Comprehensive care plans for patients with Chronic Obstructive Pulmonary Disease (COPD): Effect on health services utilization
Bibliographic record
Abstract
RATIONALE There is limited real-world evidence on evaluation of chronic disease management initiatives provided by general physicians to patients with chronic obstructive pulmonary disease (COPD).OBJECTIVES We aimed to evaluate changes in COPD-related healthcare resource utilization between COPD patients who had general physician’s provided comprehensive annual care plan (CACP) and those who did not have CACP.METHODS We conducted a retrospective cohort study using health administrative data (Alberta) from 2009 to 2016. COPD patients who received a CACP were identified and matched with two control patients based on age, sex, provider, date of service and qualifying comorbidities. Controlled interrupted-time series analysis was used to evaluate changes in COPD-specific hospitalizations, emergency department (ED) visits, physician visits and claims for pulmonary function test (PFT). Immediate and temporal changes were calculated for the difference in outcomes 1 year before and 1 year after receiving the CACP for the intervention group and matched controls.RESULTS Eligible patients (N = 88,002), of whom 35,847 had received CACPs were matched to a total of 52,155 controls. In 1 year after the CACPs implementation the number of COPD-related hospitalization visits significantly increased by 105.33 (95% CI 58.17-152.49), ED visits increased by 172.65 (95% CI 168.09–177.20), general practitioners (GP) visits increased by 359.53 (95% CI 247.64–471.41), specialist visits increased by 77.21 (95% CI 31.58–122.85) and PFT claims increased by 50.82 (95% CI 35.33–66.30) when compared to the controls who did not receive CACP per 10,000 patients per month. However, only increase in ED and specialist visits was confirmed by the sensitivity analysis.CONCLUSIONS Annual care plans provided by physicians were found to be associated with a statistically significant increase in COPD-related events (including ED visits) in the following year; however, clinical significance was minimal.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".