Decision making based on quality-of-information a clinical guideline for chronic obstructive pulmonary disease scenario

Springer - Series Advances in Intelligent and Soft Computing, vol. 79In this work we intend to advance towards a computational model to hold up a Group Decision Support System for VirtualECare, a system aimed at sustaining online healthcare services, where Extended Logic Programs (ELP) will be used for knowledge re-presentation and reasoning. Under this scenario it is possible to evaluate the ELPs making in terms of the Quality-of-Information (QoI) that is assigned to them, along the several stages of the decision making process, which is given as a truth value in the interval 0…1, i.e., it is possible to provide a measure of the value of the QoI that supports the decision making process, an end in itself. It will be also considered the problem ofQoI evaluation in a multi-criteria decision setting, being the criteria to be fulfilled that of a Clinical Guideline (CG) for Chronic Obstructive Pulmonary Disease

Cost-effectiveness of integrated disease management for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease in a primary care setting

Availability of data and materials: The datasets generated and/or analysed during the current study are not publicly available due to the requirement to keep individual patient health information confdential but are available from Dr. Licskai on reasonable request.Copyright © The Author(s) 2022. Background: We evaluate the cost-effectiveness of the ‘Best Care’ integrated disease management (IDM) program for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease (COPD) compared to usual care (UC) within a primary care setting from the perspective of a publicly funded health system (i.e., Ontario, Canada). Methods: We conducted a model-based, cost-utility analysis using a Markov model with expected values of costs and outcomes derived from a Monte-Carlo Simulation with 5000 replications. The target population included patients started in GOLD II with a starting age of 68 years in the trial-based analysis. Key input parameters were based on a randomized control trial of 143 patients (i.e., UC (n = 73) versus IDM program (n = 70)). Results were shown as incremental cost per quality-adjusted life year (QALY) gained. Results: The IDM program for high risk, exacerbation prone, patients is dominant in comparison with the UC group. After one year, the IDM program demonstrated cost savings and improved QALYs (i.e., UC was dominated by IDM) with a positive net-benefit of $5360 (95$5175, $5546) based on a willingness to pay of$50,000 (CAN) per QALY. Conclusions: This study demonstrates that the IDM intervention for patients with COPD in a primary care setting is cost-effective in comparison to the standard of care. By demonstrating the cost-effectiveness of IDM, we confirm that investment in the delivery of evidence based best practices in primary care delivers better patient outcomes at a lower cost than UC. Highlights I. Interventions that can reduce the frequency and severity of exacerbations in patients who sufer from COPD have the potential to reduce the fnancial burden of COPD on the health system; II. Tis is the frst study that demonstrates the cost-efectiveness of integrated disease management for patients who sufer from COPD within a primary care environment; II. Tis study makes the case for embedding Certifed Respiratory Educators (CREs) within the primary care environment to improve the quality of life of patients who sufer from COPD, as well as alleviating unneces sary health services utilization and decreasing the overall fnancial burden of the disease on the health system.Asthma Research Group Windsor Essex County Inc. doctoral stipend

Four patients with a history of acute exacerbations of COPD: implementing the CHEST/Canadian Thoracic Society guidelines for preventing exacerbations

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Continuing to Confront COPD International Physician Survey: Physician Knowledge and Application of COPD Management Guidelines in 12 Countries

AIM: Utilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease) International Physician Survey, this study aimed to describe physicians\u27 knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease) Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs) and respiratory specialists. MATERIALS AND METHODS: Physicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one) who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face to face. Physicians were questioned about COPD risk factors, prognosis, diagnosis, and treatment, including knowledge and application of the GOLD global strategy using patient scenarios. RESULTS:Physicians reported using spirometry routinely (PCPs 82%, respiratory specialists 100%; P\u3c0.001) to diagnose COPD and frequently included validated patient-reported outcome measures (PCPs 67%, respiratory specialists 81%; P\u3c0.001). Respiratory specialists were more likely than PCPs to report awareness of the GOLD global strategy (93% versus 58%, P\u3c0.001); however, when presented with patient scenarios, they did not always perform better than PCPs with regard to recommending GOLD-concordant treatment options. The proportion of PCPs and respiratory specialists providing first- or second-choice treatment options concordant with GOLD strategy for a GOLD B-type patient was 38% versus 67%, respectively. For GOLD C and D-type patients, the concordant proportions for PCPs and respiratory specialists were 40% versus 38%, and 57% versus 58%, respectively. CONCLUSION: This survey of physicians in 12 countries practicing in the primary care and respiratory specialty settings showed high awareness of COPD-management guidelines. Frequent use of guideline-recommended COPD diagnostic practices was reported; however, gaps in the application of COPD-treatment recommendations were observed, warranting further evaluation to understand potential barriers to adopt guideline recommendations