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Identifying and characterizing COPD patients in US managed care. A retrospective, cross-sectional analysis of
Douglas W Mapel1, Michael P Dutro, Jeno P Marton
1Lovelace Clinic Foundation, Albuquerque, NM, USA.
Insights
Identifying patients with chronic obstructive pulmonary disease (COPD) using illness complexity can predict higher healthcare use and exacerbations. This approach helps target high-risk COPD patients for better disease management.
Area of Science:
- Pulmonary Medicine
- Health Services Research
- Epidemiology
Background:
- Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the US, with increasing healthcare burdens.
- A need exists to identify high-utilization COPD patients for better resource allocation.
Purpose of the Study:
- To develop a practical method for identifying and stratifying patients with COPD.
- To analyze healthcare utilization and exacerbation prevalence based on illness complexity.
Main Methods:
- Retrospective analysis of US managed care administrative claims data (7.79 million members).
- Stratification of COPD patients based on comorbid conditions ('complexity' algorithm).
- Development of an algorithm to identify and stratify COPD exacerbations.
Main Results:
- 42,565 commercial and 8,507 Medicare COPD patients identified.
- Significant differences in comorbidities between commercial and Medicare populations.
- Higher illness complexity correlated with increased exacerbations and healthcare service utilization.
Conclusions:
- Illness complexity, based on comorbidities, is linked to exacerbations and healthcare use in COPD patients.
- Complexity stratification can identify high-risk COPD patients for targeted disease management.
Background:
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death among US adults and is projected to be the third by 2020. In anticipation of the increasing burden imposed on healthcare systems and payers by patients with COPD, a means of identifying COPD patients who incur higher healthcare utilization and costs is needed.
Methods:
This retrospective, cross-sectional analysis of US managed care administrative claims data describes a practical way to identify COPD patients. We analyze 7.79 million members for potential inclusion in the COPD cohort, who were continuously eligible during a 1-year study period. A younger commercial population (7.7 million) is compared with an older Medicare population (0.115 million). We outline a novel approach to stratifying COPD patients using "complexity" of illness, based on occurrence of claims for given comorbid conditions. Additionally, a unique algorithm was developed to identify and stratify COPD exacerbations using claims data.
Results:
A total of 42,565 commercial (median age 56 years; 51.4% female) and 8507 Medicare patients (median 75 years; 53.1% female) were identified as having COPD. Important differences were observed in comorbidities between the younger commercial versus the older Medicare population. Stratifying by complexity, 45.0%, 33.6%, and 21.4% of commercial patients and 36.6%, 35.8%, and 27.6% of older patients were low, moderate, and high, respectively. A higher proportion of patients with high complexity disease experienced multiple (≥2) exacerbations (61.7% commercial; 49.0% Medicare) than patients with moderate- (56.9%; 41.6%), or low-complexity disease (33.4%; 20.5%). Utilization of healthcare services also increased with an increase in complexity.
Conclusion:
In patients with COPD identified from Medicare or commercial claims data, there is a relationship between complexity as determined by pulmonary and non-pulmonary comorbid conditions and the prevalence of exacerbations and utilization of healthcare services. Identification of COPD patients at highest risk of exacerbations using complexity stratification may facilitate improved disease management by targeting those most in need of treatment.
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