Implementation of an Integrated Care Model for Frequent-Exacerbator COPD Patients: A Controlled Prospective Study

Borja G Cosío; Hanaa Shafiek; Javier Verdú; Federico Fiorentino; Jose Luis Valera; Rocío Martínez; Susana Romero; Lluisa Ramón; Nuria Toledo-Pons; Ernest Sala

doi:10.1016/j.arbres.2021.01.025

Implementation of an Integrated Care Model for Frequent-Exacerbator COPD Patients: A Controlled Prospective Study

Arch Bronconeumol (Engl Ed). 2021 Feb 13:S0300-2896(21)00050-8. doi: 10.1016/j.arbres.2021.01.025. Online ahead of print.

[Article in English, Spanish]

Authors

Affiliations

¹ Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: borja.cosio@ssib.es.
² Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
³ Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa, Spain.
⁴ Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain.

PMID: 33771388
DOI: 10.1016/j.arbres.2021.01.025

Abstract

Introduction: Frequent-exacerbator COPD (fe-COPD) associated with frequent hospital admissions have high morbidity, mortality and use of health resources. These patients should be managed in personalized integrated care models (ICM). Accordingly, we aimed to evaluate the long-term effectiveness of a fe-COPD ICM on emergency room (ER) visits, hospital admissions, days of hospitalization, mortality and improvement of health status.

Methods: Prospective-controlled study with analysis of a cohort of fe-COPD patients assigned to ICM and followed-up for maximally 7 years that were compared to a parallel cohort who received standard care. All patients had a confirmed diagnosis of COPD with a history of ≥2 hospital admissions due to exacerbations in the year before enrollment. The change in CAT score and mMRC dyspnea scale, hospital admissions, ER visits, days of hospitalization, and mortality were analyzed.

Results: 141 patients included in the ICM were compared to 132 patients who received standard care. The ICM reduced hospitalizations by 38.2% and ER visits by 69.7%, with reduction of hospitalizations for COPD exacerbation, ER visits and days of hospitalization (p<0.05) compared to standard care. Further, health status improved among the ICM group after 1 year of follow-up (p=0.001), effect sustained over 3 years. However, mortality was not different between groups (p=0.117). Last follow-up CAT score>17 was the strongest independent risk factor for mortality and hospitalization among ICM patients.

Conclusions: An ICM for fe-COPD patients effectively decreases ER and hospital admissions and improves health status, but not mortality.

Keywords: CAT score; EPOC con agudizaciones frecuentes; Frequent exacerbator COPD; Hospitalización; Hospitalization; Long-term mortality; Mortalidad a largo plazo; Puntuación CAT©.