title: Effect of a telephonic alert system (Healthy outlook) for patients with chronic obstructive pulmonary disease: a cohort study with matched controls.
abstract: BACKGROUND
  Healthy Outlook was a telephonic alert system for patients with chronic obstructive pulmonary disease (COPD) in the UK. It used routine meteorological and communicable disease reports to identify times of increased risk to health. We tested its effect on hospital use and mortality.
  
  
  METHODS
  Enrolees with a history of hospital admissions were linked to hospital administrative data. They were compared with control patients from local general practices, matched for demographic characteristics, health conditions, previous hospital use and predictive risk scores. We compared unplanned hospital admissions, admissions for COPD, outpatient attendances, planned admissions and mortality, over 12 months following enrolment.
  
  
  RESULTS
  Intervention and matched control groups appeared similar at baseline (n = 1413 in each group). Over the 12 months following enrolment, Healthy Outlook enrolees experienced more COPD admissions than matched controls (adjusted rate ratio 1.26, 95% confidence interval (CI), 1.05-1.52) and more outpatient attendances (adjusted rate ratio 1.08, 95% CI, 1.03-1.12). Enrolees also had lower mortality rates over 12 months (adjusted odds ratio 0.61, 95% CI, 0.45-0.84).
  
  
  CONCLUSIONS
  Healthy Outlook did not reduce admission rates, though mortality rates were lower. Findings for hospital utilization were unlikely to have been affected by confounding.
authors.affiliation: The Nuffield Trust, 59 New Cavendish Street, London W1G 7LP, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Steventon
authors.affiliation: The Nuffield Trust, 59 New Cavendish Street, London W1G 7LP, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Bardsley
authors.affiliation: Policy Innovation Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mays
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000628:therapy*; D017010:Reminder Systems; D013689:Telephone
keywords: COPD; exacerbation; forecast; health promotion; patient admission; respiratory disorders; telehealth