title: Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial.
abstract: 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).
authors.affiliation: Pulmonary Section, Department of Medicine, VA Medical Center, Minneapolis, Minnesota 55417, USA. Kathryn.Rice@va.gov
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Rice
authors.forename: Naresh
authors.initials: N
authors.lastname: Dewan
authors.forename: Hanna E
authors.initials: HE
authors.lastname: Bloomfield
authors.forename: Joseph
authors.initials: J
authors.lastname: Grill
authors.forename: Tamara M
authors.initials: TM
authors.lastname: Schult
authors.forename: David B
authors.initials: DB
authors.lastname: Nelson
authors.forename: Sarita
authors.initials: S
authors.lastname: Kumari
authors.forename: Mel
authors.initials: M
authors.lastname: Thomas
authors.forename: Lois J
authors.initials: LJ
authors.lastname: Geist
authors.forename: Caroline
authors.initials: C
authors.lastname: Beaner
authors.forename: Michael
authors.initials: M
authors.lastname: Caldwell
authors.forename: Dennis E
authors.initials: DE
authors.lastname: Niewoehner
mesh_terms: 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