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Impact of Proactive Integrated Care on Chronic Obstructive Pulmonary Disease.
Koff, Patricia B; Min, Sung-Joon; Freitag, Tammie J; Diaz, Debora L P; James, Shannon S; Voelkel, Norbert F; Linderman, Derek J; Diaz Del Valle, Fernando; Zakrajsek, Jonathan K; Albert, Richard K; Bull, Todd M; Beck, Arne; Stelzner, Thomas J; Ritzwoller, Debra P; Kveton, Christine M; Carwin, Stephanie; Ghosh, Moumita; Keith, Robert L; Westfall, John M; Vandivier, R William.
  • Koff PB; Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.
  • Min SJ; Division of Health Care Policy and Research, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States.
  • Freitag TJ; Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.
  • Diaz DLP; Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.
  • James SS; Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.
  • Voelkel NF; Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.
  • Linderman DJ; Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.
  • Diaz Del Valle F; Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.
  • Zakrajsek JK; Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.
  • Albert RK; Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.
  • Bull TM; Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.
  • Beck A; Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States.
  • Stelzner TJ; Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States.
  • Ritzwoller DP; Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States.
  • Kveton CM; Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States.
  • Carwin S; Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States.
  • Ghosh M; National Jewish Health, Denver, Colorado, United States.
  • Keith RL; Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.
  • Westfall JM; Denver Veterans Administration Medical Center, Denver, Colorado, United States.
  • Vandivier RW; Department of Family Medicine, High Plains Research Network, University of Colorado Denver, Anschutz Medical Campus, United States.
Chronic Obstr Pulm Dis ; 8(1)2021 Jan.
Article in English | MEDLINE | ID: covidwho-946392
ABSTRACT

BACKGROUND:

Up to 50% of chronic obstructive pulmonary disease (COPD) patients do not receive recommended care for COPD. To address this issue, we developed Proactive Integrated Care (Proactive iCare), a health care delivery model that couples integrated care with remote monitoring.

METHODS:

We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD or a recent COPD exacerbation, to test whether Proactive iCare impacts patient-centered outcomes and health care utilization. Patients were allocated to Proactive iCare (n=352) or Usual Care ( =159) and were examined for changes in quality of life using the St George's Respiratory Questionnaire (SGRQ), symptoms, guideline-based care, and health care utilization.

FINDINGS:

Proactive iCare improved total SGRQ by 7-9 units (p < 0.0001), symptom SGRQ by 9 units (p<0.0001), activity SGRQ by 6-7 units (p<0.001) and impact SGRQ by 7-11 units (p<0.0001) at 3, 6 and 9 months compared with Usual Care. Proactive iCare increased the 6-minute walk distance by 40 m (p<0.001), reduced annual COPD-related urgent office visits by 76 visits per 100 participants (p<0.0001), identified unreported exacerbations, and decreased smoking (p=0.01). Proactive iCare also improved symptoms, the body mass index-airway obstruction-dyspnea-exercise tolerance (BODE) index and oxygen titration (p<0.05). Mortality in the Proactive iCare group (1.1%) was not significantly different than mortality in the Usual Care group (3.8%; p=0.08).

INTERPRETATION:

Linking integrated care with remote monitoring improves the lives of people with advanced COPD, findings that may have been made more relevant by the coronavirus 2019 (COVID-19) pandemic.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2021 Document Type: Article Affiliation country: Jcopdf.2020.0139

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2021 Document Type: Article Affiliation country: Jcopdf.2020.0139