Integrated care prevents hospitalizations for exacerbations in COPD patients

¹ Servei de Pneumologia and Technology Innovation Unit, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Spain
² Respiratory Division, UZ-Leuven, and Faculty of Kinesiology and Rehabilitation, KU-Leuven, Belgium
³ Respiratory and Environmental Health Research Unit, Institut Municipal d'Investigació Mèdica (IMIM-IMAS), Universitat Pompeu Fabra, Barcelona
⁴ Grupo de Bioingeniería y Telemedicina (GBT-UPM), Universidad Politécnica de Madrid, Spain

^* To whom correspondence should be addressed. E-mail: jroca{at}clinic.ub.es.

	Abstract

Hospital admissions due to COPD exacerbations have a major impact on the disease evolution and costs. We postulated that a simple and well standardized low intensity integrated care intervention can be effective to prevent such hospitalisations.

To this end, 155 exacerbated COPD patients (17% women) were recruited after hospital discharge from Barcelona (Spain) and Leuven (Belgium). They were randomly assigned either to integrated care (n=65) (age, 70±9 (SD) yrs, FEV₁ 1.1±0.5 L, 43% predicted) or usual care (n=90) (age, 72±9 (SD) yrs, FEV₁ 1.0±0.4 L, 41% predicted). The integrated care intervention consisted of an individually tailored care plan at discharge shared with the primary care team and accessibility to a specialized nurse case manager through a web-based call centre.

After 12 m follow-up, integrated care showed lower hospitalisation rate (1.5±2.6 vs 2.1±3.1) (p=0.03) and higher percentage of patients without re-admissions (49% vs 31%) (p=0.03) than usual care without differences in mortality (19% vs 16%), respectively.

This trial demonstrates that a standardized integrated care intervention based on shared care arrangements among different levels of the system with support of information technologies effectively prevents hospitalisations for exacerbations in COPD patients.

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