Integrated Disease Management Programs Improve Short-Term Outcomes for COPD Patients

By Umur Hatipoglu, MD

Taking care of patients with COPD presents unique challenges. Frequently, patients are afflicted with multiple comorbidities, lower socioeconomic status and ongoing tobacco addiction. Patients become particularly vulnerable to cardiovascular complications around the time of an exacerbation of the disease. Furthermore, an exacerbation, which may be brought on by infections, allergies or noxious inhaled material could last for six to eight weeks.

A holistic approach is necessary particularly for those patients with history of high healthcare utilization. It is therefore not surprising that integrated disease management programs for COPD patients of mid- to long-term duration have had some success in reducing healthcare utilization and improving quality of life metrics. Nonetheless, there have been no clinical interventions with proven efficacy in reducing COPD 30-day readmissions, a short-term outcome, despite the emphasis placed on the metric.

Analysis shows 90-day benefit

Recently, we reported the retrospective analysis of a multicomponent COPD post-discharge integrated disease management program for COPD, entitled “Impact of a post-discharge integrated disease management program on COPD hospital readmissions.” The program was implemented at Cleveland Clinic to improve the care of patients with COPD and reduce hospital readmissions.

The study, recently published in Respiratory Care, aimed to tease out the efficacy of different components of a post-discharge program consisting of a follow-up at a COPD clinic and care coordination program that involved weekly phone calls to the patient after discharge from the hospital. Groups of patients who were exposed to different components of the program were compared. One hundred sixty patients completed a 90-day follow-up, of which 67 attended the exacerbation clinic. Sixteen subjects received care coordination, 51 subjects completed both and 26 subjects did not participate in either component despite referral.

The number of hospitalizations within the previous year and use of noninvasive ventilation were highly predictive of 30 day readmissions. After adjustment for other explanatory variables, participation in at least one component of the post-discharge integrated disease management program was associated with lower rate of 90-day readmissions. Although there was a trend toward a reduction in 30-day readmissions, this was not statistically significant.

We speculated that interventions that have been proven to reduce readmissions and exacerbations such as participating in a pulmonary rehabilitation program or prescription of a long-acting bronchodilator may take longer than 30 days for accrual of the benefits. Studies suggest that provision of longitudinal care that utilizes best practices for patients with complex chronic illness is cost effective and beneficial. Our study demonstrates that the benefits for COPD patients may be apparent as early as three months.

Dr. Hatipoglu is staff in the Department of Pulmonary Medicine and Quality Improvement Officer in the Respiratory Institute.