One-Year Outcomes from a Disease Management Program for Chronic Obstructive Pulmonary Disease

摘要

To present the results of our 1-year, telephonic disease management interventions for 349 patientswith mild to severe chronic obstructive pulmonary disease (COPD). parameters measuring utilization of medical services, days lost from work, and quality-of-life measurements (utilizing the St. George's Questionnaire) were determined for the 12-month period prior to enrollment of patients and compared with those observed during the 12-month participation in the program.There was a statistically significant reduction in all utilization measurements and a statistically significant improvement in quality of life. Emergency room (ER) visits decreased by 57% (p < 0.001), hospital-izations by 53% (p < 0.001), intensive care unit admissions by 66% (p = 0.001), unscheduled office visits by 67% (p < 0.001), and oral antibacterial bursts by 48% (p < 0.001). Of the 114 employed patients, days missed from work were reduced by 77% (p < 0.001). The total saving from reduction in hospitalizations and ER visits was USUS672 000. This was against an approximate cost of the program of USUS223 500 (average of USUS635 per enrollee). Costs associated with medications and physician visits were not obtained.These outcomes suggest that, with ongoing patient support, the provision of physical rehabilitation, and improved communication between those engaged in the healing process, it is possible to reduce utilization and overall healthcare expenditures and improve the quality of life for a population of patients with moderate to severe COPD. This intervention was both cost effective and medically effective. Our experience suggests that further trials of COPD disease management are warranted.