scholarly journals Using Computational Methods to Improve Integrated Disease Management for Asthma and Chronic Obstructive Pulmonary Disease: Protocol for a Secondary Analysis (Preprint)

2021 ◽  
Author(s):  
Gang Luo ◽  
Bryan L Stone ◽  
Xiaoming Sheng ◽  
Shan He ◽  
Corinna Koebnick ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
High Risk ◽  
Disease Management ◽  
Pulmonary Disease ◽  
Administrative Data ◽  
Chronic Obstructive ◽  
Integrated Disease Management ◽  
Obstructive Pulmonary Disease ◽  
Temporal Features

BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) impose a heavy burden on health care. Approximately one-fourth of patients with asthma and patients with COPD are prone to exacerbations, which can be greatly reduced by preventive care via integrated disease management that has a limited service capacity. To do this well, a predictive model for proneness to exacerbation is required, but no such model exists. It would be suboptimal to build such models using the current model building approach for asthma and COPD, which has 2 gaps due to rarely factoring in temporal features showing early health changes and general directions. First, existing models for other asthma and COPD outcomes rarely use more advanced temporal features, such as the slope of the number of days to albuterol refill, and are inaccurate. Second, existing models seldom show the reason a patient is deemed high risk and the potential interventions to reduce the risk, making already occupied clinicians expend more time on chart review and overlook suitable interventions. Regular automatic explanation methods cannot deal with temporal data and address this issue well. OBJECTIVE To enable more patients with asthma and patients with COPD to obtain suitable and timely care to avoid exacerbations, we aim to implement comprehensible computational methods to accurately predict proneness to exacerbation and recommend customized interventions. METHODS We will use temporal features to accurately predict proneness to exacerbation, automatically find modifiable temporal risk factors for every high-risk patient, and assess the impact of actionable warnings on clinicians’ decisions to use integrated disease management to prevent proneness to exacerbation. RESULTS We have obtained most of the clinical and administrative data of patients with asthma from 3 prominent American health care systems. We are retrieving other clinical and administrative data, mostly of patients with COPD, needed for the study. We intend to complete the study in 6 years. CONCLUSIONS Our results will help make asthma and COPD care more proactive, effective, and efficient, improving outcomes and saving resources. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/27065

scholarly journals Using Computational Methods to Improve Integrated Disease Management for Asthma and Chronic Obstructive Pulmonary Disease: Protocol for a Secondary Analysis

10.2196/27065 ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. e27065
Author(s):  
Gang Luo ◽  
Bryan L Stone ◽  
Xiaoming Sheng ◽  
Shan He ◽  
Corinna Koebnick ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
High Risk ◽  
Disease Management ◽  
Pulmonary Disease ◽  
Administrative Data ◽  
Chronic Obstructive ◽  
Integrated Disease Management ◽  
Obstructive Pulmonary Disease ◽  
Temporal Features

Background Asthma and chronic obstructive pulmonary disease (COPD) impose a heavy burden on health care. Approximately one-fourth of patients with asthma and patients with COPD are prone to exacerbations, which can be greatly reduced by preventive care via integrated disease management that has a limited service capacity. To do this well, a predictive model for proneness to exacerbation is required, but no such model exists. It would be suboptimal to build such models using the current model building approach for asthma and COPD, which has 2 gaps due to rarely factoring in temporal features showing early health changes and general directions. First, existing models for other asthma and COPD outcomes rarely use more advanced temporal features, such as the slope of the number of days to albuterol refill, and are inaccurate. Second, existing models seldom show the reason a patient is deemed high risk and the potential interventions to reduce the risk, making already occupied clinicians expend more time on chart review and overlook suitable interventions. Regular automatic explanation methods cannot deal with temporal data and address this issue well. Objective To enable more patients with asthma and patients with COPD to obtain suitable and timely care to avoid exacerbations, we aim to implement comprehensible computational methods to accurately predict proneness to exacerbation and recommend customized interventions. Methods We will use temporal features to accurately predict proneness to exacerbation, automatically find modifiable temporal risk factors for every high-risk patient, and assess the impact of actionable warnings on clinicians’ decisions to use integrated disease management to prevent proneness to exacerbation. Results We have obtained most of the clinical and administrative data of patients with asthma from 3 prominent American health care systems. We are retrieving other clinical and administrative data, mostly of patients with COPD, needed for the study. We intend to complete the study in 6 years. Conclusions Our results will help make asthma and COPD care more proactive, effective, and efficient, improving outcomes and saving resources. International Registered Report Identifier (IRRID) PRR1-10.2196/27065

