Research Centre, Division of Chest Medicine, Hôpital du Sacré-Cœur de Montréal-a University of Montréal affiliated hospital, Montreal, Canada.
Respirology. 2012 May;17(4):707-14. doi: 10.1111/j.1440-1843.2012.02168.x.
Hospital admissions due to exacerbations of chronic obstructive pulmonary disease (COPD) have a major impact on disease progression and costs. We hypothesized that a 1-year integrated care (IC) programme comprising two components (patient-centred education+case management) would be effective in preventing COPD-related hospitalizations.
This was a retrospective longitudinal cohort study. Data were retrieved both from an administrative database in the province of Quebec (Canada), and from the medical records at two hospitals in Montreal. One hundred and eighty-nine COPD patients were randomly selected from registers at these centres, from 2004 to 2006. Patients in the intervention group underwent a programme comprising two components: patient -centred education-involving three group sessions of self-management education that included one motivational interview and instruction in the use of a written action plan; and case management-involving scheduled follow-up visits with access to a call centre. The intervention group was compared with a group receiving usual care (UC). The main outcome was COPD-related re-hospitalizations, with length of hospital stay and emergency department (ED) visits being secondary outcomes.
Logistic regression analysis with adjustment for covariates showed that there was a lower probability of re-hospitalization over the follow-up year in the IC group compared with the UC group (odds ratio 0.44; 95% confidence interval 0.23-0.85). Subgroup analyses revealed that the IC programme prevented more COPD-related hospitalizations in women compared with men. There were no significant between-group differences in length of hospital stay or number of ED visits.
An IC programme combining self-management education and case-management can decrease rates of COPD-related hospitalizations, particularly among women.
慢性阻塞性肺疾病（COPD）恶化导致的住院治疗对疾病进展和费用有重大影响。我们假设，包括两个部分（以患者为中心的教育+病例管理）的为期一年的综合护理（IC）计划将有效预防 COPD 相关住院治疗。
这是一项回顾性纵向队列研究。数据来自加拿大魁北克省的一个行政数据库，以及蒙特利尔的两家医院的病历。从这些中心的登记处随机选择了 189 名 COPD 患者，时间为 2004 年至 2006 年。干预组患者接受了包括两个部分的计划：以患者为中心的教育——包括三次自我管理教育小组课程，其中包括一次动机访谈和书面行动计划的使用指导；以及病例管理——包括定期随访和可访问呼叫中心。干预组与接受常规护理（UC）的组进行了比较。主要结局是 COPD 相关再住院，住院时间和急诊部（ED）就诊为次要结局。
调整协变量的逻辑回归分析显示，与 UC 组相比，IC 组在随访年内再住院的可能性较低（比值比 0.44；95%置信区间 0.23-0.85）。亚组分析显示，与男性相比，IC 计划在女性中更能预防 COPD 相关住院治疗。两组在住院时间或 ED 就诊次数方面无显著差异。
结合自我管理教育和病例管理的 IC 计划可以降低 COPD 相关住院率，特别是在女性中。
