COPD treatment ratio: a measure for improving COPD population health.

OBJECTIVES: Despite chronic obstructive pulmonary disease (COPD) being a leading cause of death in the US, there are few COPD measures in current quality programs. The objective of this study was to assess the validity and applicability of the COPD treatment ratio (CTR) as a surrogate marker of COPD exacerbation risk for use in quality measurement. CTR is defined as the ratio of COPD maintenance medications to all COPD medications (maintenance and rescue). STUDY DESIGN: This retrospective cohort study used 2016-2019 administrative claims from Optum Clinformatics Data Mart to evaluate CTR values over a 12-month baseline period, with exacerbations measured the following year. Patients 40 years or older with Medicare Advantage or commercial insurance and with a COPD diagnosis were included. METHODS: Logistic regression models were used to examine relationships between CTR values and COPD exacerbations. Prediction model performance was evaluated using C statistics, and receiver operating characteristics were used to determine the optimal cut point for CTR. RESULTS: Of 132,960 patients included in the analysis, 79.5% were Medicare Advantage beneficiaries, and the mean age was 69.6 years. Higher CTR values were significantly associated with reduced risk of any, moderate, and severe exacerbations in the total population and when stratified by insurance type. CTR performed fairly to moderately well in predicting COPD exacerbations. The optimal cut point for COPD exacerbation prediction was 0.7. CONCLUSIONS: Study results substantiated CTR as a valid measure of COPD exacerbation risk and support the use of CTR in quality improvement to drive evidence-based care for individuals with COPD.

Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs.

Background: Physical therapy is an important treatment option for patients with low back pain (LBP). However, whether to refer patients for physical therapy and the timing of initiation remain controversial. Objective: The objective of this study was to evaluate the impact of receiving physical therapy and the timing of physical therapy initiation on downstream health care utilization and costs among patients with acute LBP. Design: The design was a retrospective cohort study. Methods: Patients who had a new onset of LBP between January 1, 2009, and December 31, 2013, in New York State were identified and grouped into different cohorts on the basis of whether they received physical therapy and the timing of physical therapy initiation. The probability of service use and LBP-related health care costs over a 1-year period were analyzed. Results: Among 46,914 patients with acute LBP, 40,246 patients did not receive physical therapy and 6668 patients received physical therapy initiated at different times. After controlling for patient characteristics and adjusting for treatment selection bias, health care utilization and cost measures over the 1-year period were the lowest among patients not receiving physical therapy, followed by patients with immediate physical therapy initiation (within 3 days), with some exceptions. Among patients receiving physical therapy, those receiving physical therapy within 3 days were consistently associated with the lowest health care utilization and cost measures. Limitations: This study was based on commercial insurance claims data from 1 state. Conclusions: When referral for physical therapy is warranted for patients with acute LBP, immediate referral and initiation (within 3 days) may lead to lower health care utilization and LBP-related costs.