Simple Case Management Cuts Pulmonary Disease Admissions

WEDNESDAY May 21, 2008 -- Simple patient management can significantly reduce hospitalization and emergency room visits by people with chronic obstructive pulmonary disease (COPD), according to a U.S. study.

"While a model of intensive case management for COPD was previously shown to reduce hospitalizations for COPD, until now there has been little evidence that a more limited intervention model is effective," Dr. Kathryn Rice, staff physician in the pulmonary division of the Minneapolis Veterans Affairs Hospital and associate professor of medicine at the University of Minnesota, said in a prepared statement.

She and her colleagues studied 743 COPD patients at five VA hospitals who were randomly selected to receive either limited case management or conventional care from their primary-care provider.

The patients in the limited management group received: an hour of clinical assessment and education in a group setting; personalized adjustment of their medications according to GOLD/ATS guidelines; a written action plan that included a description of symptoms of COPD exacerbations; and refillable prescriptions for antibiotics and/or short courses of prednisone to manage exacerbations.

The patients also received monthly follow-up calls from a case manager, a respiratory therapist, who was also available for phone consultations when needed.

During the year-long study, emergency room visits for COPD decreased by more than one-half and hospitalizations for COPD decreased by nearly one-third among patients in the limited management group, compared to those in the traditional treatment group. Hospital admissions for any cause decreased by more than 20 percent in the limited management group.

"The limited management model also improved measures of quality of life and was associated with a non-statistically significant reduction in mortality, although the study was not large enough to detect a definite effect on mortality," Rice said.

"Because of its relative simplicity, we believe that this model could be easily implemented across a wide variety of clinical settings. This may not only improve patient outcomes, but could also reduce strain on hospital systems overburdened by preventable emergencies," she said.

The study was to be presented May 21 at the American Thoracic Society's International Conference, in Toronto.

Posted: May 2008


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