January 14, 2009
Baskets of Care Steering Committee
Minnesota Health Care Reform
Attention: ICSI
Dear Baskets of Care Steering Committee;
On behalf of the Minnesota COPD Coalition and the American Lung Association
of Minnesota, I would like to request that you consider Chronic Obstructive Lung
Disease (COPD), often called emphysemia and/or chronic bronchitis, as one of the
seven original Baskets of Care. COPD would be an excellent first Basket of Care
for several reasons, including:
1. COPD is usually under-managed in Minnesota. This provides an
opportunity not only to manage costs, but to guide evidence-based,
appropriate health care for individuals with COPD.
2. COPD is a disease which occurs in individuals 40 years of age and older.
By selecting COPD, it would balance nicely with other disease states which
might affect children and young adults more frequently.
3. A surveillance system exists in Minnesota to monitor the prevalence,
incidence, and treatment patterns of COPD (including costs). This
information could provide a baseline from which the Baskets of Care
legislation could monitor progress.
4. The treatment for COPD could be easily bundled into a Basket of Care.
COPD management falls into the following categories: spirometry and
other pulmonary function testing, professional fees, medication therapy,
pulmonary rehabilitation, and oxygen therapy. Therefore the scope of this
Basket of Care would be limited and potentially less complicated, making it
an excellent pilot test for the Basket of Care movement.
5. The Minnesota COPD Coalition, a statewide network of health care
professionals, public health, community-based organizations, and patients
and caregivers, is a neutral, non-political group available with local and
national experts to provide consultation to your Steering Committee.
6. COPD is currently the fourth leading cause of worldwide death and is
predicted to become the third leading cause of death worldwide by the year
20201 . COPD is also predicted to rise from the 12th leading cause of
worldwide disability in 1990 to the fifth leading cause by 20202 . The
economic burden of this disease is also substantial. In 2000, there were 8
million physician office and hospital outpatient visits, 1.5 million
emergency department visits, and 726,000 hospitalizations attributable to
COPD3 . Among patients ≥65 years old, COPD accounts for 11.3% to
15.1% of all hospital admissions4 . The overall direct and indirect medical
cost of COPD for the United States in 2007 was estimated to be in excess of
$42 billion5 and hospitalizations for acute exacerbations of COPD
(AECOPD) represent > 60% of all COPD-related costs6 . Between 2002
and 2004, the total direct costs for COPD grew from $18 billion to $20.9
billion, with an increase in hospitalizations being the primary contributor7 .
7. COPD is also a growing issue for Minnesota. Every day, five Minnesotans die from
COPD8. The Minnesota Department of Health’s 2005 Behavioral Risk Factor Survey
indicated that 7.4% of Minnesotans age 65 and over reported they have ever been told by
the physician that they have COPD. In Minnesota, the rate for COPD emergency
department visits increased 250% between 1996 and 20078.
Thank you for your consider for COPD to be a Basket of Care. If you have any questions or
would like assistance from the Minnesota COPD Coalition, please do not hesitate to ask. I can
be reached at 651-223-9578 or [email protected].
Sincerely,
Jill Heins Nesvold, MS
Director of Respiratory Health
REFERENCES
1. Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention
of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med.
2007;176:532-555.
2. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020:
Global burden of disease study. Lancet. 1997;349:1498-1504.
3. Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC. Chronic obstructive pulmonary disease
surveillance--united states, 1971-2000. MMWR Surveill Summ. 2002;51:1-16.
4. Holguin F, Folch E, Redd SC, Mannino DM. Comorbidity and mortality in COPD-related
hospitalizations in the united states, 1979 to 2001. Chest. 2005;128:2005-2011.
5. Morbidity and mortality: 2007 chart book on cardiovascular, lung, and blood diseases. Bethesda,
MD: National Institutes of Health, National Heart, Lung, and Blood Institute; 2007.
6. Sullivan SD, Ramsey SD, Lee TA. The economic burden of COPD. Chest. 2000;117:5S-9.
7. Minkoff NB. Analysis of the current care model of the COPD patient: A health outcomes assessment
and economic evaluation. J Manag Care Pharm. 2005;11:S3-7; quiz S20-2.
8. Minnesota and COPD: Leading the Way for the Nation: a surveillance and 2009-2010 strategic
plan report. Fall 2008. American Lung Association of Minnesota.