Impact of Proactive Integrated Care on Chronic Obstructive Pulmonary Disease.

BACKGROUND

Up to 50% of chronic obstructive pulmonary disease (COPD) patients do not receive recommended care for COPD. To address this issue, we developed Proactive Integrated Care (Proactive iCare), a health care delivery model that couples integrated care with remote monitoring.

METHODS

We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD or a recent COPD exacerbation, to test whether Proactive iCare impacts patient-centered outcomes and health care utilization. Patients were allocated to Proactive iCare (n=352) or Usual Care ( =159) and were examined for changes in quality of life using the St George's Respiratory Questionnaire (SGRQ), symptoms, guideline-based care, and health care utilization.

FINDINGS

Proactive iCare improved total SGRQ by 7-9 units ( < 0.0001), symptom SGRQ by 9 units (<0.0001), activity SGRQ by 6-7 units <0.001) and impact SGRQ by 7-11 units (<0.0001) at 3, 6 and 9 months compared with Usual Care. Proactive iCare increased the 6-minute walk distance by 40 m (<0.001), reduced annual COPD-related urgent office visits by 76 visits per 100 participants <0.0001), identified unreported exacerbations, and decreased smoking (=0.01). Proactive iCare also improved symptoms, the ody mass index-airway bstruction-yspnea-xercise tolerance (BODE) index and oxygen titration (<0.05). Mortality in the Proactive iCare group (1.1%) was not significantly different than mortality in the Usual Care group (3.8%; =0.08).

INTERPRETATION

Linking integrated care with remote monitoring improves the lives of people with advanced COPD, findings that may have been made more relevant by the coronavirus 2019 (COVID-19) pandemic.