B.E.S.T. Asthma Program (Breathe easy. Start today.®): A Primary Care-Based Program For Dispensing Asthma Medication and Devices Reduces Acute Hospitalization and Expenditures in Medicaid Subjects

VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8

comorbidities, and the associated cost of treatment (e.g the cost of hospitalisations due to exacerbations). Furthermore, the indirect costs associated with loss of productivity, absenteeism and impaired patient’s and caregiver’s work pose an additional burden on individuals and economies.  Conclusions: The substantial burden of COPD warrants active management and development of new classes of COPD medications that reduce the symptoms and exacerbations associated with the severity of the disease, improve patient’s HRQoL and consequently contribute to minimising the overall economic burden. PRS52 B.E.S.T. Asthma Program (Breathe easy. Start today.®): A Primary Care-Based Program For Dispensing Asthma Medication and Devices Reduces Acute Hospitalization and Expenditures in Medicaid Subjects Higgins YL, Keleti D, Shera D, Varma R, Odeleye A, Donia T, Michael KE, Gelzer AD Keystone First, Philadelphia, PA, USA

Objectives: To determine whether primary care-based dispensing of asthma supplies and hands-on education to Medicaid subjects with asthma reduces asthmarelated acute hospitalization and expenditures. Methods: Keystone First (a Medicaid managed care organization) and a pharmacy services supplier deliver secured cabinets stocked with asthma medication and devices to participating providers and support reimbursable provider-led education, allowing dispensation and training in the use of asthma supplies at the member’s point of service. Home delivery of asthma supplies was arranged by pre-refill calls made to the member 4–5 days prior to the refill due date. Provider and medication rates (utilization per member per year and expenditures per member per month) were calculated from subject claims pre- and post-engagement.  Results: In 2014, 23 participating practices used secured asthma cabinets to dispense 12,822 asthma medications and supplies to more than 6,000 members. Subjects were primarily African American males living in Philadelphia, both children and adolescents (50% and 85% were ≤ 6 and ≤ 12 years old, respectively). About 400–500 pre-refill calls are made weekly to members to arrange home delivery of medications. A one year pre/post analysis of all participating members in 2014 (N= 2,962) demonstrated: 1) decreases in inpatient admissions and outpatient visits (−19.5% and -4.3%; p=0.01) and corresponding expenditures (35.2% and -5.5%; p=0.01); 2) decreases in potentially preventable emergency department visits and expenditures (23.8% and -26.7%); 3) no significant change in potentially preventable readmissions and expenditures (+4.2% and +4.7%; p>0.9); 4) increases in prescription utilization and expenditures (+20% and 59.4%); 5) slight increases in medication adherence (PDC, 0.04; MPR, 0.11; SD, 0.42 and 0.37, respectively; and 6) significant expenditures savings (-20.2% and -10% with and without prescription, respectively; p>0.05).  Conclusions: Point-of-service dispensing of asthma supplies for Medicaid subjects with asthma significantly increases outpatient and prescription-related utilization and expenditures, but significantly reduces asthma-related acute hospitalization and expenditures. PRS53 Association Between Access-To-Care Factors And Health Care Resource Utilization Among Adults With Chronic Obstructive Pulmonary Disease Kim M1, Ren J1, Tillis W2, Asche CV1, Kim IK3, Kirkness CS1 of Illinois College of Medicine at Peoria, Peoria, IL, USA, 2OSF Saint Francis Medical Center, Peoria, IL, USA, 3Battelle Memorial Institute, Atlanta, GA, USA

