Disease management program for chronic obstructive pulmonary disease a randomized controlled trial

Kathryn L. Rice, Naresh Dewan, Hanna E. Bloomfield, Joseph Grill, Tamara M. Schult, David B. Nelson, Sarita Kumari, Mel Thomas, Lois J. Geist, Caroline Beaner, Michael Caldwell, Dennis E. Niewoehner

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211 Scopus citations

Abstract

Rationale: The effect of disease management for chronic obstructive pulmonary disease (COPD) is not well established. Objectives: 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,andmonthly follow-up calls from a case manager. Measurements and Main 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).

Original languageEnglish (US)
Pages (from-to)890-896
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Volume182
Issue number7
DOIs
StatePublished - Oct 1 2010

Keywords

  • Chronic obstructive
  • Disease management
  • Education
  • Pulmonary disease

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    Rice, K. L., Dewan, N., Bloomfield, H. E., Grill, J., Schult, T. M., Nelson, D. B., Kumari, S., Thomas, M., Geist, L. J., Beaner, C., Caldwell, M., & Niewoehner, D. E. (2010). Disease management program for chronic obstructive pulmonary disease a randomized controlled trial. American journal of respiratory and critical care medicine, 182(7), 890-896. https://doi.org/10.1164/rccm.200910-1579OC