Abstract Background Chronic obstructive pulmonary disease (COPD) affects about 16.4 million adults in the United States and is the fifth leading cause of death in the US, with significant patient and healthcare system burden. Pulmonologists drive COPD care at critical time points with better outcomes compared to non-specialists. This study explores COPD population characteristics, including comorbidities, COPD exacerbation history, and medication usage, and their association with the timing of transfer of care of COPD patients from a primary care provider (PCP) to a pulmonologist. Methods This retrospective cohort study identified prevalent COPD patients from January 2014 to March 2024 in Optum’s Market Clarity database with linked electronic health record (EHR) and claims data. Patients were 40-85 years old, had at least 3 years of baseline (pre-index) and 1 year of follow-up (post-index) continuous enrollment, and required transition from a PCP to a first pulmonologist index visit for COPD care. Patients were stratified based on the time interval of transition of care from a PCP to a pulmonologist within 0-12-month (C1), 12-24-month (C2), and 24-36-month (C3) subgroups. Descriptive analyses of patient demographics, clinical characteristics and medications were performed in the 3-year pre-index period. In addition, medication use, health resource utilization, and COPD exacerbation were assessed in the 12-month pre-index period. Results Patients with delayed transition (C2 or C3) were significantly older and comprised more females than in C1. Patients with greatest delay (C3) comprised more black patients and had significantly more patients on Medicare or Medicaid, compared to timely transfer (C1) patients. C2 or C3 patients had higher Charlson comorbidity score (CCS), and more prevalent baseline comorbidities. C2 and C3 patients also had higher rates of smoking (current or former) and had higher use of maintenance and rescue COPD medications. In the 12 months before the first pulmonologist visits, patients with delayed transition timing (C2 and C3) had less frequent all-cause emergency room visits, and in-patient stays, but more frequent COPD-related office visits than with timely transition (C1). C3 patients generally had more frequent moderate-or-severe exacerbations with higher mean COPD exacerbation counts, and longer days with an exacerbation. Conclusions Study results showed that patients with delayed timing of transition of COPD patient care from PCPs to pulmonologists had higher COPD burden, providing critical insights into COPD management and long-term morbidity in these patients. This abstract is funded by: Research sponsored by Sanofi and Regeneron Pharmaceuticals, Inc.
Bhatt et al. (Fri,) studied this question.