病例管理在预防慢性阻塞性肺疾病再入院方面的有效性：一项试点研究。
Effectiveness of case management in the prevention of COPD re-admissions: a pilot study.
作者信息
van Eeden Annelies E, van de Poll Ingrid, van Vulpen Gertrud, Roldaan Tim, Wagenaar Wies, Boland Melinde R S, Wolterbeek Ron, Chavannes Niels H
机构信息
Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands.
Lung Alliance Netherlands, Amersfoort, Netherlands.
出版信息
BMC Res Notes. 2017 Nov 25;10(1):621. doi: 10.1186/s13104-017-2946-5.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) exacerbations are associated with high disease burden and costs, especially in the case of hospitalizations. The overall number of hospital admissions due to exacerbations of COPD has increased. It is remarkable that re-admissions account for a substantial part of these hospitalizations. This pilot study investigates the use of case management to reduce re-admissions due to COPD.
METHODS
COPD patients with more than one hospitalization per year due to an exacerbation were included. The participants (n = 10) were closely monitored and intensively coached for 20 weeks after hospitalization. The case manager provided care in a person-focused manner. The case manager informed and supported the patient, took action when relapse threatened, coordinated and connected primary and secondary care. Data of 12 months before and after start of the intervention were compared. Primary outcome was the difference in number of hospitalizations. Secondary outcomes were health-related quality of life (measured by the Clinical COPD Questionnaire, CCQ) and dyspnoea (measured by the MRC Dyspnoea Scale).
RESULTS
The incidence rate of hospitalizations was found to be 2.25 times higher (95% confidence interval [CI] 1.3-3.9; P = 0.004) 12 months before compared with 12 months after the start of case management. COPD patients had a mean CCQ score of 3.3 (95% CI 2.8-3.8) before and 2.4 (95% CI 1.9-2.8) after 20 weeks of case management; a difference of 1.0 (95% CI 0.4-1.6; P = 0.001). The mean MRC scores showed no significant differences before (4.3; 95% CI 3.7-4.9) and after the case management period (3.9; 95% CI 3.2-4.6); a difference of 0.4 (95% CI - 0.1 to 0.9; P = 0.114).
CONCLUSIONS
This pilot study shows that the number of COPD hospital re-admissions decreased significantly after the introduction of a case manager. Moreover, there was an improvement in patient-reported health-related quality of life.
背景
慢性阻塞性肺疾病（COPD）急性加重与高疾病负担和高成本相关，尤其是在住院治疗的情况下。因COPD急性加重导致的住院总人数有所增加。值得注意的是，再次入院占这些住院病例的很大一部分。这项试点研究调查了使用病例管理来减少因COPD导致的再次入院情况。
方法
纳入每年因急性加重住院不止一次的COPD患者。参与者（n = 10）在住院后接受了20周的密切监测和强化指导。病例管理员以以人为本的方式提供护理。病例管理员为患者提供信息并给予支持，在复发风险出现时采取行动，协调并联系初级和二级护理。比较干预开始前后12个月的数据。主要结局是住院次数的差异。次要结局是健康相关生活质量（通过临床COPD问卷[CCQ]测量）和呼吸困难（通过医学研究委员会[MRC]呼吸困难量表测量）。
结果
发现病例管理开始前12个月的住院发生率比开始后12个月高2.25倍（95%置信区间[CI] 1.3 - 3.9；P = 0.004）。COPD患者在病例管理20周前的平均CCQ评分为3.3（95% CI 2.8 - 3.8），20周后的平均CCQ评分为2.4（95% CI 1.9 - 2.8）；差异为1.0（95% CI 0.4 - 1.6；P = 0.001）。病例管理期间前后的平均MRC评分无显著差异（管理前4.3；95% CI 3.7 - 4.9，管理后3.9；95% CI 3.2 - 4.6）；差异为0.4（95% CI - 0.1至0.9；P = 0.114）。
结论
这项试点研究表明，引入病例管理员后，COPD患者再次入院的次数显著减少。此外，患者报告的健康相关生活质量有所改善。
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