Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial.

Abstract

RATIONALE:

The effect of disease management for chronic obstructive pulmonary disease (COPD) is not well established.

OBJECTIVES:

To determine whether a simplified disease management program reduces hospital admissions and emergency department (ED) visits due to COPD.

METHODS:

We performed a randomized, adjudicator-blinded, controlled, 1-year trial at five Veterans Affairs medical centers of 743 patients with severe COPD and one or more of the following during the previous year: hospital admission or ED visit for COPD, chronic home oxygen use, or course of systemic corticosteroids for COPD. Control group patients received usual care. Intervention group patients received a single 1- to 1.5-hour education session, an action plan for self-treatment of exacerbations, and monthly follow-up calls from a case manager.

MEASUREMENTS AND MAIN RESULTS:

We determined the combined number of COPD-related hospitalizations and ED visits per patient. Secondary outcomes included hospitalizations and ED visits for all causes, respiratory medication use, mortality, and change in Saint George's Respiratory Questionnaire. After 1 year, the mean cumulative frequency of COPD-related hospitalizations and ED visits was 0.82 per patient in usual care and 0.48 per patient in disease management (difference, 0.34; 95% confidence interval, 0.15-0.52; P < 0.001). Disease management reduced hospitalizations for cardiac or pulmonary conditions other than COPD by 49%, hospitalizations for all causes by 28%, and ED visits for all causes by 27% (P < 0.05 for all).

CONCLUSIONS:

A relatively simple disease management program reduced hospitalizations and ED visits for COPD. Clinical trial registered with www.clinicaltrials.gov (NCT00126776).

• Authors: Kathryn L Rice, Naresh Dewan, Hanna E Bloomfield, Joseph Grill, Tamara M Schult, David B Nelson, Sarita Kumari, Mel Thomas, Lois J Geist, Caroline Beaner, Michael Caldwell, Dennis E Niewoehner
• Journal: American journal of respiratory and critical care medicine (Am J Respir Crit Care Med) Vol. 182 Issue 7 Pg. 890-6 (Oct 01 2010) ISSN: 1535-4970 [Electronic] United States
• PMID: 20075385 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, U.S. Gov't, Non-P.H.S.)

Topics

• Aged
• Disease Management
• Female
• Health Services (statistics & numerical data)
• Humans
• Male
• Patient Admission (statistics & numerical data)
• Patient Education as Topic
• Pulmonary Disease, Chronic Obstructive (therapy)
• Self Care
• Single-Blind Method
• Survival Analysis
• Veterans (statistics & numerical data)