A new method for examining the cost savings of reducing COPD exacerbations.

Background: Some treatments for chronic obstructive pulmonary disease (COPD) can reduce exacerbations, and thus could have a favourable impact on overall healthcare costs.

Objective: To evaluate a new method for assessing the potential cost savings of COPD controller medications based on the incidence of exacerbations and their related resource utilization in the general population.

Methods: Patients with COPD (n = 1074) enrolled in a regional managed care system in the US were identified using administrative data and divided by their medication use into three groups (salbutamol, ipratropium and salmeterol).

Optimizing practice through research: a new perspective to solve an old problem.

Policy makers, researchers, clinicians, and the public are frustrated that research in the health sciences has not resulted in a greater improvement in patient outcomes. Our experience as clinicians and researchers suggests that this frustration could be reduced if health sciences research were directed by 5 broad principles: (1) the needs of patients and populations determine the research agenda; (2) the research agenda addresses contextual and implementation issues, including the development of delivery and accountability systems; (3) the research agenda determines the research methods rather than methods determines the research agenda; (4) researchers and clinicians collaborate to define the research agenda, allocate resources, and implement findings; and (5) the level of funding for implementation research is commensurate with and proportional to the magnitude of the task. To keep the research agenda focused on the task of improving health and to acknowledge that the effort must be seen as more comprehensive than translating or transferring research into practice (TRIP), we suggest that the task be reframed, using the term optimizing practice through research.

A comparison of health-care costs in patients with chronic obstructive pulmonary disease using lightweight portable oxygen systems versus traditional compressed-oxygen systems.

Background: Lightweight portable oxygen systems are commonly preferred by patients over compressed-oxygen systems that use E-size cylinders. However, cost is often perceived as a barrier to the prescription of lightweight portable oxygen systems.

Objective: To compare the overall health-care costs of patients with COPD who used lightweight portable oxygen systems to those who used E-cylinder systems.

The direct medical costs of undiagnosed chronic obstructive pulmonary disease.

Objective: To estimate the costs of undiagnosed chronic obstructive pulmonary disease (COPD) by describing inpatient, outpatient, and pharmacy utilization in the years before and after the diagnosis.

Methods: A total of 6,864 patients who were enrolled in the Lovelace Health Plan for at least 12 months during the study period (January 1, 1999 through December 31, 2004) were identified. The first date that utilization was attributed to COPD was considered the first date of diagnosis.

Survival among COPD patients using fluticasone/salmeterol in combination versus other inhaled steroids and bronchodilators alone.

Recent retrospective studies have suggested that use of inhaled corticosteroids (ICS) may improve survival in chronic obstructive pulmonary disease (COPD), particularly when combined with a long-acting beta-agonist (LABA). However, the study methodologies have been questioned, and no study has examined the survival effect of the newer combination ICS/LABA inhalers. The goal of this project was to further examine the relationship between ICS treatment, with or without LABA, and survival in COPD.

The Lower Extremity Gain Scale: a performance-based measure to assess recovery after hip fracture.

Objective: To develop and determine the reliability and validity of a sensitive observational measure to assess recovery in clinically meaningful areas of function after hip fracture.

Design: Used survey data to identify activities difficult to perform after fracture; conducted focus groups; interviewed patients; and developed a standardized protocol to prospectively test the highest ranking activities.

Setting: Evaluations conducted in 8 Baltimore hospitals or the patients' residence.

Predicting the costs of managing patients with chronic obstructive pulmonary disease.

The economic consequences of chronic obstructive pulmonary disease (COPD) are considerable, although the factors that best predict costs are largely unknown. This study used a population-based cohort to identify the clinical factors during an index year that were most predictive of increased direct medical costs in the subsequent year, and to develop a predictive model that described the cost variations in COPD. The medical records of 2116 patients enrolled in one regional health system who had COPD and health-care resource utilisation data for 1998 and 1999, were abstracted for information about symptoms, smoking history, chronic illnesses, and pulmonary function data.

Compliance with pharmacologic therapy for osteoporosis.

There is little information available concerning compliance with pharmacologic therapy for osteoporosis in the usual care setting. We evaluated 176 consecutive, previously untreated women whose physicians initiated treatment for osteoporosis following a bone mineral density (BMD) test obtained as part of routine medical practice. All patients were contacted >/=1 year after the initial BMD test and offered a follow-up BMD.

Compliance with oral HRT in postmenopausal women in clinical trials--meta analysis.

Objective: To assess compliance with oral hormone replacement therapy (HRT) over time in postmenopausal women in clinical trials and to examine aspects of study conduct (e.g. randomized vs.

Impact of case ascertainment on recent trends in diabetes incidence in Rochester, Minnesota.

The authors previously reported an increase in the incidence of diabetes mellitus among Rochester, Minnesota, residents during the period 1970-1989. This study provides updated rates from data collected through 1994. Trends in diabetes surveillance, i.