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OUTCOMES OF AN
ASTHMA/COPD CASE MANAGEMENT PROGRAM
Joe Dwan, MS,
RRT, Kaiser Permanente, Portland, Oregon.
Background:
Following positive results of a RCT pilot project, our case management program
concluded the first year in 2001. Four ER?s were target for outreach to asthma
& COPD patients, along with physician referrals. Two trained RCPs were utilized
for 1.5 FTEs. The interventions include phone contact, PFTs, office visits with
the RCP case manager. Plus follow up with the patient and primary care provider
(PCP). Our goal was to optimize management of patients with adult asthma and
COPD according to the KPNW Regional Clinical Practice Guidelines by improving
our patients? state of health, well being and satisfaction and to efficiently
utilize resources.
Method: Program
evaluation included reviewing entry and exclusion criteria, procedures for screening
& managing patients, discharge criteria, outcomes measures, PCP & patient
surveys, cost measures, and learning?s & systems barriers. Utilization data
was retrieved from our electronic medical record (EMR). Utilization data includes
hospitalization, ER and urgent care/unscheduled visits, plus doctor office visits.
Cost measures utilized national average costs for ER and hospitalizations.
Results: A total
of 901 patients were screened with 450 receiving outreach interventions. Enrolled
patients totaled 319 with 164 asthmatics and 155 COPD. Patient satisfaction
and PCP surveys showed positive feedback. ER utilization decreased 56%, hospitalizations
decreased 39%, urgent care visits decreased 52%, and doctor office visits decreased
32%. Cost savings calculated at $106,874.
Respiratory
Utilization & Costs before and after enrollment in RCP Case Management |
| |
Enrolled |
ER before |
ER after |
hospital
before |
hospital
after |
UCC
before |
UCC
after |
| Asthma |
164 |
122 |
32 |
13 |
5 |
31 |
18 |
| COPD |
155 |
183 |
102 |
81 |
52 |
25 |
9 |
| total: |
319 |
305 |
134 |
94 |
57 |
56 |
27 |
| Asthma costs |
$25,620 |
$6,720 |
$35,503 |
$13,655 |
$2,573 |
$1,494 |
|
| COPD costs |
$53,802 |
$29,988 |
$291,762 |
$187,304 |
$2,075 |
$747 |
|
Savings difference before and af ter case ma nagement |
| Asthma
= |
$47,527 |
$18,900 |
$21,848 |
$1,079 |
|
| COPD
= |
$134,410 |
$23,814 |
$104,458 |
$1,328 |
| Total
= |
$181,957 |
|
| Wage
& Benefits = |
$75,083 |
| Program
Savings = |
$106,874 |
| Assumes |
AsthmaER |
AsthmaHosp |
COPD
ER |
COPD
Hos |
Clinic
visit |
UCC |
| Costs = |
$210 |
$2,731 |
$294 |
$3,602 |
$65 |
$83 |
Conclusions: Adult
asthma and COPD case management provided by respiratory care practitioners is
both effective in improving self-management and care satisfaction by patients
and in decreasing utilization of scheduled and unscheduled healthcare visits.
Measuring outcomes of both customer satisfaction and cost savings are strong
motivation to health care systems to provide case management for this population.
OF-02-120
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