title: Integrated care prevents hospitalisations for exacerbations in COPD patients.
abstract: Hospital admissions due to chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on the disease evolution and costs. The current authors postulated that a simple and well-standardised, low-intensity integrated care intervention can be effective to prevent such hospitalisations. Therefore, 155 exacerbated COPD patients (17% females) were recruited after hospital discharge from centres in Barcelona (Spain) and Leuven (Belgium). They were randomly assigned to either integrated care (IC; n = 65; age mean+/-sd 70+/-9 yrs; forced expiratory volume in one second (FEV(1)) 1.1+/-0.5 L, 43% predicted) or usual care (UC; n = 90; age 72+/-9 yrs; FEV(1) 1.1+/-0.05 L, 41% pred). The IC intervention consisted of an individually tailored care plan upon discharge shared with the primary care team, as well as accessibility to a specialised nurse case manager through a web-based call centre. After 12 months' follow-up, IC showed a lower hospitalisation rate (1.5+/-2.6 versus 2.1+/-3.1) and a higher percentage of patients without re-admissions (49 versus 31%) than UC without differences in mortality (19 versus 16%, respectively). In conclusion, this trial demonstrates that a standardised integrated care intervention, based on shared care arrangements among different levels of the system with support of information technologies, effectively prevents hospitalisations for exacerbations in chronic obstructive pulmonary disease patients.
authors.affiliation: Servei de Pneumologia, Hospital Clínic, Villarroel 170, Barcelona-08036, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Casas
authors.forename: T
authors.initials: T
authors.lastname: Troosters
authors.forename: J
authors.initials: J
authors.lastname: Garcia-Aymerich
authors.forename: J
authors.initials: J
authors.lastname: Roca
authors.forename: C
authors.initials: C
authors.lastname: Hernández
authors.forename: A
authors.initials: A
authors.lastname: Alonso
authors.forename: F
authors.initials: F
authors.lastname: del Pozo
authors.forename: P
authors.initials: P
authors.lastname: de Toledo
authors.forename: J M
authors.initials: JM
authors.lastname: Antó
authors.forename: R
authors.initials: R
authors.lastname: Rodríguez-Roisín
authors.forename: M
authors.initials: M
authors.lastname: Decramer
mesh_terms: D000368:Aged; D019033:Delivery of Health Care, Integrated; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000706:statistics & numerical data*; D006751:Hospital Information Systems; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000473:pathology / Q000517:prevention & control* / Q000628:therapy*