Low-intensity case management cuts chronic obstructive pulmonary disease-related hospital visits in half

A new study has found that patients with chronic obstructive pulmonary disease (COPD) who are at high risk for hospitalization or emergency room visits from exacerbations or complications benefit from simple low-intensity case management.

"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," said Kathryn Rice, M.D., staff physician in the Pulmonary Division of Minneapolis Veterans Affairs Hospital and associate professor of medicine at the University of Minnesota, who will present her findings at the American Thoracic Society's 2008 International Conference in Toronto on Wednesday, May 21.

Dr. Rice and co-principal investigator Naresh Dewan, M.D., of Omaha VA Medical Center and Creighton University, prospectively enrolled 743 patients at five VA hospitals and randomized them to receive limited case-management or conventional care from their primary care provider according to local practice. Those randomized to case management 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 with specific instructions as to when to take them, as well as monthly follow-up calls from the case manager. The case manager, a respiratory therapist, was also available for phone consultations as needed, and patients were instructed to contact the case manager whenever their action plan was implemented.

Over the year of the study, emergency room visits for COPD decreased by more than one-half and hospitalizations for COPD decreased by nearly one-third in the patients who received limited case management versus those who received traditional treatment. Hospital admissions for any causes decreased by more than 20 percent in case-managed patients.

"The limited case management model also improved measures of quality of life and was associated with a non-statistically significant reduction in mortality, although study was not a large enough to detect a definite effect on mortality" explained Dr. Rice. "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 the strain on hospital systems overburdened by preventable emergencies."