title: Assessment of health status and program performance in patients on long-term oxygen therapy.
abstract: BACKGROUND
  Despite well established clinical guidelines, performance of long-term oxygen therapy (LTOT) programs shows marked variability among territories. The current study assessed the LTOT program and the health status of patients on LTOT prior to the deployment of community-based integrated care in an urban health district of Barcelona (Spain).
  
  
  OBJECTIVE
  To assess: i) the LTOT program and health status of the patients on LTOT in the health district; ii) their frailty profile; and, iii) the requirements for effective deployment of integrated care services for these patients.
  
  
  METHODS
  Cross-sectional observational study design including all patients (n = 406) on LTOT living in the health district. Health status, frailty, arterial blood gases, forced spirometry and hand-grip muscle strength were measured. Network analysis of frailty was carried out.
  
  
  RESULTS
  Adequacy of LTOT prescription (n = 362): 47% and 31% of the patients had PaO2 ≤ 60 mmHg and ≤55 mmHg, respectively. Adherence to LTOT: 31% of all patients used LTOT ≥15 h/d; this figure increased to 67% in those with PaO2≤60 mmHg. Assessment of frailty: Overall, LTOT patients presented moderate to severe frailty. Care complexity was observed in 42% of the patients.
  
  
  CONCLUSIONS
  Adequacy and adherence to LTOT was poor and many patients were frail and complex. The outcomes of the network analysis may contribute to enhance assessment of frailty in LTOT patients. These observations suggest that an integrated care strategy has the potential to improve the health outcomes of these patients.
authors.affiliation: Hospital Clinic de Barcelona, CIBER en Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Catalonia, Spain; Master Plan for Respiratory Diseases (PDMAR) and Respiratory Therapies Observatory (ObsTRD), Ministry of Health and REDISSEC (Research Network in Chronic Care), Barcelona, Catalonia, Spain. Electronic address: chernan@clinic.ub.es.
authors.forename: Carme
authors.initials: C
authors.lastname: Hernandez
authors.affiliation: Hospital Clinic de Barcelona, CIBER en Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Catalonia, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Aibar
authors.affiliation: International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Jordi
authors.initials: J
authors.lastname: de Batlle
authors.affiliation: Unit of Computational Medicine, Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Gomez-Cabrero
authors.affiliation: Hospital Clinic de Barcelona, CIBER en Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Catalonia, Spain.
authors.forename: Nestor
authors.initials: N
authors.lastname: Soler
authors.affiliation: Centre de Recerca en Epidemiologia Ambiental (CREAL), CIBER en Epidemiologia y Salud Pública (CIBERESP), Department of experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Duran-Tauleria
authors.affiliation: Centre de Recerca en Epidemiologia Ambiental (CREAL), CIBER en Epidemiologia y Salud Pública (CIBERESP), Department of experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.
authors.forename: Judith
authors.initials: J
authors.lastname: Garcia-Aymerich
authors.affiliation: Consorci Sanitari de Barcelona, Servei Català de la Salut, Generalitat de Catalunya, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Altimiras
authors.affiliation: Hospital Clinic de Barcelona, CIBER en Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Catalonia, Spain.
authors.forename: Monica
authors.initials: M
authors.lastname: Gomez
authors.affiliation: Hospital Clinic de Barcelona, CIBER en Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Catalonia, Spain.
authors.forename: Alvar
authors.initials: A
authors.lastname: Agustí
authors.affiliation: Hospital Clinic de Barcelona, CIBER en Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Catalonia, Spain; Master Plan for Respiratory Diseases (PDMAR) and Respiratory Therapies Observatory (ObsTRD), Ministry of Health and REDISSEC (Research Network in Chronic Care), Barcelona, Catalonia, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Escarrabill
authors.affiliation: Hospital Clinic de Barcelona, CIBER en Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Catalonia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Font
authors.affiliation: Hospital Clinic de Barcelona, CIBER en Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Catalonia, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Roca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis / Q000379:methods; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006301:Health Services Needs and Demand; D054624:Health Status Disparities; D006801:Humans; D008134:Long-Term Care / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D013030:Spain / Q000453:epidemiology; D013147:Spirometry / Q000379:methods; D013995:Time
keywords: Adequacy; Adherence; Chronic patients; Continuous oxygen therapy; Frailty; Integrated care