Peytremann-Bridevaux Isabelle, Staeger Philippe, Bridevaux Pierre-Olivier, Ghali William A, Burnand Bernard
Institute of Social and Preventive Medicine, Healthcare Evaluation Unit, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
Am J Med. 2008 May;121(5):433-443.e4. doi: 10.1016/j.amjmed.2008.02.009.
Disease-management programs may enhance the quality of care provided to patients with chronic diseases, such as chronic obstructive pulmonary disease (COPD). The aim of this systematic review was to assess the effectiveness of COPD disease-management programs.
We conducted a computerized search of MEDLINE, EMBASE, CINAHL, PsychINFO, and the Cochrane Library (CENTRAL) for studies evaluating interventions meeting our operational definition of disease management: patient education, 2 or more different intervention components, 2 or more health care professionals actively involved in patients' care, and intervention lasting 12 months or more. Programs conducted in hospital only and those targeting patients receiving palliative care were excluded. Two reviewers evaluated 12,749 titles and fully reviewed 139 articles; among these, data from 13 studies were included and extracted. Clinical outcomes considered were all-cause mortality, lung function, exercise capacity (walking distance), health-related quality of life, symptoms, COPD exacerbations, and health care use. A meta-analysis of exercise capacity and all-cause mortality was performed using random-effects models.
The studies included were 9 randomized controlled trials, 1 controlled trial, and 3 uncontrolled before-after trials. Results indicate that the disease-management programs studied significantly improved exercise capacity (32.2 m, 95% confidence interval [CI], 4.1-60.3), decreased risk of hospitalization, and moderately improved health-related quality of life. All-cause mortality did not differ between groups (pooled odds ratio 0.84, 95% CI, 0.54-1.40).
COPD disease-management programs modestly improved exercise capacity, health-related quality of life, and hospital admissions, but not all-cause mortality. Future studies should explore the specific elements or characteristics of these programs that bring the greatest benefit.
疾病管理项目可能会提高为慢性疾病患者（如慢性阻塞性肺疾病，COPD）提供的护理质量。本系统评价的目的是评估COPD疾病管理项目的有效性。
我们对MEDLINE、EMBASE、CINAHL、PsychINFO和Cochrane图书馆（CENTRAL）进行了计算机检索，以查找评估符合我们疾病管理操作定义的干预措施的研究：患者教育、2种或更多不同的干预组成部分、2名或更多积极参与患者护理的医疗保健专业人员，以及持续12个月或更长时间的干预。仅在医院开展的项目以及针对接受姑息治疗患者的项目被排除。两名评审员评估了12,749个标题并全面审查了139篇文章；其中，纳入并提取了13项研究的数据。所考虑的临床结局包括全因死亡率、肺功能、运动能力（步行距离）、健康相关生活质量、症状、COPD急性加重以及医疗保健利用情况。使用随机效应模型对运动能力和全因死亡率进行了荟萃分析。
纳入的研究包括9项随机对照试验、1项对照试验和3项非对照前后试验。结果表明，所研究的疾病管理项目显著提高了运动能力（32.2米，95%置信区间[CI]，4.1 - 60.3），降低了住院风险，并适度改善了健康相关生活质量。两组之间的全因死亡率没有差异（合并比值比0.84，95% CI，0.54 - 1.40）。
COPD疾病管理项目适度改善了运动能力、健康相关生活质量和住院情况，但未改善全因死亡率。未来的研究应探索这些项目中带来最大益处的具体要素或特征。
