1. FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

2. Pauwels RA, et al. Lancet 2004; 364:616-620 FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

3. Jamal A, et al. JAMA 2005; 294:1255-1259 Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

4. September 28 th, 2006 #4 #7 #12 Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

6. SHR Hospitalizations Saskatoon Health Region Statistics, 2005 Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

7. SHR Hospitalizations Disease Length of StayReadmission Rate COPD (02-03) 11.030% (03-04) 9.128% Diabetes (02-03) 10.121% (03-04) 9.922% CHF (02-03) 10.620% (03-04) 9.517% IHD (02-03) 7.013% (03-04) 7.111% Saskatoon Health Region Statistics, 2005 Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

8. Exacerbations and Mortality Time (months) p<0.0001 p<0.0002 A B C p=0.069 0102030405060 1.0 0.8 0.6 0.4 0.2 0 Survival probability Group A: no exacerbations Group B: 1–2 exacerbations Group C: ≥3 exacerbations n=304 Soler-Cataluna JJ, et al. Thorax 2005;60:925–931 Exacerbation = ER visit or hospital admission Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

9. Acute Event Mortality Myocardial Infarction 25% of men and 38% of women will die within 1 year of a first recognized MI (5,6) The in-hospital acute MI mortality rate is 9.4% (1999) (5,6) 1. Eriksen N, et al. Ugeskr Laeger 2003;165:3499–3502. 2. Groenewegen KH, et al. Chest 2003;124:459–467. 3. Almagro P, et al. Chest 2002;121:1441–1448. 4. Connors AF, et al. Am J Respir Crit Care Med 1996;154:959– 967. 5. Thom T et al. Circulation 2006. 6. Heart and Stroke Foundation of Canada Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

10. Acute Event Mortality COPD Exacerbation 22-43% of patients hospitalized with a COPD exacerbation will die within 1 year (1,2,3,4) The in-hospital mortality rate for COPD exacerbations is 7-11% (1,2) Myocardial Infarction 25% of men and 38% of women will die within 1 year of a first recognized MI (5,6) The in-hospital acute MI mortality rate is 9.4% (1999) (5,6) 1. Eriksen N, et al. Ugeskr Laeger 2003;165:3499–3502. 2. Groenewegen KH, et al. Chest 2003;124:459–467. 3. Almagro P, et al. Chest 2002;121:1441–1448. 4. Connors AF, et al. Am J Respir Crit Care Med 1996;154:959– 967. 5. Thom T et al. Circulation 2006. 6. Heart and Stroke Foundation of Canada Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

12. Risk of Death - Exercise Capacity Risk of death in subjects with risk factors and exercise capacity of 8 MET (MET = VO 2 3.5 ml/kg/min) Myers J et al, NEJM 2002; 346:793-801 Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

13. Rehab and Health Care Utilization Ries AL, et al. J Cardiopulm Rehabil 2004; 24(1): 52-62 Healthcare utilization over 18 months of follow-up. Data presented include physicians visits, telephone calls, hospital days, and urgent care visits over the preceding 3 months. The results are presented as mean + SE. Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

14. Bronchodilators and Rehabilitation Casaburi R, et al. Chest 2005; 127:809-817 * * Rehabilitation Study Drug 16% 32% 42% Endurance Time (mins) FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE Placebo Tiotropium Optimizing Chronic Disease Management Weeks on Treatment * p<0.05

15. Comprehensive COPD Management Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE Bourbeau J, et al. Arch Int Med 2003, 163:585-91 *Can Respir J 2004; 11(Suppl B): 7B-59B

16. Comprehensive COPD Management benefits persist over 2 years (Gadoury MA, et al. Eur Resp J 2005; 26:853-857) a caseload of 50 patients equals cost-savings (program vs usual care) of $2,149 – $2,300 /year concluded that a caseload of 70 patients was achievable and reasonable (additional savings of $310 /year) reduced hospitalizations, reduced exacerbations, and reduced healthcare costs Bourbeau J, et al. Chest 2006; in press Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

17. Ezekowitz, JA, et al. CMAJ 2005; 172:189-194 Comprehensive CHF Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

18. Knowler WC, et al. NEJM 2002; 346:393-403 Preventing Type 2 Diabetes n= 3234 non-diabetics with elevated fasting glucose FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE

19. Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE team-based, multidisciplinary program to help COPD pts and their families improve self- management of their disease focused on outcomes increased Pulmonary Rehabilitation capacity –home site (Field House) is full –assisted with establishing program in Regina –established 1st satellite in part of Saskatoon with the highest incidence of chronic diseases –additional satellites rolled out (Humboldt and Prince Albert) and other’s planned (Lawson Heights/Soccer, Saskatoon core, Yorkton, Moose Jaw) “Inspire” COPD Program

20. What Have We Seen So Far? Saskatoon Health Region Statistics, 2006 Optimizing Chronic Disease Management FOR SASK RESPIRATORY SUMMIT ONLY DO NOT CIRCULATE reduced COPD re-admissions - net cost savings of ~129,000 in 2005, and ~$79,000 in 2006 re-admission rates of 1 : 1.9 : 2.1 (2004), changed to 1 : 1.6 : 1.2 (2006) with recent programming at 3 acute-care sites in SHR decreased ICU days by 44% (2006), with a cost savings in 2005 of $261,333, and in 2006 of $308,333.

22. Community- based supervised exercise programming Group education Socialization Group Exercise and Rehabilitation

23. Community- based supervised exercise programming Group education Socialization Group Exercise and Rehabilitation “Live-Well with a Chronic Condition” Patient-led group classes / support Enhanced self- management skills and decision- making Patient Self- Management Skills

24. Community- based supervised exercise programming Group education Socialization Group Exercise and Rehabilitation Nurse-Clinician working with the patient, their Family Physician and/or Specialist Evidence-based optimal care delivery Disease-Specific Management Patient Self- Management Skills “Live-Well with a Chronic Condition” Patient-led group classes / support Enhanced self- management skills and decision- making

25. Live Well ™ Program a cost-effective, integrated [provincial] program - centralized coordination with both urban and rural delivery strategic, focused design and delivery “the right person doing the right job” cement the relationship between the patient [and family] and their family physician interventions that are not evidenced-based will not be utilized or promoted

26. Live Well ™ Program (cont’d) ongoing evaluation of both patient and program outcomes is necessary an electronic data management system is used for patient care, and also to facilitate communication, coordination and evaluation the program philosophy, design and delivery is common [ie. efficient] for many medical conditions – only Pillar 2 is “disease-specific” the model works and borrows on the learning's of others

27. Live Well ™ Program (cont’d) proposed Centers of Excellence in Regina and Saskatoon, but with comprehensive program delivery in every health region, using an achievable phased implementation benefits to patients are coupled with significant cost savings targeted funding would best be provided “provincially” to the health regions with the expectation of tangible deliverables and appropriate evaluation/reporting