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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

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National Meeting 2009

1002 — Case/Self-Management in COPD: A Randomized Trial

Rice KL (Minneapolis VAMC), Dewan N (Omaha VAMC), Niewoehner DE (Minneapolis VAMC), Bloomfield HE (Minneapolis VAMC), Grill J (Minneapolis VAMC), Schult TM (Minneapolis VAMC), Nelson DB (Minneapolis VAMC), Kumari S (Pittsburgh VAMC), Thomas M (Sioux Falls VAMC), Geist LJ (Iowa City VAMC)

Objectives:
The aim of our study was to determine whether a simplified disease management program reduces hospital admissions and emergency department (ED) visits due to COPD exacerbations (COPD-E).

Methods:
This was a prospective multi-center, randomized, controlled, 1 yr study of disease management (1hr educational and clinical assessment session, adjustment of respiratory medications according to guidelines, a written action plan with refillable prescriptions for antibiotics and prednisone bursts, and a monthly telephone call from the disease manager) compared to usual medical care. Eligibility included a hospital admission, ED visit, systemic steroid use, or use of home O2 for COPD.

Results:
743 patients were enrolled at 5 VA sites. Baseline characteristics were similar in both groups.The composite primary endpoint of hospitalizations and ED visits for COPD was 49.0/100 pt yr in the intervention group and 83.1 in the usual care group (p < 0.0001, 41% reduction; reduction in COPD hospitalizations 31%, ED visits 51%). The difference in St. George’s Respiratory Questionnaire scores at 1 yr was 4.9 in favor of disease management (p < 0.001). All-cause mortality was 10.1/100 patient yr in the intervention group and 13.8 /100 patient yr in the usual care group (p = 0.09).

Implications:
A simplified COPD disease management program in a VA setting reduces hospital admissions and ED visits due to COPD exacerbation.

Impacts:
Implementation of a simplified disease management program reduces COPD exacerbations that are severe enough to require hospitalizations or ED visits, improves disease-specific quality of life and likely saves medical costs.


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