1University

Objectives: One of barriers to obtaining good care may be the limited accessibility to health care. Few studies have been reported investigating the association between availability of access-to-care factors and chronic obstructive pulmonary disease (COPD)-hospitalizations. The objective of this study is to estimate the association between access-to-care factors and healthcare utilization including hospital/ emergency department (ED) visits and primary care physician (PCP) office visits among adults with COPD utilizing a nationally representative survey data.  Methods: We conducted a pooled cross-sectional analysis based upon a bivariate probit model, utilizing datasets from the 2011-2012 Behavioral Risk Factor Surveillance System linked with the 2014 Area Health Resource Files among adults with COPD. Dichotomous outcomes were hospital/ED visits and PCP office visits. Key covariates were county-level access-to-care factors including the population-weighted numbers of pulmonary care specialists, PCPs, hospitals, rural health centers and federally qualified health centers.  Results: Among a total of 9,332 observations, proportions of hospital/ED visits and PCP office visits were 16.2% and 44.2%, respectively. Results demonstrated that access-to-care factors were closely associated with hospital/ED visits. An additional pulmonary care specialist per 100,000 persons serves to reduce the likelihood of a hospital/ED visit by 0.4 percentage points (pp) (p= 0.028). In contrast, an additional hospital per 100,000 persons increases the likelihood of hospital/ED visit by 0.8 pp (p= 0.008). However, safety net facilities were not related to hospital utilizations. PCP office visits were not related with access-to-care factors.  Conclusions: Pulmonary care specialist availability was a key factor in reducing hospital utilization among adults with COPD. The findings of our study implied that an increase in the availability of pulmonary care specialists may reduce hospital utilizations in counties with little or no access to pulmonary care specialists, and that since availability of hospitals increases hospital utilization, directing COPD patients to pulmonary care specialists may decrease hospital utilizations. PRS54 Embracing Patient Heterogeneity Using Agent-Based Modeling And Preemptive Care Pathways Allows For Improved Care In The Treatment Of Bronchiolitis Obliterans Syndrome Zia A1, Weimersheimer P2, Mesa OA3, Peters C4, Jones C5 1University of Vermont, Burlington, VT, USA, 2University of Vermont College of Medicine, Burlington, VT, USA, 3Therakos, Inc., Wokingham, Berkshire, UK, 4Therakos, Inc., a Mallinckrodt Company, West Chester, PA, USA, 5University of Vermont - College of Medicine, Burlington, VT, USA

A119

Objectives: Existing BOS models predict survival rates and effectiveness of interventions but they lack the ability to provide pre-emptive high intensive care. These care pathways are sequential, rather than pre-emptive, and create as a consequence a downward spiral of path dependency and severity. In this study, our goal was to build an Agent Based Model (ABM) that could provide a transparent mechanism to compare existing path dependency with preemptive high intensity treatment including extracorporeal photophoresis (ECP) for patients who may have very different circumstances, tolerances and comorbidities.  Methods: Using recent data, we developed an ABM that captures patient heterogeneity and simulates an alternative scenario using what we call pre-emptive care pathways (PCPs). We compared this scenario with a usual care scenario using measures of health status, costs and treatment effects according to the guidelines established by International Society for Heart and Lung Transplantation (ISHLT).  Results: From 10,000+ experimental simulations in the ABM, we found that earlier introduction of ECP for patients with specific age, gender and underlying disease dynamics could increase the survival rates as compared with a scenario in which ECP was not introduced. Modeling changes from baseline in forced expiratory volume (FEV) per second, as per ISHLT guidelines, and their respective quality of life measures for patients in different stages of BOS, the proposed ABM with PCPs can predict and match an optimal individualized care pathway and the timing of treatment intervention for a specific patient conditional upon her/his disease characteristics.  Conclusions: We identified a new utility for ABMs to power PCPs in the context of confounding patient and treatment heterogeneity. It is anticipated that this tool will aid decision makers with clearer treatment pathways for BOS that are more aligned with individual circumstances, especially in maximizing chances of survival with respect to improved quality of life. PRS55 Relationship Between Severity And Acute Inhaler Use In Chronic Obstructive Pulmonary Disease Hur P1, Albrecht J2, Huang T3, Simoni-Wastila L3, Moyo P3, Khokhar B3, Harris I4, Wei Y5 1University of Maryland, School of Pharmacy, Baltimore, MD, USA, 2Univeristy of Maryland, School of Medicine, Baltimore, MD, USA, 3University of Maryland, School of Pharmacy, Baltimore, MD, USA, 4Impaq International, Columbia, MD, USA, 5University of Florida College of Pharmacy, Gainesville, FL, USA

