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Low-intensity Case-Management Significantly Improves COPD Outcomes

Low-intensity Case-Management Significantly Improves COPD Outcomes

Low-intensity case management can reduce emergency room visits by more than half and hospital stays by one-third for patients at high risk of hospitalization due to chronic obstructive pulmonary disease (COPD), according to a landmark study.

“Even we were surprised by the magnitude of our results. In the past, most studies have shown very little benefit from limited intervention. However, those studies were not as rigorous and did not include as many patients,” said Naresh A. Dewan, M.D., study co-principal investigator. Dewan, a Creighton University professor of medicine, is chief of the pulmonary section at Omaha Veterans Affairs (VA) Hospital.

The findings were reported Wednesday, May 21, at the American Thoracic Society’s 2008 International Conference in Toronto.

“Due to the low cost and relative ease of our model, we believe it could and should be used in a variety of patient settings to improve patient outcomes and help control health care costs,” Dewan noted.

For the randomized, year-long study, researchers enrolled 743, mostly male, patients at five VA hospitals, including about 200 patients at the Omaha facility. To qualify for the study, participants had to meet certain criteria showing them to be at high risk of COPD exacerbations and hospital admissions.

About half of the patients received limited case management, and the others obtained conventional care from their primary-care providers for 12 months.

Those with limited case management received a one-hour educational and clinical assessment session, adjustment of respiratory medications according to recommended guidelines, a written action plan, refillable antibiotics and steroid prescriptions, and a monthly telephone call from a case manager. The manager, a respiratory therapist, was also available for phone consultations as needed.

Over the course of the year, case-managed patients reduced their emergency-room visits for COPD by more than one-half and hospitalizations by nearly one-third, compared to those who received conventional care. Hospital admissions for any cause decreased by more than 20 percent in the case-managed group.

“Our case-management model also showed an improved quality of life for patients, Dewan said. “While we also found a nonstatistically significant drop in the number of deaths, a larger study is needed to determine whether this model can decrease COPD-related mortality.”

COPD is the fourth-leading cause of mortality in the United States, annually accounting for about 110,000 deaths, 750,000 hospitalizations and 16 million office or emergency room visits, Dewan noted. He estimated that between 90-95 percent of COPD cases involve current or former smokers.

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