Quantifying the Sustained Benefits of Primary Care-Based Interventions
The Importance of Effective COPD Management
Chronic obstructive pulmonary disease (COPD) is a major global health concern, contributing to high rates of hospital admissions, emergency department (ED) visits, and significant healthcare costs. Worldwide, over 212 million people were living with COPD in 2019, leading to 3.3 million deaths and 74.4 million disability-adjusted life years. COPD exacerbations, characterized by acute worsening of symptoms, drive much of this burden, with hospitalizations accounting for the largest proportion of direct economic costs.
Integrated disease management (IDM) programs offer an effective, proactive approach to COPD care. By formally integrating evidence-based guidelines through a multicomponent, multidisciplinary model, IDM aims to prevent and manage exacerbations, ultimately improving patient prognosis and avoiding costly acute healthcare utilization. Randomized controlled trials have demonstrated the efficacy of IDM in reducing respiratory-related hospitalizations and ED visits, as well as improving health-related quality of life.
However, a key challenge is translating the proven efficacy of IDM from controlled research settings to real-world clinical practice. The majority of patients with COPD are managed in primary care, yet the long-term, health system-level impacts of primary care-based COPD IDM have not been extensively evaluated. Addressing this evidence gap is crucial, as it could unlock substantial opportunities to improve health system performance and patient outcomes.
The Best Care COPD Program: A Primary Care-Based IDM Intervention
The Best Care COPD program is a primary care-based, self-management IDM intervention that has been rigorously evaluated. Emerging from a randomized controlled trial confirming its efficacy, the program has also demonstrated real-world effectiveness, cost-effectiveness, and positive impacts on patient and provider experiences.
The Best Care COPD program creates a collaborative triad of care involving the patient, their primary care provider, and a certified respiratory educator-case manager. It delivers all elements of evidence-based COPD management, including:
- Comprehensive patient assessment and individualized care planning
- Education and self-management support
- Guideline-based pharmacological management
- Referrals for specialized respiratory care
- Smoking cessation and vaccination support
Previous evaluations of the Best Care COPD program have focused on short-term (1-year) outcomes, demonstrating reductions in acute healthcare utilization and improvements in health-related quality of life. However, to fully understand the long-term, health system-level impacts of this primary care-based IDM intervention, longer-term analyses are essential.
Quantifying the Long-Term Health System Impacts of Best Care COPD
To address this evidence gap, a recent study used health administrative data from the Ontario Health Insurance Plan to examine the impact of the Best Care COPD program on acute healthcare utilization over a 6-year period. The study employed an interrupted time series analysis, comparing monthly rates of COPD-related and all-cause hospitalizations and ED visits in the 3 years prior to program implementation to the 3 years after.
The findings were striking. In the 3 years prior to the Best Care COPD program, COPD-related and all-cause healthcare utilization rates were steadily increasing. However, with program implementation, there was an immediate and significant decrease in COPD-related hospitalizations and ED visits, with these reductions continuing to grow over the 3-year intervention period.
Specifically, the study found:
- At 12 months, COPD-related hospitalizations decreased by 9.1 events per 1,000 participants per month, and COPD-related ED visits decreased by 19.0 events per 1,000 participants per month.
- By 36 months, the reductions had nearly doubled, with COPD-related hospitalizations down by 18.1 events per 1,000 participants per month and COPD-related ED visits down by 44.6 events per 1,000 participants per month.
Similar sustained reductions were observed for all-cause hospitalizations and ED visits, highlighting the broader health system impacts of this primary care-based IDM intervention.
Importantly, these findings reinforce the value of the Best Care COPD program for the Stanley Park High School community. By effectively preventing acute exacerbations and reducing costly healthcare utilization, the program can help improve health outcomes for students, families, and staff living with COPD, while also generating substantial savings for the broader health system.
Implications and Conclusions
The real-world evaluation of the Best Care COPD program provides strong evidence that primary care-based IDM can deliver sustained, long-term benefits for both patients and health systems. By shifting the trajectory of COPD from one of increasing acute healthcare utilization to one of significant and progressive reductions, this intervention has the potential to substantially improve health system performance and patient outcomes.
These findings are particularly noteworthy given the high burden of COPD and the persistent challenge of low guideline concordance and high rates of acute care use globally. The success of the Best Care COPD program highlights that a substantial opportunity exists to enhance the quality and value of COPD care through the implementation of proactive, evidence-based IDM models in primary care settings.
As the Stanley Park High School community continues to navigate the complexities of chronic disease management, the proven long-term impacts of the Best Care COPD program provide a valuable roadmap. By embedding this integrated, patient-centered approach to COPD care, the school can help improve the health and wellbeing of affected students, families, and staff, while also supporting the broader sustainability of the healthcare system.
Ultimately, the quantification of the sustained benefits of primary care-based IDM interventions, as demonstrated by the Best Care COPD program, underscores the crucial role that schools can play in catalyzing positive change within their local health ecosystems. By partnering with evidence-based programs like Best Care COPD, educational institutions can make meaningful contributions to improving population health and healthcare system performance.
