Effectiveness of case management in the prevention of COPD re-admissions: a pilot study

Annelies E Van Eeden,Ron Wolterbeek,Gertrud Van Vulpen,Wies Wagenaar,Melinde R S Boland,Tim Roldaan,Niels H Chavannes,Ingrid Van De Poll

doi:10.1186/s13104-017-2946-5

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) exacerbations are associated with high disease burden and costs, especially in the case of hospitalizations. The overall number of hospital admissions due to exacerbations of COPD has increased. It is remarkable that re-admissions account for a substantial part of these hospitalizations. This pilot study investigates the use of case management to reduce re-admissions due to COPD.MethodsCOPD patients with more than one hospitalization per year due to an exacerbation were included. The participants (n = 10) were closely monitored and intensively coached for 20 weeks after hospitalization. The case manager provided care in a person-focused manner. The case manager informed and supported the patient, took action when relapse threatened, coordinated and connected primary and secondary care. Data of 12 months before and after start of the intervention were compared. Primary outcome was the difference in number of hospitalizations. Secondary outcomes were health-related quality of life (measured by the Clinical COPD Questionnaire, CCQ) and dyspnoea (measured by the MRC Dyspnoea Scale).ResultsThe incidence rate of hospitalizations was found to be 2.25 times higher (95% confidence interval [CI] 1.3–3.9; P = 0.004) 12 months before compared with 12 months after the start of case management. COPD patients had a mean CCQ score of 3.3 (95% CI 2.8–3.8) before and 2.4 (95% CI 1.9–2.8) after 20 weeks of case management; a difference of 1.0 (95% CI 0.4–1.6; P = 0.001). The mean MRC scores showed no significant differences before (4.3; 95% CI 3.7–4.9) and after the case management period (3.9; 95% CI 3.2–4.6); a difference of 0.4 (95% CI − 0.1 to 0.9; P = 0.114).ConclusionsThis pilot study shows that the number of COPD hospital re-admissions decreased significantly after the introduction of a case manager. Moreover, there was an improvement in patient-reported health-related quality of life.

Highlights

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with high disease burden and costs, especially in the case of hospitalizations [1]
FER forced expiratory ratio (FEV1/FVC × 100%), FVC forced vital capacity, FEV1 forced expiratory volume in 1 s, post-bronchodilator, predicted according to age and height; global initiative for chronic obstructive lung disease (GOLD) global initiative for chronic obstructive pulmonary disease CCQ Clinical Chronic obstructive pulmonary disease (COPD) Questionnaire; MRC Medical Research Council Dyspnea Scale cancelled because these patients were admitted to the hospital
The case manager subsequently visited these patients during their hospitalization

Summary

Introduction

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with high disease burden and costs, especially in the case of hospitalizations [1]. In the Netherlands, the number of hospital admissions due to COPD exacerbations has increased [2]. One of the main goals is to reduce the number of hospital admission days due to COPD by 25% [5]. Chronic obstructive pulmonary disease (COPD) exacerbations are associated with high disease burden and costs, especially in the case of hospitalizations. The overall number of hospital admissions due to exacerbations of COPD has increased. It is remarkable that re-admissions account for a substantial part of these hospitalizations. This pilot study investigates the use of case management to reduce re-admissions due to COPD

Methods

Results

Discussion

Conclusion