Systematic Review of the Chronic Care Model in Chronic Obstructive Pulmonary Disease Prevention and Management

Adams, Sandra G.; Smith, Paulla K.; Allan, Patrick F.; Anzueto, Antonio; Pugh, Jacqueline A.; Cornell, John E.

doi:10.1001/archinte.167.6.551

Cited by 319 publications

(307 citation statements)

References 53 publications

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“…[7][8][9][10][11] As yet, however, the German DMP for COPD patients has not been broadly evaluated. Studies investigating the utility of such programs for COPD have come to varying conclusions, and the authors of several meta-analyses 12,13 have argued that larger randomized controlled trials are needed. A randomized controlled study conducted by Rice et al 14 showed that a relatively simple DMP reduced hospitalizations and emergency department visits for patients with COPD.…”

Section: Introductionmentioning

confidence: 99%

Disease Management Programs for Patients With COPD in Germany: A Longitudinal Evaluation of Routinely Collected Patient Records

et al. 2013

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INTRODUCTION:The primary aim of the disease management program (DMP) for patients with COPD is to improve health outcomes and thereby to reduce overall costs. Six years after its introduction in Germany, no consensus has yet been reached as to whether the DMP has been effective in reaching these goals. The objective of the study was an evaluation of the DMP for COPD in Bavaria using routinely collected subject medical records. METHODS: A longitudinal population-based study, comparing the total DMP population of up to 86,560 patients with a stable cohort of 17,549 subjects over a period of 5 years. The effect of subject dropout in the cohort is further estimated by means of inverse probability weighting. RESULTS: The proportion of subjects in the total population who were prescribed and received treatment with oral corticosteroids declined at a constant rate of 1.0% per year (P < .001). The proportion of subjects who were given a prescription for theophylline decreased at a constant rate of 2.0% per year (P < .001). By 2012, 15.6% of the total population and 26% of the cohort had undergone self-management education. While the proportion of smokers in the total population remained constant because of the effect of newly enrolled subjects, the proportion of smokers decreased significantly even after dropout adjustment, from 29% to 21%. The occurrence of exacerbations decreased steadily at a rate of 0.9% (total population) or 0.7% (cohort) per year. While the occurrence of emergency hospital admissions decreased in the total population, an increase was observed within the cohort. CONCLUSIONS: Summarizing all results leads to the suggestion that the German DMP for COPD has been effective in enhancing the quality of care in regard to an improved adherence to guidelines, pharmacotherapy, exacerbations, and self-management education. However, the DMP was not able to prevent an increase in emergency hospital admissions for the stable population in the cohort.

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Section: Introductionmentioning

confidence: 99%

Disease Management Programs for Patients With COPD in Germany: A Longitudinal Evaluation of Routinely Collected Patient Records

et al. 2013

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“…This all suggests that self-management, in partnership with health-care professionals, could reduce exacerbations and hospitalisations. A systematic review 6 has recently concluded that chronic care models in COPD can indeed reduce …”

Section: Introductionmentioning

confidence: 99%

Use and utility of a 24-hour Telephone Support Service for ‘high risk’ patients with COPD

Hurst

Fitzgerald-Khan

Quint

et al. 2010

Primary Care Respiratory Journal

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“…Previous systematic reviews in patients with COPD have studied self-management education (11,12), integrated care (13)(14)(15), shared management between specialists and primary care physicians (16), and home care (17) in patients with stable COPD, or hospital at home for acutely ill patients with COPD exacerbations (18) or other conditions (19). Previous reviews on care transitions from hospital to home have focused on other patient populations (ie, not patients with COPD exacerbations) (20)(21)(22).…”

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confidence: 99%

Interventions to Reduce Rehospitalizations after Chronic Obstructive Pulmonary Disease Exacerbations. A Systematic Review

Prieto-Centurion¹,

Markos

Ramey³

et al. 2014

Annals ATS

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Rationale: Approximately 20% of patients hospitalized for COPD exacerbations in the United States will be readmitted within 30 days. The Centers for Medicare and Medicaid Services has recently proposed to revise the Hospital Readmissions Reduction Program to financially penalize hospitals with high all-cause 30-day rehospitalization rates after a hospitalization for COPD exacerbation on or after October 1, 2014.Objectives: To report the results of a systematic review of randomized clinical trials evaluating interventions to reduce the rehospitalizations after COPD exacerbations.Methods: Multiple electronic databases were systematically searched to identify relevant studies published between January 1966 and June 2013. Titles, abstracts, and, subsequently, full-text articles were assessed for eligibility. Each study was appraised using predefined criteria.Measurements and Main Results: Among 913 titles and abstracts screened, 5 studies (1,393 participants) met eligibility criteria. All studies had a primary outcome of rehospitalization at 6 or 12 months. No study examined 30-day rehospitalization as the primary outcome. Each study tested a different set of interventions. Two studies (one conducted in Canada and one conducted in Spain and Belgium) showed a decrease in all-cause rehospitalization over 12 months in the intervention group versus comparator group (mean number of hospitalizations per patient, 1.0 vs. 1.8; P = 0.01; percent hospitalized, 45 vs. 67%; P = 0.028; respectively). The only study conducted in the United States found a greater than twofold higher risk of mortality in the intervention group (17 vs. 7%, P = 0.003) but no significant difference in rehospitalizations. It was unclear which set of interventions was effective or harmful. Conclusions:The evidence base is inadequate to recommend specific interventions to reduce rehospitalizations in this population and does not justify penalizing hospitals for high 30-day rehospitalization rates after COPD exacerbations.

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Systematic Review of the Chronic Care Model in Chronic Obstructive Pulmonary Disease Prevention and Management

Cited by 319 publications

References 53 publications

Disease Management Programs for Patients With COPD in Germany: A Longitudinal Evaluation of Routinely Collected Patient Records

Disease Management Programs for Patients With COPD in Germany: A Longitudinal Evaluation of Routinely Collected Patient Records

Use and utility of a 24-hour Telephone Support Service for ‘high risk’ patients with COPD

Interventions to Reduce Rehospitalizations after Chronic Obstructive Pulmonary Disease Exacerbations. A Systematic Review

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