title: Comprehensive care programme for patients with chronic obstructive pulmonary disease: a randomised controlled trial.
abstract: There have been no randomised controlled trials that specifically evaluate the effect of a comprehensive programme with multidisciplinary input on patients who have just been discharged from hospital after treatment of acute exacerbation of COPD (AECOPD). The aim of this study was to assess whether a comprehensive care programme would decrease hospital readmissions and length of hospital stay (LOS) for patients with COPD.
  
  
  
  Patients discharged from hospital after an episode of AECOPD were randomised to an intervention group (IG) or usual care group (UG). The IG received a comprehensive, individualised care plan which included education from a respiratory nurse, physiotherapist support for pulmonary rehabilitation, 3-monthly telephone calls by a respiratory nurse over 1 year, and follow-up at a respiratory clinic with a respiratory specialist once every 3 months for 1 year. The UG were managed according to standard practice. The primary outcome was hospital readmission rate at 12 months.
  
  
  
  180 patients were recruited (IG, N=90; UG, N=90; mean±SD age 74.7±8.2 years, 172 (95.6%) men; mean±SD FEV145.4±16.6% predicted). At 12 months, the adjusted relative risk of readmission was 0.668 (95% CI 0.449 to 0.995, p=0.047) for the IG compared with the UG. At 12 months, the IG had a shorter LOS (4.59±7.16 vs 8.86±10.24 days, p≤0.001), greater improvement in mean Modified Medical Research Council Dyspnoea Scale (-0.1±0.6 vs 0.2±0.6, p=0.003) and St George's Respiratory Questionnaire score (-6.9±15.3 vs -0.1±13.8, p=0.003) compared with the UG.
  
  
  
  A comprehensive COPD programme can reduce hospital readmissions for COPD and LOS, in addition to improving symptoms and quality of life of the patients.
  
  
  
  NCT 01108835, Results.
authors.affiliation: Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
authors.forename: Fanny W S
authors.initials: FW
authors.lastname: Ko
authors.affiliation: Accident and Emergency Department, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: N K
authors.initials: NK
authors.lastname: Cheung
authors.affiliation: Accident and Emergency Department, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Rainer
authors.affiliation: Department of Medicine, Shatin Hospital, Hong Kong, Hong Kong.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lum
authors.affiliation: Physiotherapy Department, Prince of Wales Hospital, Hong Kong, Hong Kong.
authors.forename: Ivor
authors.initials: I
authors.lastname: Wong
authors.affiliation: Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
authors.forename: David S C
authors.initials: DS
authors.lastname: Hui
mesh_terms: D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: COPD Exacerbations