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

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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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Licskai C, Hussey A, Rowley V, Ferrone M, Lu Z, Zhang K, Terebessy E, Scarffe A, Sibbald S, Faulds C, O’Callahan T, To T. Thorax. 2024; 79(8):725-734.

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