Getting to the Point of Care
How bringing lung function testing to respiratory therapists and primary care physicians will help millions of people through earlier detection and more accurat
How bringing lung function testing to respiratory therapists and primary care physicians will help millions of people through earlier detection and more accurate diagnosis of lung disease.
Understanding COPD
As the third leading cause of death in the U.S.[[^0]], chronic obstructive pulmonary disease (COPD) continues to be a growing challenge to the healthcare industry. With millions of people already diagnosed, an additional 12 million Americans may have the disease without even knowing it[2]. Every four minutes one person dies from this slow developing disease[3]. COPD is not curable, but precise, early, diagnosis along with ongoing monitoring will slow the progression of the disease and have a significant impact on the quality of life of these patients.
It is estimated that the economic burden associated with treating COPD will reach $50 billion by 2020[4]. Similar to how the healthcare industry has tackled diabetes and other chronic health conditions, earlier detection during routine check-ups is critical to fighting this disease. Screenings can identify COPD before a major loss of lung function occurs, but most people are still diagnosed in a lung function lab. This testing often comes too late in the game when significant irreversible lung damage has already occurred.
Moving testing beyond the lung function lab
Despite simplified and cost-effective tools that facilitate the diagnosis of COPD such as spirometry used by doctors in the primary care setting, there is still low adoption and underutilization of these solutions. Today, most patients who are showing signs of lung disease or already experiencing symptoms – meaning that the disease may have progressed to late-stage COPD – are usually sent to lung function laboratories. Today’s conventional lab equipment requires specialized personnel, who are primarily trained to maintain the equipment and to coach the patients through a series of tests – not to provide the level of care and attention that a patient would receive from their primary care physicians.
While it is critical to adapt lung function testing in primary care settings, it is important to note that these simplified tools are an extension to the lung function labs rather than a replacement. Many lung function labs are overwhelmed and incredibly busy and primarily focus on maintaining the equipment rather than ongoing patient care. With easy-to-use tools, respiratory therapists will have access to mobile and effective tools that require minimal training, which will enable them to focus more on the wellbeing of the patient.
Extending care also has operational benefits – lung function laboratories have high running costs and are only available in larger hospitals. It often takes weeks to get an appointment, which creates additional barriers for the earlier detection of lung disease. If the healthcare industry continues to rely on the current approach — that is solely built around conventional lab equipment being the standard of care – lung disease diagnosis will continue to lag behind with many hospitals not utilizing new technologies that are available today that provide earlier and more accurate detection.
Changing the standard of care and stressing the importance of education
With millions of people suffering from COPD, the healthcare industry must bring reliable lung function testing to more respiratory therapists and to primary care physicians (PCPs), which will help more people receive therapy and management earlier at the point of care. When people visit their therapist, a specialist or doctor, a lung function test should be as standard as taking a person’s blood pressure and temperature. Spirometers are the simplest lung function test that can be done anywhere, from an emergency to a home care setting. Spirometry measures how much and how fast a patient breathes in and out.
The Global Initiative for Obstructive Lung Disease (GOLD) guidelines recommend spirometry as one of the primary tools to establish a COPD diagnosis in patients with a historic cough, difficulty breathing or exposures to risk factors, such as smoking[5]. While, spirometry is known and widely available, these pulmonary function tests continue to be underutilized. Spirometry helps find the presence of the obstruction as it occurs in COPD before symptoms develop. Other pulmonary function tests, diffusing capacity (DLCO) and measurement of lung volumes can provide information about the overall impact of the disease and can be valuable in resolving diagnostic uncertainties and assessing patients for surgery[6].
In addition to spirometry, DLCO test can provide decisive information for respiratory therapists and physicians to help to precisely diagnose respiratory conditions. In addition, DLCO testing is the most powerful predictor of survival in COPD patients. It measures the ability of the lungs to transfer gas from inhaled air to the red blood cells in pulmonary capillaries. DLCO testing can help distinguish pulmonary from cardiac issues and emphysema from chronic bronchitis. The combination of spirometry and DLCO testing can be seen as a one-two punch for both respiratory therapists and PCPs to more accurately detect and treat chronic lung disease.
