Koff Patricia B, Min Sung-Joon, Freitag Tammie J, Diaz Debora L P, James Shannon S, Voelkel Norbert F, Linderman Derek J, Diaz Del Valle Fernando, Zakrajsek Jonathan K, Albert Richard K, Bull Todd M, Beck Arne, Stelzner Thomas J, Ritzwoller Debra P, Kveton Christine M, Carwin Stephanie, Ghosh Moumita, Keith Robert L, Westfall John M, Vandivier R William
Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.
Division of Health Care Policy and Research, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States.
Chronic Obstr Pulm Dis. 2021 Jan;8(1):100-16. doi: 10.15326/jcopdf.2020.0139.
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.
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.
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).
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.
高达50%的慢性阻塞性肺疾病（COPD）患者未接受推荐的COPD护理。为解决这一问题，我们开发了主动综合护理（Proactive iCare），这是一种将综合护理与远程监测相结合的医疗服务模式。
我们对511例晚期COPD患者或近期有COPD加重的患者进行了一项前瞻性、准随机临床试验，以测试主动综合护理是否会影响以患者为中心的结局和医疗服务利用情况。患者被分配到主动综合护理组（n = 352）或常规护理组（n = 159），并使用圣乔治呼吸问卷（SGRQ）、症状、基于指南的护理和医疗服务利用情况来检查生活质量的变化。
与常规护理相比，主动综合护理在3个月、6个月和9个月时使SGRQ总分提高了7 - 9分（P < 0.0001），症状SGRQ提高了9分（P < 0.0001），活动SGRQ提高了6 - 7分（P < 0.001），影响SGRQ提高了7 - 11分（P < 0.0001）。主动综合护理使6分钟步行距离增加了40米（P < 0.001），每100名参与者每年与COPD相关的紧急门诊就诊次数减少了76次（P < 0.0001），发现了未报告的病情加重情况，并减少了吸烟率（P = 0.01）。主动综合护理还改善了症状、体重指数-气道阻塞-呼吸困难-运动耐力（BODE）指数和氧滴定情况（P < 0.05）。主动综合护理组的死亡率（1.1%）与常规护理组的死亡率（3.8%；P = 0.08）无显著差异。
将综合护理与远程监测相结合可改善晚期COPD患者的生活，这一发现可能因2019冠状病毒病（COVID - 19）大流行而更具相关性。
