Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial.

RATIONALE: The effect of disease management for chronic obstructive pulmonary disease (COPD) is not well established. OBJECTIVES: To determine whether a simplified disease management program reduces hospital admissions and emergency department (ED) visits due to COPD. METHODS: We performed a randomized, adjudicator-blinded, controlled, 1-year trial at five Veterans Affairs medical centers of 743 patients with severe COPD and one or more of the following during the previous year: hospital admission or ED visit for COPD, chronic home oxygen use, or course of systemic corticosteroids for COPD. Control group patients received usual care. Intervention group patients received a single 1- to 1.5-hour education session, an action plan for self-treatment of exacerbations, and monthly follow-up calls from a case manager. MEASUREMENTS AND MAIN RESULTS: We determined the combined number of COPD-related hospitalizations and ED visits per patient. Secondary outcomes included hospitalizations and ED visits for all causes, respiratory medication use, mortality, and change in Saint George's Respiratory Questionnaire. After 1 year, the mean cumulative frequency of COPD-related hospitalizations and ED visits was 0.82 per patient in usual care and 0.48 per patient in disease management (difference, 0.34; 95% confidence interval, 0.15-0.52; P < 0.001). Disease management reduced hospitalizations for cardiac or pulmonary conditions other than COPD by 49%, hospitalizations for all causes by 28%, and ED visits for all causes by 27% (P < 0.05 for all). CONCLUSIONS: A relatively simple disease management program reduced hospitalizations and ED visits for COPD. Clinical trial registered with www.clinicaltrials.gov (NCT00126776).

Commentary: Mentoring the mentor: executive coaching for clinical departmental executive officers.

Departmental executive officers (DEOs), department chairs, and department heads in medical schools are often hired on the basis of their accomplishments in research as well as their skills in administration, management, and leadership. These individuals are also expected to be expert in multiple areas, including negotiation, finance and budgeting, mentoring, and personnel management. At the same time, they are expected to maintain and perhaps even enhance their personal academic standing for the purposes of raising the level of departmental and institutional prestige and for recruiting the next generation of physicians and scientists. In the corporate world, employers understand the importance of training new leaders in requisite skill enhancement that will lead to success in their new positions. These individuals are often provided with extensive executive training to develop the necessary competencies to make them successful leaders. Among the tools employed for this purpose are the use of personal coaches or executive training courses. The authors propose that the use of executive coaching in academic medicine may be of benefit for new DEOs. Experience using an executive coach suggests that this was a valuable growth experience for new leaders in the institution.