Implementation of an integrated care model for fragile COPD patients: a controlled prospective study

Abstract

<b>Background:</b> Fragile COPD (f-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). <b>Objectives:</b> To evaluate the long-term effectiveness of a f-COPD ICM on emergency room (ER) visits, hospital admissions, days of hospitalization, mortality and improvement of health status. <b>Methods:</b> Prospective-controlled study with analysis of a cohort of f-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. <b>Results:</b> 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 &lt;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 &gt;17 was the strongest independent risk factor for mortality and hospitalization among ICM patients. <b>Conclusions:</b> An ICM for f-COPD patients effectively decreases ER and hospital admissions and improves health status, but not mortality.