Disease management of chronic obstructive pulmonary disease from a disease management organization perspective: Providing technology and time to address gaps in care

Treatment of patients with chronic obstructive pulmonary disease (COPD) demands a great deal of time and technology, which physicians and healthcare systems tend to have in short supply. COPD is the fourth leading cause of death in the US and the disease is severely under-diagnosed. Many physicians report being too rushed to provide optimal care to patients with COPD, and many gaps exist in patient care and physician knowledge.This article examines the methods used by a disease management organization to provide value to patients with COPD, physicians, and payers through innovative information technology (IT) applications and telephonic nurse coaching. The organization encourages patient self-care through regular phone calls from a nurse coach, interactive web and telephone health status reporting, educational materials, and other means. Many patients with COPD need help understanding concepts that may seem obvious to healthcare professionals. By using motivational interviewing techniques, nurse coaches provide emotional support and information on how to monitor and track symptoms in an effort to improve clinical outcomes.The disease management organization works with the physician to support the physician plan of care, while also reinforcing evidence-based medicine and best-practice guidelines. The organization partners with physicians, offering data useful to medical practice without disrupting delivery of care. The disease management organization can assist payers in gaining a population perspective via data mining and predictive modeling. There is a growing body of evidence that disease management organizations can improve patient outcomes in individuals with chronic conditions such as COPD.