OBJECTIVES : Morbidity from asthma and chronic obstructive pulmonary disease (COPD) is increasing in the U.S.; these conditions are major drivers of health care resource utilization (HCRU). However, few data exist regarding management of asthma and COPD within “real-world” populations, hampering strategy development to improve outcomes. Accordingly, this study characterizes a cohort of patients with asthma and COPD in a large care delivery organization (CDO), including epidemiology, HCRU, exacerbation rates, and therapeutic interventions.

METHODS : Retrospective data on >1.7M unique patients seen in the CDO over 3 years (2016-2018) were extracted from electronic health records (EHR). Patients with asthma and/or COPD were identified using encounter primary diagnosis codes. Descriptive statistics were used to delineate the CDO patient population with these conditions, examine HCRU, quantify disease exacerbations, and assess therapies.

RESULTS : 149,086 unique patients (8.6% of the total population with accessible EHR data) had encounters in the CDO for asthma and/or COPD. Of this group, 47,805 (32.1%) patients had at least 1 documented visit for pulmonary care with a CDO provider in an outpatient clinic. In the population with recorded CDO outpatient visits, acute care utilization (“ever/never” over the study period) was moderate for asthma (18.4% ED visits, 10.3% hospitalization) and high for COPD (25.0% ED visits, 36.6%hospitalization). Annualized exacerbation rates were 0.86 for asthma and 1.16 for COPD. Recorded use of spirometry was low (4.7% for asthma, 2.6% for COPD). The majority of patients were prescribed short-acting therapies (beta₂-agonists and/or anticholinergics, asthma-77.9%, COPD-59.7%). Use of maintenance therapies [ICS, long-acting beta-agonist (LABA), long-acting anticholinergic (LAMA), or any combination of these agents] was low for asthma (38.3%) and COPD (51.7%).

CONCLUSIONS : Analysis of an EHR-derived dataset from an integrated CDO indicates specific opportunities to improve care for patients with asthma and/or COPD. Key targets include access to outpatient follow-up, use of spirometry, and appropriate tailoring of therapies.