PROJECT SUMMARY/ABSTRACT Chronic obstructive pulmonary disease (COPD) causes the largest burden of disease among chronic respiratory conditions in the United States, affecting 16 million Americans and leading to 150,000 deaths annually. Home oxygen therapy is one of few therapies in COPD that reduces mortality. Over the last decade, a Medicare policy, the Competitive Bidding Program (CBP), has significantly changed the price of home oxygen and the number of suppliers servicing patients. The effect of this policy has not been studied extensively and is currently unknown. Professional societies have voiced concern that patient access to home oxygen and its associated clinical benefits have been negatively affected. On the other hand, program monitoring by Medicare has not revealed any unintended consequences of the CBP. This mixed methods study proposes to use quasi-experimental observational methods and semi-structured qualitative interviews to independently and rigorously evaluate the effects of the CBP on home oxygen access and clinical outcomes among patients with COPD. Dr. Duan will (1) assess the effect of the CBP on access to home oxygen among patients with COPD, (2) examine the association between the CBP and patient-centered clinical outcomes among patients with COPD, and (3) identify patient and provider perspectives about their current experience with home oxygen prescribing. This proposal will generate important policy and patient care insights that have the potential to inform CBP redesign and lay the foundation for future strategies to improve home oxygen care. Through this grant, Dr. Duan, an early career investigator and pulmonologist, will receive training in advanced causal inference methods, the analysis of large administrative datasets for policy research, and qualitative research methods. The proposed research and comprehensive career development plan will prepare Dr. Duan for a career as an independent investigator studying how health systems and policies can be optimized to improve respiratory health and value for patients. These research and training activities will be supervised by an expert team of mentors at the academically rich research environments of the University of Washington Schools of Medicine and Public Health, as well as the Department of Veterans Affairs Puget Sound Health Care System.

PROJECT NARRATIVE Home oxygen is one of few treatments that improves survival in chronic obstructive pulmonary disease (COPD), the leading chronic respiratory cause of morbidity and mortality in the United States. Medicare’s Competitive Bidding Program (CBP) has significantly changed the home oxygen payment process over the last ten years, with unknown effects on home oxygen access and outcomes among patients with COPD. This project will use rigorous methods to study the effect of the CBP and understand patient and provider perspectives, which could have significant public health implications as stakeholders seek to improve the CBP and home oxygen care for patients.