Integrated care prevents hospital isations for exacerbations in COPD patients
Integrated care prevents hospital isations for exacerbations in COPD patients
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DOI：
10.1183/09031936.06.00063205
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发表时间：
2006-07-01
影响因子：
24.3
通讯作者：
Decramer, M.
中科院分区：
文献类型：
--
作者：
Casas, A.;Troosters, T.;Decramer, M.
慢性阻塞性肺疾病（COPD）急性加重导致的住院对疾病进展和费用有重大影响。目前的作者假设，一个简单的和良好的标准化，低强度的综合护理干预可以有效地防止这样的hospitalisation.So，155加重COPD患者（17%女性）从巴塞罗那（西班牙）和鲁汶（比利时）的中心出院后招募。他们被随机分配到综合治疗组（IC组; n=65;年龄平均值+/- SD 70 +/- 9岁;一秒用力呼气量（FEV 1）1.1 +/- 0.5 L，43%预测值）或常规治疗组（UC组; n =90;年龄72 +/- 9岁; FEV 1 1.1 +/- 0.05 L，41%预测值）。IC干预包括出院后与初级保健团队共享的个性化护理计划，以及通过基于网络的呼叫中心联系专业护士病例经理。经过12个月的随访，IC显示住院率较低（1.5 +/- 2.6 vs 2.1 +/- 3.1），未再次入院的患者百分比更高（49% vs 31%）与UC相比，死亡率无差异（分别为19%和16%）。总之，这项试验表明，标准化的综合护理干预，通过信息技术的支持，在不同级别的系统之间建立共享护理安排，有效防止慢性阻塞性肺病患者因病情加重而住院。
Hospital admissions due to chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on the disease evolution and costs. The current authors postulated that a simple and well-standardised, low-intensity integrated care intervention can be effective to prevent such hospitalisations.Therefore, 155 exacerbated COPD patients (17% females) were recruited after hospital discharge from centres in Barcelona (Spain) and Leuven (Belgium). They were randomly assigned to either integrated care (IC; n=65; age mean +/- SD 70 +/- 9 yrs; forced expiratory volume in one second (FEV1) 1.1 +/- 0.5 L, 43% predicted) or usual care (UC; n =90; age 72 +/- 9 yrs; FEV1 1.1 +/- 0.05 L, 41% pred). The IC intervention consisted of an individually tailored care plan upon discharge shared with the primary care team, as well as accessibility to a specialised nurse case manager through a web-based call centre.After 12 months' follow-up, IC showed a lower hospitalisation rate (1.5 +/- 2.6 versus 2.1 +/- 3.1) and a higher percentage of patients without re-admissions (49 versus 31%) than UC without differences in mortality (19 versus 16%, respectively).In conclusion, this trial demonstrates that a standardised integrated care intervention, based on shared care arrangements among different levels of the system with support of information technologies, effectively prevents hospitalisations for exacerbations in chronic obstructive pulmonary disease patients.