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APHA Scientific Session and Event Listing

Recorded presentation

Rob Gately, MS¹, Susan Boardman, RN², Karen L. Johnson, RN², Maryam Navaie-Waliser, DrPH¹, and Jeff Stevens, MA². (1) Outcomes and Analytics, Pfizer Health Solutions Inc., 2400 Broadway, Suite 500, Santa Monica, CA 90404, 310-586-2558, rob.gately@pfizer.com, (2) Providence Health Plans, 3601 SW Murray Blvd #10, Beaverton, OR 97005

Background and Objective: In the United States, over 11.2 million adults suffer from Chronic Obstructive Pulmonary Disease (COPD). Nationally, COPD is the fourth leading cause of mortality, claiming over 120,000 lives annually. U.S. expenditures for COPD are estimated at $31.9 billion a year. In response, health systems have increased their reliance on disease management programs for cost containment. The objective of this study was to examine the impact of a telephonic nurse care management intervention on cost reductions for a COPD population.

Methods: Medical claims from January 2001 through July 2005 were linked with a care management technology platform to identify patients who: (a) were 34 years of age or older, and (b) received one or more telephonic nurse care management intervention sessions, and either had (c) a primary diagnosis of COPD, or (d) 2 or more COPD prescriptions and a medical claim with a primary/secondary diagnosis of COPD, or (e) an emergency department or inpatient visit with a primary diagnosis of COPD. From 775 identified patients, 637 (82%) completed the telephonic intervention with at least 6 nurse contacts during an eight-month period. To examine the relationship between frequency of nurse contacts and cost reductions, intervention completers were categorized into three groups: group 1=6-8 nurse contacts (n=237), group 2=9-10 nurse contacts (n=183), and group 3=11 or more nurse contacts (n=217). Demographic, clinical, financial, and health service utilization data were examined. Descriptive, bivariate and multivariate analyses were performed, using log transformations to reduce outlier effects.

Results: On average, patients were 74.1 years old (SD=9.3); the majority were women (60%) and Medicare beneficiaries (84%). Mean enrollment time in the intervention was 469.5 days (SD=254.3). The average number of patient-nurse contacts was 9.8 (SD=2.7; range=6 to 20). After adjusting for potential confounders (i.e., payor, gender, age, and baseline costs), multivariate models revealed significant total cost reductions per member per month for patients in group 1 as compared to patients in group 2 ($234.68; p<.05) and group 3 ($376.93; p<.05). The largest cost savings were observed in hospital and medical expenditures. After intervention completion, diminishing returns on investment were observed in the group that required increased nurse contacts. Conclusions and Implications: The findings suggest that there may be a clinical threshold after which reductions in preventable costs are less likely to be achieved by a behaviorally-focused care management program. A well-designed disease management program can cost-effectively educate, motivate, and empower patients to self-manage COPD.

Learning Objectives:

• To discuss how disease management programs can be delivered to maximize return on investment for COPD populations;
• To evaluate the cost-effectiveness of a telephonic disease management program; and
• To analyze a dose-response relationship between telephonic care management and cost reductions.

Keywords: Disease Management, Cost-Effectiveness

Presenting author's disclosure statement:

Any relevant financial relationships? Yes

Organization	Clinical/Research Area	Type of Relationship
Pfizer Health Solutions	Disease Management	Employment (includes retainer)

Any company-sponsored training?	No
Any institutionally-contracted trials related to this submission?	No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Recorded presentation