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Am J Respir Crit Care Med. 2010 Oct 1;182(7):890-6. doi: 10.1164/rccm.200910-1579OC. Epub 2010 Jan 14.

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

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  • 1Pulmonary Section, Department of Medicine, VA Medical Center, Minneapolis, Minnesota 55417, USA. Kathryn.Rice@va.gov

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).

Comment in

PMID:
20075385
[PubMed - indexed for MEDLINE]
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