Acting as a one-two punch, spirometry and DLCO test allow for earlier detection of lung disease, creating differential diagnosis from COPD to asthma to cardiovascular disease and deciding the correct decision for immediate start of treatment at the point of care. Both spirometry screenings and DLCO testing should be centralized to occur at the point of care – moving these tests beyond the lung function lab into doctor’s offices, making it convenient for patients and achieving an earlier diagnosis. Even with normal spirometry results, people with low DLCO are still at significant risk of developing COPD[7], showing the importance of using a spirometer and DLCO test in combination with one another for the most accurate diagnosis.
In addition to making these tools available, it is important to offer training and to educate physicians and nurses that spirometry and DLCO test are easy-to-use, reliable and enable them to make the best decisions about lung health with the best information available. Studies show that low utilization of spirometry with PCPs may be due to a lack of education among general practitioners about its importance. By enhancing their ability to better detect chronic respiratory conditions through these solutions, primary care physicians will be able to better treat their patients and grow their practices. Spirometry and DLCO testing is viable for offering more services, especially for areas with a high prevalence of COPD.
Improving outcomes at the point of care
Given the growing populations affected by COPD, it is critical to add spirometry and DLCO testing at the point of care. For example, Summa Health, an Ohio-based health care system, noticed a high prevalence of COPD in the state, with smoking identified as the top two concerns in a Community Health Needs Assessment conducted by Summa Health and other area health systems.
Summa Health has a strong commitment to population health management – keeping patient populations as healthy as possible through prevention and good control of chronic disease. Population health management can only be effective if the health system is diagnosing and managing at the point of care. Summa Health saw the increase in underdiagnosed COPD patients and clearly recognized the importance of detecting COPD at the point of care and decided to take proactive action.
Instead of replacing outdated conventional lab equipment and expanding the lung function lab, Summa Health equipped their clinics with modern, portable and maintenance free devices for measuring spirometry and DLCO at the point of care, equipment significantly different than what they have used in the past. One immediate benefit of this modern approach was that it standardized test results regardless of where the patient was tested, something that wasn’t true with the old equipment. In addition to that being able to quickly test patients at the point of care, these devices reduced wait times, decreased misdiagnosis, patient transport costs. By increasing the number of patients that could be tested, Summa Health improved its workflow and drastically increased the efficiency of the health system. With the successful implementation of this innovative technology, Summa Health expanded the purchasing of this equipment to small community health centers.
Summa Health demonstrated how adoption of these devices at the point of care can have a broader impact on a health system’s overall population health strategy. Traditionally, some health care providers have been reluctant – because of cost pressures and complexity with traditional systems – to perform comprehensive pulmonary function tests on a wide swath of patients if they can’t be reimbursed. With the DLCO testing, not only pulmonologists and primary care physicians, but also cardiothoracic surgeons and oncologists at Summa Health are now receiving better information about their patients’ pulmonary status, enabling them to improve treatment of a range of diseases.
The road ahead
With WHO predicting that COPD will become the third leading cause of death worldwide by 2030[8], it is critical that the healthcare industry focuses on early diagnosis at the point of care. Cost-effective, easy-to-use tools need to be available to respiratory therapists as well as becoming the standard of care similar to a blood pressure test in PCPs’ offices and other locations where people receive their care.
To detect and better diagnose COPD, respiratory therapists and PCPs must work together with today’s modern tools with a focus on patient centric care at the point of care. Through better diagnosis and treatment of people living with lung disease at the point of care, the healthcare industry can fight the COPD epidemic while helping to reduce the significant economic burden of lung disease across the entire health care system.
[4]American College of Chest Physicians
[5]Global Initiative for Chronic Obstructive Lung Disease
[6]Global Initiative for Chronic Obstructive Lung Disease