Effect of a rehabilitation-based chronic disease management program targeting severe COPD exacerbations on readmission patterns

Abstract

Background

Pulmonary rehabilitation (PR) is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established.

Aims

The aims of this study were to evaluate patient compliance with a chronic disease management (CDM) program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year.

Materials and methods

COPD patients with a severe exacerbation were included in a case-cohort study at admission. An intervention group participated in a nurse-supervised CDM program during the 2 months after discharge, comprising of home-based PR with exercise components directly supervised by a physiotherapist, while the remaining patients followed usual care.

Results

Nineteen of the twenty-one participants (90.5%) were compliant with the CDM program and were compared with 29 usual-care patients. Compliance with the program was associated with statistically significant reductions in admissions due to respiratory disease in the following year (median [interquartile range]: 0 [0–1] vs 1 [0–2.5]; P=0.022) and in days of admission (0 [0–7] vs 7 [0–12]; P=0.034), and multiple linear regression analysis confirmed the protective effect of the CDM program (β coefficient −0.785, P=0.014, and R²=0.219).

Conclusion

A CDM program incorporating exercise training for COPD patients without limiting comorbidities after a severe exacerbation achieves high compliance and reduces admissions in the year following after the intervention.

Keywords:

• COPD
• chronic disease management
• CDM
• rehabilitation
• exacerbation
• admission

Acknowledgments

We thank Michael Maudsley for providing an outline for this manuscript and support in editing and journal styling. The study has been a proposal of Pla Director de Malalties Respiratòries–Generalitat de Catalunya, and funded by Sociedad Española de Neumología y Cirugía Torácica–SEPAR, BRN-Ramon Pla Armengol Foundation and an AstraZeneca unrestricted grant.

On behalf of the COPD Multidisciplinary Management Group: Servei de Pneumologia, Hospital Universitari Parc Taulí (C Lalmolda, N Martinez, M Arranz, and E Monsó [coordinator]); Servei de Rehabilitació, Hospital Universitari Parc Taulí (R Coll-Fernandez, H Prados, J Estela, C Pozo); Servei d’Atenció Primària Vallés Occidental, Institut Català de la Salut (M Bare, M Teixido, O Sanchez, E Jaimez); Servei d´Urgències, Hospital Universitari Parc Taulí (F Epelde).

Disclosure

The authors report no conflicts of interest in this work.