Objectives: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommends maintenance inhaler use based on disease severity but offers limited guidance for acute inhaler use. The study aims to examine the relationship between chronic obstructive pulmonary disease (COPD) severity and acute inhaler use, alone or in conjunction with maintenance medications.  Methods: Using 5% sample of Medicare administrative claims from Chronic Condition Data Warehouse from 2006-2011, beneficiaries diagnosed with COPD were followed for two years. Individuals with at least 1 COPD-related inpatient visit, COPD-related emergency department visit, or supplemental oxygen claim during first six months of follow-up were categorized with moderate-severe COPD; otherwise, subjects were classified with mild COPD. Severity cohorts were compared on acute and maintenance inhaler use. Acute inhaler use per year was categorized into six groups (> 0 to ≤ 2, > 2 to ≤ 4, > 4 to ≤ 6, > 6 to ≤ 8, > 8 to ≤ 10, and > 10 to ≤ 12).  Results: 25,268 beneficiaries met inclusion criteria; of these beneficiaries, 81% had mild COPD. For acute inhaler use per year, there was a bimodal distribution for both cohorts, with highest peak use at > 0 to ≤ 2 and > 2 to ≤ 4 acute inhalers per year, and a second peak use at > 10 to ≤ 12 acute inhalers per year. Differences in median (interquartile range) acute inhaler use per year between mild (4.2 (5.9)) and moderate-severe (4.8 (6.4)) COPD cohorts were statistically significant (p< 0.001). Similar findings were found for maintenance inhalers.  Conclusions: The bimodal distribution for acute inhalers may indicate a group of patients with suboptimal use and a group with overuse of acute inhalers. Higher use of acute inhalers for moderate-severe COPD patients may indicate suboptimal use of and/or adherence to maintenance inhalers, overuse of acute inhalers, and/or insufficient control of COPD. Thus, it may be important for clinicians to be sensitive to patients’ COPD inhaler use patterns. PRS56 Comparative Effectiveness Of Smoking Cessation Medications Among Schizophrenic Smokers Wu I1, Chen H2, Bordnick P1, Essien EJ2, Johnson ML2, Peters RJ3, Wang X2, Abughosh S2 of Houston, houston, TX, USA, 2University of Houston, Houston, TX, USA, 3University of Texas Health Science Center at Houston, houston, TX, USA 1University

Objectives: To compare short term and long term smoking abstinence with different cessation medications among schizophrenia patients.  Methods: A retrospective cohort study was conducted using General Electric (GE) medical records database (1995 – 2011). The cohort consisted of adult smokers with a diagnosis of schizophrenia who newly initiated cessation medication (NRT, Bupropion or Varenicline). Cessation outcome was abstinence. It was measured at 12 weeks and 1 year following the initiation of cessation medications. Logistic regression models were carried out to determine the predictors of short term and long term abstinence.  Results: Of the 3,976 patients identified, majority used nicotine replacement therpapy (NRT) (n= 2,590, 65.14%) followed by Bupropion SR (n= 89, 2.24%) and Varenicline (n= 1,164, 29.28%). Although unadjusted analysis showed that abstinence rate was the highest for Varenicline across all cessation regimens (21.04%) in both the short term (21.04%) and the long term follow up (20.07%) among all cessation regimens, statistically significant difference was not detected in the multivariate analysis. Older age (OR= 1.02, 95% CI= 1.01 – 1.03), white race (OR= 1.83, 95% CI= 1.04 – 3.20), western household locations (OR= 2.18, 95% CI= 1.39 – 3.41) and receiving counseling (OR= 0.67, 95% CI= 0.49 – 0.92) were significantly associated with abstinence at week 12. Patients who had a 2nd exposure were less likely to quit compared to those without the 2nd exposure at one year (OR= 0.26, 95% CI= 0.13–0.55). No significant differences were found between cessation medications.  Conclusions: There were no statistically significant differences in quitting with type of cessation medication. Predictors of better abstinence identified included older age, white race, western