SESSION TITLE: Quality & Clinical Improvement I
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 26, 2014 at 04:30 PM - 05:30 PM
PURPOSE: The annual cost of COPD in US in 2008 was $53.7 billion, largely due to visits to a medical facility for exacerbations. We sought to determine whether a protocolized COPD management program would lead to reductions in COPD exacerbations and improved lung function as measured by forced expiratory volume at one second (FEV1 ), when compared with routine COPD management.
METHODS: Data were collected prospectively and retrospectively and entered into an Excel™ database. Inclusion criteria were patients with evidence of COPD with at least 1 exacerbation over the past year. The management consisted of a protocol based on published Global Initiative for Chronic Obstructive Lung Disease guidelines. The number of exacerbations was measured subjectively relying on patient history of use of prednisone or antibiotics. We also tracked the number of patients who underwent alpha-1 antitrypsin testing and who were referred for pulmonary rehabilitation. Data were analyzed by a two-sample equal variance t-test.
RESULTS: Thirty-eight patients were enrolled into the protocol and were compared compared with fifty-one patients in the non-protocolized group. Follow up was completed for approximately one year. Total requirement for hospital or ED visits, or use of prednisone, was 0.5 in the protocolized group versus 0.96 in the non-protocolized group, respectively (p = 0.18). The mean FEV1 was 2.28 L and 1.51 L in the protocolized and non-protocolized groups, respectively (p = 0.04). 13 of 50 patients were tested for alpha-1 antitrypsin deficiency in the group not protocolized versus 32 of 36 patients in the protocol. One patient of 50 was referred for pulmonary rehab in the non-protocolized group as compared with 8 of 20 patients in our protocol.
CONCLUSIONS: The use of a protocolized COPD management program was associated with a trend towards reduced COPD exacerbations, as measured by use of prednisone and antibiotics. Although not statistically significant, these results are encouraging and suggest further continuation of this study. In addition, patients in the protocolized group had better lung function compared to those in the non-protocolized group at one year, were more likely to undergo testing for alpha-1 antitrypsin deficiency and to be referred for pulmonary rehabilitation.
CLINICAL IMPLICATIONS: Protocolization may lead to improved preservation of lung function in COPD patients and improved disease management. A longer follow-up and increased enrollment will be necessary to determine its impact on COPD exacerbation rates.
DISCLOSURE: The following authors have nothing to disclose: Matthew Nobari, Karina Serban, Babar Khan, Irina Petrache, Khalil Diab
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