Cost and Quality Issues Related to the Management of COPD

Abstract

The United States health care system must meet many challenges to preserve a patient's ability to access health care that is both affordable and of the highest quality. The ability to access health care providers has changed dramatically in the past decade and public debate continues about issues related to access and cost. In this article, we will focus on cost and quality issues related to the care of patients with chronic obstructive pulmonary disease (COPD). These issues are dynamic and rapidly evolving. COPD is a chronic process that mainly results from long term exposure to cigarette smoke. Treatment for COPD requires large expenditures of money to address the many problems encountered as the disease progresses and dyspnea worsens. Reimbursement for treating patients with COPD has declined as the result of federal initiatives. Fortunately, the quality of care has been preserved through better application of medications, earlier detection and intervention, and smoking cessation efforts. In addition, patient education and self help programs, rehabilitation, surgical interventions, and the application of new technologies have been of value. Physician input has ushered in a new era for patients with COPD and the widespread use of these modalities is beginning to restore quality-of-life once thought to be irretrievable. Lung volume reduction surgery (LVRS) offers new promise by countering physiologic alterations that increase the work of breathing. This procedure alters the derangements of gas exchange and dead space that heightens dyspnea and promotes a sedentary lifestyle. Surgical intervention coupled with exercise-focused rehabilitation may provide yet another avenue for patients with advanced COPD to improve the quality-of-life. Each intervention entails cost. Limited data are currently available about cost and quality issues related to the diagnosis, treatment and long term management of COPD and are reviewed below. We also address chronic childhood respiratory diseases with respect to medical care costs and quality.

Key Words:

COPD - cost and quality issues - medical effectiveness - adults - adolescents