Development of MDS-Based Predication Model for COPD Severity in Nursing Home Residents

Background Assessing chronic obstructive pulmonary disease (COPD) severity is challenging in nursing home (NH) residents due to incomplete symptom assessments and exacerbation history. Objective The objective of this study was to predict COPD severity in NH residents using the Minimum Data Set (MDS), a clinical assessment of functional capabilities and health needs. Methods A cohort analysis of prospectively collected longitudinal data was conducted. Residents from geographically varied Medicare-certified NHs with age ≥60 years, COPD diagnosis, and ≥6 months NH residence at enrollment were included. Residents with severe cognitive impairment were excluded. Demographic characteristics, medical history, and MDS variables were extracted from medical records. The care provider–completed COPD Assessment Test (CAT) and COPD exacerbation history were used to categorize residents by Global Initiative for Chronic Lung Disease (GOLD) A to D groups. Multivariate multinomial logit models mapped the MDS to GOLD A to D groups with stepwise selection of variables. Results Nursing home residents (N = 175) were 64% women and had a mean age of 77.9 years. Among residents, GOLD B was most common (A = 13.1%; B = 44.0%; C = 5.7%; D = 37.1%). Any long-acting bronchodilator (LABD) use and any dyspnea were significant predictors of GOLD A to D groups. The predicted MDS-GOLD group (A = 6.9%; B = 52.6%; C = 4.6%; D = 36.0%) showed good model fit (correctly predicted = 60.6%). Nursing home residents may underuse group-recommended LABD treatment (no LABD: B = 53.2%; C = 80.0%; D = 40.0%). Conclusion and Relevance The MDS, completed routinely for US NH residents, could potentially be used to estimate COPD severity. Predicted COPD severity with additional validation could provide a map to evidence-based treatment guidelines and may help to individualize treatment pathways for NH residents.

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A review of national guidelines for management of COPD in Europe

European Respiratory Journal ◽

10.1183/13993003.01170-2015 ◽

2016 ◽

Vol 47 (2) ◽

pp. 625-637 ◽

Cited By ~ 87

Author(s):

Marc Miravitlles ◽

Claus Vogelmeier ◽

Nicolas Roche ◽

David Halpin ◽

João Cardoso ◽

...

Keyword(s):

Treatment Guidelines ◽

Inhaled Corticosteroids ◽

Chronic Obstructive ◽

Treatment Goals ◽

National Guidelines ◽

Obstructive Pulmonary Disease ◽

The Czech Republic ◽

Criteria For Diagnosis ◽

Long Acting

The quality of care can be improved by the development and implementation of evidence-based treatment guidelines. Different national guidelines for chronic obstructive pulmonary disease (COPD) exist in Europe and relevant differences may exist among them.This was an evaluation of COPD treatment guidelines published in Europe and Russia in the past 7 years. Each guideline was reviewed in detail and information about the most important aspects of patient diagnosis, risk stratification and pharmacotherapy was extracted following a standardised process. Guidelines were available from the Czech Republic, England and Wales, Finland, France, Germany, Italy, Poland, Portugal, Russia, Spain and Sweden. The treatment goals, criteria for COPD diagnosis, consideration of comorbidities in treatment selection and support for use of long-acting bronchodilators, were similar across treatment guidelines. There were differences in measures used for stratification of disease severity, consideration of patient phenotypes, criteria for the use of inhaled corticosteroids and recommendations for other medications (e.g. theophylline and mucolytics) in addition to bronchodilators.There is generally good agreement on treatment goals, criteria for diagnosis of COPD and use of long-acting bronchodilators as the cornerstone of treatment among guidelines for COPD management in Europe and Russia. However, there are differences in the definitions of patient subgroups and other recommended treatments.

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Present and Prospective Therapeutic Regimens for COPD

Clinical Medicine Insights Therapeutics ◽

10.4137/cmt.s2106 ◽

2012 ◽

Vol 4 ◽

pp. CMT.S2106

Author(s):

Teresa A. Schweiger

Keyword(s):

Combination Therapy ◽

Patient Outcomes ◽

Treatment Guidelines ◽

Chronic Obstructive ◽

Anticholinergic Agent ◽

Obstructive Pulmonary Disease ◽

Prevalent Disease ◽

Appropriate Therapy ◽

Long Acting ◽

General Step

Chronic Obstructive Pulmonary Disease is a prevalent disease throughout the world. Recently updated treatment guidelines were published and still endorse a general step-wise approach to therapy based on severity of disease. The heterogeneity of the disease makes it difficult to determine appropriate therapy based on the data available. Currently, combination therapy, specifically triple therapy with a long acting beta2 agonist, a long acting anticholinergic agent, and an inhaled corticosteroid appear to achieve the best patient outcomes. In addition, there is a desperate need for new therapy with a different mechanism of action than those already on the market. The recommendations concerning stable COPD treatment will be reviewed, as well as, efficacy data regarding combination therapy. In addition, a few new and prospective therapies will be evaluated.

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