Publications by authors named "Thomas Stibolt"
Background: Although inhaled therapy reduces exacerbations among patients with COPD, the effectiveness of providing inhaled treatment per risk stratification models remains unclear.
Research Question: Are inhaled regimens that align with the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy associated with clinically important outcomes?
Study Design And Methods: We conducted secondary analyses of Long-term Oxygen Treatment Trial (LOTT) data. The trial enrolled patients with COPD with moderate resting or exertional hypoxemia between 2009 and 2015.
Rationale: Characteristics associated with adherence to long-term oxygen therapy (LTOT) in COPD remain unclear.
Objectives: To identify patient characteristics at the time of oxygen initiation associated with its adherence.
Methods: We conducted a secondary analysis of data from 359 COPD participants assigned to oxygen in the Long-term Oxygen Treatment Trial.
The Long-Term Oxygen Treatment Trial demonstrated that long-term supplemental oxygen did not reduce time to hospital admission or death for patients who have stable chronic obstructive pulmonary disease and resting and/or exercise-induced moderate oxyhemoglobin desaturation, nor did it provide benefit for any other outcome measured in the trial. Nine months after initiation of patient screening, after randomization of 34 patients to treatment, a trial design amendment broadened the eligible population, expanded the primary outcome, and reduced the goal sample size. Within a few years, the protocol underwent minor modifications, and a second trial design amendment lowered the required sample size because of lower than expected treatment group crossover rates.
View Article and Find Full Text PDFA Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation.
N Engl J Med
October 2016
Article Synopsis
- - The study investigated whether long-term supplemental oxygen treatment affects survival and hospitalization rates in stable COPD patients with moderate oxygen desaturation during rest or exercise.
- - Initially designed to compare oxygen treatment with no treatment among 34 patients, the trial was expanded to include more participants and modified to monitor times to death and first hospitalization.
- - Results showed no significant differences in mortality, hospitalization rates, or quality of life between patients receiving supplemental oxygen and those who did not, indicating that long-term oxygen might not provide the expected benefits.
Study Objectives: To develop simple clinical tools predictive of acute asthma care and to identify modifiable risk factors.
Design: Prospective cohort study.
Setting: A large health maintenance organization (430,000 members).
Objective: To test the ability of an automated telephone outreach intervention to reduce acute healthcare utilization and improve quality of life among adult asthma patients in a large managed care organization.
Study Design: Randomized clinical trial.
Methods: Patients with persistent asthma were randomly assigned to telephone outreach (automated = 3389, live caller = 192) or usual care (n = 3367).
Objective: To validate a risk stratification scheme using computerized pharmacy data to predict emergency hospital utilization for persistent asthma.
Study Design: Retrospective cohort.
Methods: The development sample consisted of 1079 HMO members aged 18 to 56 years with persistent asthma.
Background: The ratio of controller medication to total asthma medications has been related to asthma utilization outcomes, but its relationship to patient-centered outcomes has not been explored.
Methods: Surveys that included validated asthma quality-of-life, control, and symptom severity tools were completed by a random sample of 2,250 health maintenance organization members aged 18 to 56 years who had persistent asthma. Linked computerized pharmacy data provided dispensing information on beta-agonist canisters and asthma controller medication.
Background: Asthma control has been defined clinically by using validated tools, but an asthma control scale using administrative data has not been reported.
Objective: We sought to validate a beta-agonist asthma control scale derived from administrative data.
Methods: Surveys that included validated asthma symptom and control tools were completed by a random sample of 2250 health maintenance organization members aged 18 to 56 years with persistent asthma.
Background: Prior studies suggest that allergist care improves asthma outcomes, but many of these studies have methodological shortcomings.
Objective: We sought to compare patient-based and medical utilization outcomes in randomly selected asthmatic patients cared for by allergists versus primary care providers.
Methods: A random sample of 3568 patients enrolled in a staff model health maintenance organization who were given diagnoses of persistent asthma completed surveys.
Study Objective: To evaluate the relationship of potential asthma quality-of-care markers to subsequent emergency hospital care.
Design: Retrospective administrative database analysis.
Setting: Managed care organization.
Objectives: (1) To determine if the Health Plan Employer Data and Information Set (HEDIS) asthma inclusion criteria consistently identify persistent asthma on a year-to-year basis and (2) to explore whether variation in the number of years of qualification is associated with medication and resource utilization outcomes.
Study Design: Retrospective observational study.
Methods: We identified 132 414 patients in a large healthcare program who were included in 1 or more HEDIS persistent asthma cohorts between 1999 and 2002 and who had continuous insurance and pharmacy benefit coverage for the entire 4-year observation period.
Background: Validated psychometric tools measuring quality of life, asthma control, and asthma severity have been developed, but their relationships with each other and with other important patient-centered outcomes have not been rigorously assessed.
Objective: To use factor analysis to evaluate the relationships of these validated tools with each other and with other patient-centered outcomes.
Methods: Surveys were completed by a random sample of 2854 Health Maintenance Organization members age 18 to 56 years with persistent asthma.
Background: Risk stratification is used to identify patients with asthma at increased risk of experiencing morbidity and resource utilization. Validated psychometric tools are infrequently studied sources of data for this purpose.
Purpose: To evaluate 4 types of validated psychometric tools as predictors for subsequent asthma utilization and determine their clinical usefulness.