Effects of an integrated care intervention on risk factors of COPD readmission.
An integrated care intervention including education, coordination among levels of care, and improved accessibility, reduced hospital readmissions in chronic obstructive pulmonary disease (COPD) after 1 year. This study analyses the effectiveness of this intervention in terms of clinical and functional status, quality of life, lifestyle, and self-management, under the hypothesis that changes in these factors could explain the observed reduction in readmissions. A total of 113 exacerbated COPD patients (14% female, mean (SD) age 73(8) years, FEV(1) 1.2(0.5) l) were recruited after hospital discharge in Barcelona, Spain, and randomly assigned (1:2) to integrated care (IC) (n=44) or usual care (UC) (n=69). The intervention consisted of an individually tailored care plan at discharge shared with the primary care team and access to a specialized case manager nurse through a web-based call centre. After 1 year of intervention, subjects in the intervention group improved body mass index by 1.34 kg/m(2). Additionally, they scored better in self-management items: COPD knowledge 81% vs. 44%, exacerbation identification 85% vs. 22%, exacerbation early treatment 90% vs. 66%, inhaler adherence 71 vs. 37%, and inhaler correctness 86 vs. 24%. There were no differences in the evolution of dyspnea, lung function, quality of life scores, lifestyle factors, or medical treatment.


CONCLUSIONS
This IC trial improved disease knowledge, and treatment adherence, after 1 year of intervention, suggesting that these factors may play a role in the prevention of severe COPD exacerbations triggering hospital admissions.
Garcia-Aymerich
Judith
J
Centre for Research in Environmental Epidemiology, Institut Municipal d'Investigació Mèdica, Barcelona, Spain. jgarcia@imim.es
Hernandez
Carme
C
Alonso
Albert
A
Casas
Alejandro
A
Rodriguez-Roisin
Robert
R
Anto
Josep M
JM
Roca
Josep
J
D000368:Aged; D015992:Body Mass Index; D002245:Carbon Dioxide / Q000097:blood; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D008019:Life Style; D008297:Male; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D010359:Patient Readmission; D017060:Patient Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000517:prevention & control / Q000534:rehabilitation*; D011788:Quality of Life; D012307:Risk Factors; D012648:Self Care; D013030:Spain; D014797:Vital Capacity
D002245:Carbon Dioxide; D010100:Oxygen