Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial.
BACKGROUND
The effect of disease management for chronic obstructive pulmonary disease (COPD) is not well established.


OBJECTIVE
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.


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).
Rice
Kathryn L
KL
Pulmonary Section, Department of Medicine, VA Medical Center, Minneapolis, Minnesota 55417, USA. Kathryn.Rice@va.gov
Dewan
Naresh
N
Bloomfield
Hanna E
HE
Grill
Joseph
J
Schult
Tamara M
TM
Nelson
David B
DB
Kumari
Sarita
S
Thomas
Mel
M
Geist
Lois J
LJ
Beaner
Caroline
C
Caldwell
Michael
M
Niewoehner
Dennis E
DE
D000368:Aged; D019468:Disease Management; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012648:Self Care; D016037:Single-Blind Method; D016019:Survival Analysis; D014728:Veterans / Q000706:statistics & numerical data