95% CI:-11.88,-0.48)。12 个月后,慢性阻塞性肺病相关住院率有所下降:与慢性阻塞性肺病相关的住院率在 12 个月后有所下降:每 1000 名参与者每月的住院率为-9.1(95% CI:-12.72, -5.44),急诊室就诊率为-19.0(95% CI:-25.50, -12.46)。这一差异在 36 个月后几乎翻了一番。12 个月后,全因 HSU 的发病率也有所下降,每 1000 名参与者每月的住院率为-10.2(95% CI:-15.79, -4.44),急诊室就诊率为-30.4(95% CI:-41.95, -18.78):在基层医疗机构实施慢性阻塞性肺疾病 IDM 与慢性阻塞性肺疾病相关和全因 HSU 的变化轨迹有关,即从逐年增加的趋势转变为持续的长期减少。这凸显出现实世界中存在着巨大的机会,可以改善医疗系统的绩效和患者的预后。
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来源期刊
Thorax
Thorax 医学-呼吸系统
CiteScore
16.10
自引率
2.00%
发文量
197
审稿时长
1 months
期刊介绍: Thorax stands as one of the premier respiratory medicine journals globally, featuring clinical and experimental research articles spanning respiratory medicine, pediatrics, immunology, pharmacology, pathology, and surgery. The journal's mission is to publish noteworthy advancements in scientific understanding that are poised to influence clinical practice significantly. This encompasses articles delving into basic and translational mechanisms applicable to clinical material, covering areas such as cell and molecular biology, genetics, epidemiology, and immunology.
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