Khaled Alshabani1, Amy A Attaway1, Michael J Smith2, Uddalak Majumdar3, Richard Rice1, Xiaozhen Han4, Xiaofeng Wang4, Umur Hatipoğlu1. 1. Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. 2. Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA. 3. Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA. 4. Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract
INTRODUCTION: The effect of electronic inhaler monitoring (EIM) on healthcare utilization in chronic obstructive pulmonary disease (COPD) has not been studied. We hypothesized that the use of EIM in conjunction with a disease management program reduces healthcare utilization in patients with COPD. METHODS: This is a retrospective pre- and post-analysis of a quality improvement project. Patients with COPD and high healthcare utilization (≥one hospitalization or emergency room visit during the year prior to enrolment) were provided with electronic monitoring devices for monitoring controller and rescue inhaler utilization for one year. Patients were contacted when alerts were triggered, indicating suboptimal adherence to controller inhaler or increased use of rescue inhalers, potentially signalling an impending exacerbation. Healthcare utilization was assessed pre- and post-monitoring, with each subject serving as his/her own control. RESULTS: Patients with COPD and high healthcare utilization (n = 39) were recruited. Mean EIM duration was 280.5 (±120.6) days. The mean age was 68.6 (±9.9) years, FEV1 (mean forced expiratory volume in one second) was 1.1 (±0.4) L, and mean Charlson Comorbidity index was 5.6 (±2.7). Average adherence was 44.4% (28.4%). Compared with the year prior to enrolment, EIM was associated with a reduction in COPD-related healthcare utilization per year (2.2 (±2.3) versus 3.4 (±3.2), p = 0.01). Although there was a reduction in all-cause healthcare utilization, this was not statistically significant (3.4 (±2.6) versus 4.7 (±4.1), p = 0.06). DISCUSSION: EIM in conjunction with a disease management program may play a role in reducing healthcare utilization in COPD patients with a history of high healthcare utilization.
INTRODUCTION: The effect of electronic inhaler monitoring (EIM) on healthcare utilization in chronic obstructive pulmonary disease (COPD) has not been studied. We hypothesized that the use of EIM in conjunction with a disease management program reduces healthcare utilization in patients with COPD. METHODS: This is a retrospective pre- and post-analysis of a quality improvement project. Patients with COPD and high healthcare utilization (≥one hospitalization or emergency room visit during the year prior to enrolment) were provided with electronic monitoring devices for monitoring controller and rescue inhaler utilization for one year. Patients were contacted when alerts were triggered, indicating suboptimal adherence to controller inhaler or increased use of rescue inhalers, potentially signalling an impending exacerbation. Healthcare utilization was assessed pre- and post-monitoring, with each subject serving as his/her own control. RESULTS:Patients with COPD and high healthcare utilization (n = 39) were recruited. Mean EIM duration was 280.5 (±120.6) days. The mean age was 68.6 (±9.9) years, FEV1 (mean forced expiratory volume in one second) was 1.1 (±0.4) L, and mean Charlson Comorbidity index was 5.6 (±2.7). Average adherence was 44.4% (28.4%). Compared with the year prior to enrolment, EIM was associated with a reduction in COPD-related healthcare utilization per year (2.2 (±2.3) versus 3.4 (±3.2), p = 0.01). Although there was a reduction in all-cause healthcare utilization, this was not statistically significant (3.4 (±2.6) versus 4.7 (±4.1), p = 0.06). DISCUSSION: EIM in conjunction with a disease management program may play a role in reducing healthcare utilization in COPDpatients with a history of high healthcare utilization.
Authors: Barbara P Yawn; Gretchen M McCreary; John A Linnell; Cara B Pasquale; Elisha Malanga; Radmila Choate; David A Stempel; Rahul Gondalia; Leanne Kaye; Kathryn A Collison; Benjamin S Wu; Daniel Gratie; Richard H Stanford; Ryan Tomlinson Journal: Chronic Obstr Pulm Dis Date: 2021-10-28
Authors: Amy H Y Chan; Roy A Pleasants; Rajiv Dhand; Stephen L Tilley; Stephen A Schworer; Richard W Costello; Rajan Merchant Journal: Pulm Ther Date: 2021-08-11
Authors: Emma E Thomas; Monica L Taylor; Annie Banbury; Centaine L Snoswell; Helen M Haydon; Victor M Gallegos Rejas; Anthony C Smith; Liam J Caffery Journal: BMJ Open Date: 2021-08-25 Impact factor: 2.692