Study Shows Simple Disease Management Program Significantly Reduces Hospitalizations and ED Visits for Veterans with COPD
Disease management programs have been successfully implemented for chronic conditions such as heart failure and diabetes, but evidence is lacking that demonstrates disease management improves the overall health status for patients with chronic obstructive pulmonary disease (COPD). This study sought to determine if a simple disease management program, with a focus on early recognition and self-treatment of COPD exacerbations, would improve outcomes in Veterans with severe COPD. Investigators conducted the randomized controlled trial at five VAMCs. Veterans at high-risk of hospitalization for COPD were randomly assigned to either disease management (n=372) or usual care (n=371). Veterans assigned to usual care received a one-page handout containing a summary of the principles of COPD care and a telephone number for the 24-hour VA nursing helpline – available to all VA patients. Veterans assigned to the disease management group attended one 1-1.5 hour group education session conducted by a respiratory therapist case manager and received an action plan for self-treatment of exacerbations and monthly follow-up calls from a case manager. The education session included: general information about COPD, direct observation of inhaler techniques, a review and adjustment of COPD medications, smoking cessation counseling, vaccination recommendations for flu and pneumonia, exercise encouragement, and instruction on hand hygiene. The primary outcome was the combined number of hospitalizations and ED visits for COPD during a 12-month period.
- A relatively simple disease management program for patients with severe COPD reduced the total frequency of COPD hospitalizations and emergency visits by 41%.
- After one year of follow-up, the average number of COPD-related hospitalizations per patient was 30% lower in the disease management group compared to the usual care group, and the average number of COPD-related ED visits was 50% lower.
- The percentage of patients who experienced at least one COPD-related hospitalization was 23% in the usual care group and 17% in the disease management group; for COPD-related ED visits, the percentages were 23% and 14%, respectively.
- On average, patients in the disease management group spent 36% less time in the hospital for all causes, and also spent less time in the intensive care unit.
- Benefits of individual components of the disease management program could not be assessed.
- Risks and benefits beyond the one-year follow-up period are unknown, and the study lacked sufficient power to detect a mortality effect.
This study was partly supported by HSR&D’s Center for Chronic Disease Outcomes Research in Minneapolis and by VISN 23. Dr. Bloomfield is Director of the Center.
Rice K, Dewan N, Bloomfield H, et al. Disease Management Program for Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. American Journal of Respiratory and Critical Care Medicine October 2010;182(7):890-96.