title: Effect of an integrated care programme on re-hospitalization of patients with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Hospital admissions due to exacerbations of chronic obstructive pulmonary disease (COPD) have a major impact on disease progression and costs. We hypothesized that a 1-year integrated care (IC) programme comprising two components (patient-centred education+case management) would be effective in preventing COPD-related hospitalizations.
  
  
  METHODS
  This was a retrospective longitudinal cohort study. Data were retrieved both from an administrative database in the province of Quebec (Canada), and from the medical records at two hospitals in Montreal. One hundred and eighty-nine COPD patients were randomly selected from registers at these centres, from 2004 to 2006. Patients in the intervention group underwent a programme comprising two components: patient -centred education-involving three group sessions of self-management education that included one motivational interview and instruction in the use of a written action plan; and case management-involving scheduled follow-up visits with access to a call centre. The intervention group was compared with a group receiving usual care (UC). The main outcome was COPD-related re-hospitalizations, with length of hospital stay and emergency department (ED) visits being secondary outcomes.
  
  
  RESULTS
  Logistic regression analysis with adjustment for covariates showed that there was a lower probability of re-hospitalization over the follow-up year in the IC group compared with the UC group (odds ratio 0.44; 95% confidence interval 0.23-0.85). Subgroup analyses revealed that the IC programme prevented more COPD-related hospitalizations in women compared with men. There were no significant between-group differences in length of hospital stay or number of ED visits.
  
  
  CONCLUSIONS
  An IC programme combining self-management education and case-management can decrease rates of COPD-related hospitalizations, particularly among women.
authors.affiliation: Research Centre, Division of Chest Medicine, Hôpital du Sacré-Cœur de Montréal-a University of Montréal affiliated hospital, Montreal, Canada.
authors.forename: Grégory
authors.initials: G
authors.lastname: Moullec
authors.forename: Kim L
authors.initials: KL
authors.lastname: Lavoie
authors.forename: Khalil
authors.initials: K
authors.lastname: Rabhi
authors.forename: Marcel
authors.initials: M
authors.lastname: Julien
authors.forename: Hélène
authors.initials: H
authors.lastname: Favreau
authors.forename: Manon
authors.initials: M
authors.lastname: Labrecque
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018802:Patient-Centered Care; D029424:Pulmonary Disease, Chronic Obstructive; D012189:Retrospective Studies