scholarly journals Optimizing Wellness in Chronic Obstructive Pulmonary Disease

2007 ◽  
Vol 14 (suppl a) ◽  
pp. 5A-22A
Author(s):  
Roger S Goldstein ◽  
Dina Brooks ◽  
Gordon T Ford
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Pulmonary Disease ◽  
Chronic Disease Management ◽  
Health Agency ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Care System

Optimizing wellness in chronic obstructive pulmonary disease (COPD) is an emerging theme, in response to the substantial burden of COPD among Canadians. Population surveillance, from the Public Health Agency of Canada, as well as from international initiatives, such as the Burden of Obstructive Lung Disease (BOLD) study, has revealed the prevalence and regional disparities of a condition in which mortality, morbidity and health care resource use often reflect what was happening in the population more than 20 years previously. As COPD emerges to be an important women’s health issue, it raises questions as to how female mortality from COPD can rise at double the rate of breast cancer, why the COPD patient population is still predominantly male and whether women experience breathlessness differently than men.There is increasing awareness of the frequency and importance of assessing secondary impairments, such as muscle atrophy, an important prognostic indicator. The availability of pulmonary rehabilitation, despite its beneficial effects on exercise and quality of life, remains far behind the demand for services, a care gap unlikely to be filled by institutionally based programs. New models of chronic disease management require the health care system to proactively meet the needs of individuals with chronic conditions, rather than reacting to them through the acute care system. Such approaches occur best in partnership between health authorities and local municipalities. The present supplement includes several examples of this partnership, especially in Alberta and Saskatchewan. An increasing body of evidence supports the importance of exercise training, combined with selfmanagement, as a cornerstone of chronic disease management.

scholarly journals The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 726
Author(s):  
Claudio F. Donner ◽  
Richard ZuWallack ◽  
Linda Nici
Keyword(s):  
Physical Activity ◽  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
Disease Management ◽  
Pulmonary Disease ◽  
Health Care Providers ◽  
Medical Management ◽  
Chronic Obstructive ◽  
Care Providers ◽  
Obstructive Pulmonary Disease

Medical management of a chronic obstructive pulmonary disease (COPD) patient must incorporate a broadened and holistic approach to achieve optimal outcomes. This is best achieved with integrated care, which is based on the chronic care model of disease management, proactively addressing the patient’s unique medical, social, psychological, and cognitive needs along the trajectory of the disease. While conceptually appealing, integrated care requires not only a different approach to disease management, but considerably more health care resources. One potential way to reduce this burden of care is telemedicine: technology that allows for the bidirectional transfer of important clinical information between the patient and health care providers across distances. This not only makes medical services more accessible; it may also enhance the efficiency of delivery and quality of care. Telemedicine includes distinct, often overlapping interventions, including telecommunication (enhancing lines of communication), telemonitoring (symptom reporting or the transfer of physiological data to health care providers), physical activity monitoring and feedback to the patient and provider, remote decision support systems (identifying “red flags,” such as the onset of an exacerbation), tele-consultation (directing assessment and care from a distance), tele-education (through web-based educational or self-management platforms), tele-coaching, and tele-rehabilitation (providing educational material, exercise training, or even total pulmonary rehabilitation at a distance when standard, center-based rehabilitation is not feasible). While the above components of telemedicine are conceptually appealing, many have had inconsistent results in scientific trials. Interventions with more consistently favorable results include those potentially modifying physical activity, non-invasive ventilator management, and tele-rehabilitation. More inconsistent results in other telemedicine interventions do not necessarily mean they are ineffective; rather, more data on refining the techniques may be necessary. Until more outcome data are available clinicians should resist being caught up in novel technologies simply because they are new.

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