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Obstructive Lung Diseases |

COPD Population Health Management: Incidence, Prevalence, and Mortality in a Primary Care Accountable Care Organization FREE TO VIEW

John Lynch, MPH; Kathleen Fox, PhD; Michael DePietro, MD; David Cobden, PhD
Author and Funding Information

Connecticut Center for Primary Care, Farmington, CT


Chest. 2015;148(4_MeetingAbstracts):694A. doi:10.1378/chest.2277624
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Abstract

SESSION TITLE: COPD Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The study aim is to identify a Chronic Obstructive Pulmonary Disease (COPD) population within a primary care Accountable Care Organization (ACO) and determine the incidence, prevalence, and mortality.

METHODS: In this observational, retrospective study of real world patients with COPD treated in a primary care setting, we assembled Electronic Health Record, practice management, and claims data from a primary care group practice of 389 practitioners with 6 ACO contracts. Data include demographics, smoking history, diagnoses, medications, laboratory results, vital measurements, physician notes, claims, and system characteristics. Patients who received care in 2012 were followed through 2014.

RESULTS: Of 201,993 adults age ≥18 years who received care during 2012, 12,535 had a COPD diagnosis. Mean age of COPD patients was 67 years, with 55% female, 32.7% current smokers, and 38.3% former smokers. There were 1,390 new COPD cases, an incidence rate (IR) of 6.9 per 1000. Age-specific IR were 5.8, 12.8, 16.9, and 21.6 per 1000 (ages 40-64, 65-74, 75-84, ≥ 85, respectively). Both genders exhibited the same prevalence rate (PR) of 62.1 per 1000. Age-specific PR were 46.1, 122.9, 177.5, and 186.3 per 1000 (ages 40-64, 65-74, 75-84, ≥ 85, respectively). Age-specific PR for current/former smokers were 86.3, 183.9, 256.7, and 254.0 per 1000 (ages 40-64, 65-74, 75-84, ≥ 85, respectively). Overall adult population exhibited a 1-year mortality rate of 0.67%, while the rate was 3.7% for COPD patients. Age-specific mortality rates were 1.0%, 2.5%, 5.0%, and 11.2% (ages 40-64, 65-74, 75-84, ≥ 85, respectively). A total of 462 of the 1351 overall population’s deaths (34.2%) had a diagnosis of COPD.

CONCLUSIONS: COPD patients have a high risk and rate for mortality. While study prevalence rates are similar to published literature, this study adds unique insights on current incidence and mortality rates not obtainable using national surveys. The prevalence of COPD in a primary care ACO is sizable, continues to grow with new incident cases, and will require special, active care management if the ACO is to succeed.

CLINICAL IMPLICATIONS: These results set the stage for ACOs to improve COPD care management, define new ACO interventions, and measure their impact. Age/gender-specific COPD mortality rates will be essential to risk adjustment for managing the ACO population, and interventions are needed to address a COPD population accounting for 34% of all ACO deaths.

DISCLOSURE: John Lynch: Grant monies (from industry related sources): AstraZeneca Kathleen Fox: Other: Contractor for AstraZeneca Michael DePietro: Employee: AstraZeneca David Cobden: Employee: AstraZeneca

No Product/Research Disclosure Information


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