2010 - A COPD disease management program reduced a composite of hospitalizations or emergency department visits

Park, Kevin; Robbins, Richard A.
March 2011
ACP Journal Club;3/20/2011, Vol. 154 Issue 3, p4
Academic Journal
Question Does a disease management program improve outcomes in patients with chronic obstructive pulmonary disease (COPD)? Methods Design Randomized controlled trial. ClinicalTrials.gov NCT00126776. Allocation {Concealed}*.† Blinding Blinded {data collectors, primary outcome assessors, and data analysts}*.† Follow-up period 1 year. Setting 5 Veterans Affairs (VA) medical centers in the USA. Patients 743 patients (mean age 70 y, 98% men) who had spirometrically confirmed COPD and were at high risk for hospitalization (>1 of the following during the previous year: admission or emergency department [ED] visit for COPD, long-term home oxygen use, or course of systemic corticosteroids for COPD). Intervention Disease management (n =>372) or usual care (n =>371). Disease management comprised 1 group education session (1 to 1.5 h), which was conducted by a respiratory therapist case manager and included observation of inhaler techniques; review and adjustment of COPD medications; smoking cessation counseling; and recommendations regarding regular exercise, vaccinations, and hand hygiene. Patients received individualized care plans that included refillable prescriptions for prednisone and an oral antibiotic and monthly phone calls from the case manager. Usual care comprised a 1-page handout summarizing the principles of COPD care and the telephone number for the 24-hour VA nursing helpline. Outcomes Primary outcome was a composite of hospitalization or ED visit for COPD. Other outcomes included a composite of all-cause hospitalization or ED visit, and all-cause mortality. Patient follow-up 89% completed 1-year follow-up. Main results Disease management reduced the composites of COPD hospitalizations or ED visits and all-cause hospitalizations or ED visits more than usual care (Table). Groups did not differ for all-cause mortality (10.1 vs 13.8 per 100 patient-y, P =>0.09). Conclusion A disease management program reduced a composite of hospitalizations and emergency department visits in patients with chronic obstructive pulmonary disease.


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