Real-World Evaluation of an EHR-Enabled Chronic Obstructive Pulmonary Disease Assessment Test

Nathaniel Gaeckle,1 Edward Corazalla,2 Judy S Kelloway,3 Joshua N Liberman,4 Jonathan David Darer,4 Kristin Kahle-Wrobleski,5 Rosirene Paczkowski,5 Purva Parab,4 Charles Ruetsch4 1Division of Pulmonary, Allergy, Critical Care and Sleep, University of Minnesota, Minneapolis, MN, USA; 2Pulmonary Function Test Laboratory, M Health Fairview, University of Minnesota, Minneapolis, MN, USA; 3US Medical Affairs, GSK, Research Triangle Park, Durham, NC, USA; 4Health Analytics LLC, Clarksville, MD, USA; 5US Value Evidence and Outcomes, GSK, Philadelphia, PA, USACorrespondence: Nathaniel Gaeckle, Department of Medicine, University of Minnesota, 420 Delaware Street SE, MMC 276, Minneapolis, Minnesota, 55455, USA, Tel +001-612-624-0999, Fax +001-612-625-2174, Email [email protected]: The Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) measures COPD’s impact on well-being and daily activities and is a recommended assessment by the Global Initiative for Obstructive Lung Disease (GOLD). Our research objective was to describe a real-world CAT implementation, including the association of CAT scores with subsequent treatment and clinical outcomes.Patients and Methods: A retrospective, observational, comparative cohort study was conducted among adults with COPD who received care from M Health Fairview, a US healthcare delivery system. Eligible patients had an initial electronic health record (EHR) enabled CAT administration (index) between 8/2017 and 12/2021. Patients were grouped by score (< 10 [low impact]; 11– 20 [moderate]; and 21– 40 [high]). Demographics, comorbidities, provider specialty, and exacerbation history were derived from EHR data in the 12 months preceding index.Results: Of 11,194 eligible individuals, 821 (7.3%) were administered CAT (cases). Compared to individuals with no documented CAT scores (comparators), cases were older (66.7 vs 63.9 years; p < 0.05) and had higher rates of comorbidities (93.9% vs 79.2%, p < 0.05) and exacerbations (0.31 vs 0.14 PPPY). A total of 61.5% of pulmonologists and 11.5% of primary care providers (PCPs) administered the CAT at least once. Repeated use was more common among pulmonologists (55.7%) than PCPs (7.0%). Medication intensification was most common (28.1%) among individuals with high CAT scores, followed by moderate (21.6%), and low (10.0%). Post-index exacerbations were experienced by 24.2%, 17.4%, and 7.7% of patients with high, moderate, and low CAT scores.Conclusion: In a real-world practice setting, few patients with COPD received a CAT, although pulmonologists demonstrated repeated use. Higher CAT scores were associated with COPD medication regimen intensification and exacerbations. Further investigation on how to incorporate the CAT into routine care and optimize its impact on medical decision making and evaluation is warranted.Keywords: Pulmonary Disease, Chronic Obstructive, MeSH, Patient Reported Outcome Measures, MeSH, Clinical Relevance, MeSH, COPD Assessment Tes

The impact of generic-only drug benefits on patients' use of inhaled corticosteroids in a Medicare population with asthma

<p>Abstract</p> <p>Background</p> <p>Patients face increasing insurance restrictions on prescription drugs, including generic-only coverage. There are no generic inhaled corticosteroids (ICS), which are a mainstay of asthma therapy, and patients pay the full price for these drugs under generic-only policies. We examined changes in ICS use following the introduction of generic-only coverage in a Medicare Advantage population from 2003–2004.</p> <p>Methods</p> <p>Subjects were age 65+, with asthma, prior ICS use, and no chronic obstructive pulmonary disorder (n = 1,802). In 2004, 74.0% switched from having a $30 brand-copayment plan to a generic-only coverage plan (restricted coverage); 26$15–25 brand copayments in 2003–2004 (unrestricted coverage). Using linear difference-in-difference models, we examined annual changes in ICS use (measured by days-of-supply dispensed). There was a lower-cost ICS available within the study setting and we also examined changes in drug choice (higher- vs. lower-cost ICS). In multivariable models we adjusted for socio-demographic, clinical, and asthma characteristics.</p> <p>Results</p> <p>In 2003 subjects had an average of 188 days of ICS supply. Restricted compared with unrestricted coverage was associated with reductions in ICS use from 2003–2004 (-15.5 days-of-supply, 95% confidence interval (CI): -25.0 to -6.0). Among patients using higher-cost ICS drugs in 2003 (n = 662), more restricted versus unrestricted coverage subjects switched to the lower-cost ICS in 2004 (39.8% vs. 10.3%). Restricted coverage was not associated with decreased ICS use (2003–2004) among patients who switched to the lower-cost ICS (18.7 days-of-supply, CI: -27.5 to 65.0), but was among patients who did not switch (-38.6 days-of-supply, CI: -57.0 to -20.3). In addition, restricted coverage was associated with decreases in ICS use among patients with both higher- and lower-risk asthma (-15.0 days-of-supply, CI: -41.4 to 11.44; and -15.6 days-of-supply, CI: -25.8 to -5.3, respectively).</p> <p>Conclusion</p> <p>In this elderly population, patients reduced their already low ICS use in response to losing drug coverage. Switching to the lower-cost ICS mitigated reductions in use among patients who previously used higher-cost drugs. Additional work is needed to assess barriers to switching ICS drugs and the clinical effects of these drug use changes.</p

The influence of networking on the internationalization of SMEs: evidence from internationalized Chinese firms

This study investigates influential networking behaviours in supporting the internationalization of SMEs. Using primary data collected from 210 Chinese SMEs in Beijing and Hong Kong, regression analysis was applied to test associations between networking behaviours, resource availability and internationalization patterns. Findings indicate that resources made available from networks do not necessarily facilitate the internationalization of firms. The availability of foreign business resources is positively associated with the achievement of rapid internationalization but the availability of general organizational resources indicates a negative association. The ability of SMEs to plan and conduct networking activities strategically with key partners is beneficial to obtain the influential resources for accelerating foreign business development. The article concludes with implications for policy-makers and SME owners/managers, suggesting they should target support initiatives and skills training aimed at nurturing and developing influential networking behaviours