实施一种针对 COPD 频繁加重患者的综合护理模式：一项对照前瞻性研究。

Implementation of an Integrated Care Model for Frequent-Exacerbator COPD Patients: A Controlled Prospective Study.

机构信息

Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain.

Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

出版信息

Arch Bronconeumol. 2021 Sep;57(9):577-583. doi: 10.1016/j.arbr.2021.01.010.

DOI:10.1016/j.arbr.2021.01.010

PMID:35698933

Abstract

INTRODUCTION

Frequent-exacerbator COPD (fe-COPD) associated with frequent hospital admissions have high morbidity, mortality and use of health resources. These patients should be managed in personalized integrated care models (ICM). Accordingly, we aimed to evaluate the long-term effectiveness of a fe-COPD ICM on emergency room (ER) visits, hospital admissions, days of hospitalization, mortality and improvement of health status.

METHODS

Prospective-controlled study with analysis of a cohort of fe-COPD patients assigned to ICM and followed-up for maximally 7 years that were compared to a parallel cohort who received standard care. All patients had a confirmed diagnosis of COPD with a history of ≥2 hospital admissions due to exacerbations in the year before enrollment. The change in CAT score and mMRC dyspnea scale, hospital admissions, ER visits, days of hospitalization, and mortality were analyzed.

RESULTS

141 patients included in the ICM were compared to 132 patients who received standard care. The ICM reduced hospitalizations by 38.2% and ER visits by 69.7%, with reduction of hospitalizations for COPD exacerbation, ER visits and days of hospitalization (p<0.05) compared to standard care. Further, health status improved among the ICM group after 1 year of follow-up (p=0.001), effect sustained over 3 years. However, mortality was not different between groups (p=0.117). Last follow-up CAT score>17 was the strongest independent risk factor for mortality and hospitalization among ICM patients.

CONCLUSIONS

An ICM for fe-COPD patients effectively decreases ER and hospital admissions and improves health status, but not mortality.

摘要

简介

频繁急性加重的 COPD（FE-COPD）与频繁住院相关，具有较高的发病率、死亡率和医疗资源利用率。这些患者应在个性化综合护理模式（ICM）下进行管理。因此，我们旨在评估 FE-COPD ICM 对急诊室（ER）就诊、住院、住院天数、死亡率和健康状况改善的长期效果。

方法

前瞻性对照研究，对一组被分配到 ICM 并随访最长 7 年的 FE-COPD 患者进行分析，并与接受标准护理的平行队列进行比较。所有患者均有 COPD 确诊诊断，且在入组前一年因加重而有≥2 次住院史。分析 CAT 评分和 mMRC 呼吸困难量表、住院、ER 就诊、住院天数和死亡率的变化。

结果

纳入了 141 例 ICM 患者，并与接受标准护理的 132 例患者进行了比较。与标准护理相比，ICM 使住院率降低了 38.2%，急诊就诊率降低了 69.7%，同时也降低了 COPD 加重、急诊就诊和住院天数（p<0.05）。此外，ICM 组在随访 1 年后健康状况得到改善（p=0.001），这种效果持续了 3 年。然而，两组的死亡率无差异（p=0.117）。最后一次随访时 CAT 评分>17 是 ICM 患者死亡和住院的最强独立危险因素。