Case management may reduce length of hospital stay in patients with recurrent admissions for chronic obstructive pulmonary disease.
OBJECTIVE
The aim of the study was to determine whether the case management of patients with recurrent hospital admissions for chronic obstructive pulmonary disease (COPD) can reduce hospital days without reducing quality of life.


METHODS
Sixteen subjects (mean forced expiratory volume in 1 second; FEV1 0.64 L) with at least four admissions for COPD in the previous 2 years were case managed by a clinical nurse specialist. Admissions and hospital bed days were recorded before and after the introduction of case management, and compared with data for 16 controls at another hospital who received usual care. Quality of life was measured serially in the case-managed group.


RESULTS
In the first year of case management, the number of hospital bed days fell to eight per patient from 22 per patient in the previous year. This was mainly due to a reduction in the length of stay from 5.6 to 3.5 days. In the control group length of stay did not change. Admissions in both groups declined. Case-managed patients had a significant improvement in their quality-of-life scores.


CONCLUSIONS
In a group of patients with severe COPD and recurrent admissions, case management reduced the number of days in hospital while improving the quality of life. These findings need to be confirmed in a randomized, controlled trial.
Department of Medicine, University of Auckland, Auckland, New Zealand. p.poole@auckland.ac.nz
P J
PJ
Poole
B
B
Chase
A
A
Frankel
P N
PN
Black
D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D005260:Female; D006304:Health Status; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D008173:Lung Diseases, Obstructive / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D010865:Pilot Projects; D011788:Quality of Life; D018709:Statistics, Nonparametric