Proactive Integrated Care Improves Quality of Life in Patients with COPD

¹ University of Colorado Hospital, Aurora CO
² Dept of Biostatistics, School of Public Health
³ Dept of Medicine, University of Colorado at Denver Health Sciences Centre, Denver, CO
⁴ Dept of Medicine, Virginia Commonwealth University, Richmond VA

^* To whom correspondence should be addressed. E-mail: Bill.Vandivier{at}ucdenver.edu.

	Abstract

Self-management strategies improve a variety of health-related outcomes for patients with chronic obstructive pulmonary disease (COPD). These strategies, however, are primarily designed to improve chronic disease management and have not focused on early-detection and early-treatment of exacerbations. In COPD, the majority of exacerbations go unreported and treatment is frequently delayed resulting in worsened outcomes. Therefore, we designed a randomized clinical trial to determine whether integration of self-management education with proactive remote disease monitoring would improve health-related outcomes.

Forty GOLD stage 3 or 4 COPD patients were randomized to receive proactive integrated care (PIC) or usual care (UC) over 3 months. The primary and secondary outcomes were change in quality of life, measured by the St. Georges Respiratory Questionnaire (SGRQ) and change in healthcare costs.

PIC dramatically improved SGRQ by 10.3 units, compared to 0.6 units in the UC group (P=0.018). Healthcare costs declined in the PIC group by $1,401, compared to an increase of $1,709 in the UC group, but this was not statistically significant (P=0.21). PIC uncovered 9 exacerbations, 7 of which were unreported.

Therefore, PIC has the potential to improve outcomes in COPD patients through effects of self-management as well as early detection and treatment of exacerbations.