ABSTRACT
OBJECTIVE: To evaluate the effectiveness of two management programs on patients with chronic obstructive pulmonary disease (COPD). DESIGN: A study with a quasi-experimental design was used to evaluate the effectiveness of two interventions (I1, I2) for the care of patients with COPD after a mean follow-up of 31.2months. SETTING: Primary Care Centres in two Barcelona Health Areas and their referral hospitals. PARTICIPANTS: Patients with COPD selected by simple random sampling using any disease code corresponding to COPD. INTERVENTIONS: I1: Integrated management program that was optimised and coordinated the resources. Training was given, as well as quality control of spirometry. I2: Isolated interventions like a call-centre. Care circuits and computerised clinical notes were shared. MAIN MEASUREMENTS: Variables were recorded as regards lung function, severity, use of inhalers, lifestyles, quality of life, and exacerbations. RESULTS: Of the 393 patients evaluated at the beginning, 120 and 104 (I1 and I2, respectively) received the final evaluation. With I1, there was a reduction in patients who smoked (P=.034). Lung function and quality of life did not change significantly in either group, but shortness of breath was slightly worse. There was an increase in the correct use of inhalers, although it only reached 48% and 61% with interventions I1 and I2, respectively. The percentage of patients with exacerbations decreased with I1 compared to that of I2 (P<.001), and there were less hospital admissions due to exacerbations with I2 compared to I1 (P<.003]). CONCLUSIONS: Both interventions achieved significant improvements, and no overall worsening of a chronic and progressive disease as is COPD.
Subject(s)
Pulmonary Disease, Chronic Obstructive/therapy , Aged , Female , Humans , Male , Treatment OutcomeABSTRACT
BACKGROUND: The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1) improvement in the rational utilization of health-care services and 2) benefits reflected in improved health status and quality of life for patients. METHODS/DESIGN: A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients) and the other the control group (n = 32,114 patients). The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts. DISCUSSION: The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of complex cases.
Subject(s)
Patient Care Management/organization & administration , Primary Health Care/methods , Pulmonary Disease, Chronic Obstructive/therapy , Disease Management , Evaluation Studies as Topic , Humans , Process Assessment, Health CareABSTRACT
UNLABELLED: Hospitalizations for acute exacerbation of COPD (AECOPD) generate high consumption of health resources, frequent readmissions and high mortality. The MAG -1 study aims to identify critical points to improve the care process of severe AECOPD requiring hospitalization. METHODS: Observational study, with review of clinical records of patients admitted to hospitals of the Catalan public network for AECOPD. The centers were classified into 3 groups according to the number of discharges/year. Demographic and descriptive data of the previous year, pharmacological treatment, care during hospitalization and discharge process and follow-up, mortality and readmission at 30 and 90 days were analyzed. RESULTS: A total of 910 patients (83% male) with a mean age of 74.3 (+10.1) years and a response rate of 70% were included. Smoking habit was determined in only 45% of cases, of which 9% were active smokers. In 31% of cases, no previous lung function data were available. Median hospital stay was 7 days (IQR 4-10), increasing according the complexity of the hospital. Mortality from admission to 90 days was 12.4% with a readmission rate of 49%. An inverse relationship between length of hospital stay and readmission within 90 days was observed. CONCLUSIONS: In a large number of medical records, smoking habit and lung function tests were not appropriately reported. Average hospital stay increases with the complexity of the hospital, but longer stays appear to be associated with lower mortality at follow-up.
Subject(s)
Hospitals, Public/statistics & numerical data , Inpatients/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/epidemiology , Aged , Aged, 80 and over , Comorbidity , Diagnostic Tests, Routine/statistics & numerical data , Disease Progression , Emergency Service, Hospital/statistics & numerical data , Female , Follow-Up Studies , Forced Expiratory Volume , Hospital Departments/statistics & numerical data , Hospital Mortality , Hospital Records , Hospitalization , Humans , Length of Stay , Male , Medical Audit , Middle Aged , Noninvasive Ventilation/statistics & numerical data , Oxygen/blood , Oxygen Inhalation Therapy/statistics & numerical data , Patient Readmission/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/therapy , Severity of Illness Index , Smoking/epidemiology , Spain/epidemiology , Treatment OutcomeABSTRACT
Objetivo: Evaluar la efectividad de dos programas de gestión en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Diseño: Estudio de diseño cuasi-experimental para evaluar la efectividad de dos intervenciones (I1, I2) para la asistencia de pacientes con EPOC, tras un seguimiento medio de 31,2 meses. Emplazamiento: Centros de atención primaria de dos áreas sanitarias de Barcelona y sus hospitales de referencia. Participantes: Pacientes EPOC seleccionados por muestreo aleatorio simple en los que constara algún código correspondiente a EPOC. Intervenciones: I1: Programa de gestión integral que optimizaba y coordinaba los recursos. Se hizo formación y control de calidad de la espirometría. I2: Intervenciones aisladas, como el call-center. Compartían circuitos asistenciales y la historia clínica informatizada. Mediciones principales: variables de función pulmonar, gravedad, uso de inhaladores, estilos de vida, calidad de vida y exacerbaciones. Resultados: De los 393 pacientes evaluados al inicio, 120 y 104 (I1 e I2, respectivamente) realizaron la evaluación final. Con la I1 hubo una reducción de los pacientes fumadores (p = 0,034). En ambos grupos, la función pulmonar y la calidad de vida se mantuvieron y la disnea mostró un leve empeoramiento. El correcto uso de inhaladores aumentó, aunque solo alcanzó el 48 y el 61% con la I1 e I2, respectivamente. El porcentaje de pacientes exacerbados disminuyó con la I1 (respecto I2 [p < 0,001]) y el de ingresos hospitalarios por exacerbación disminuyó con la I2 (respecto I1 [p < 0,003]). Conclusiones: Ambas intervenciones consiguieron mejoras relevantes y el no empeoramiento global de una enfermedad crónica y progresiva como es la EPOC (AU)
Objective: To evaluate the effectiveness of two management programs on patients with chronic obstructive pulmonary disease (COPD). Design: A study with a quasi-experimental design was used to evaluate the effectiveness of two interventions (I1, I2) for the care of patients with COPD after a mean follow-up of 31.2 months. Setting: Primary Care Centres in two Barcelona Health Areas and their referral hospitals. Participants: Patients with COPD selected by simple random sampling using any disease code corresponding to COPD. Interventions: I1: Integrated management program that was optimised and coordinated the resources. Training was given, as well as quality control of spirometry. I2: Isolated interventions like a call-centre. Care circuits and computerised clinical notes were shared. Main measurements: Variables were recorded as regards lung function, severity, use of inhalers, lifestyles, quality of life, and exacerbations. Results: Of the 393 patients evaluated at the beginning, 120 and 104 (I1 and I2, respectively) received the final evaluation. With I1, there was a reduction in patients who smoked (P=.034). Lung function and quality of life did not change significantly in either group, but shortness of breath was slightly worse. There was an increase in the correct use of inhalers, although it only reached 48% and 61% with interventions I1 and I2, respectively. The percentage of patients with exacerbations decreased with I1 compared to that of I2 (P<.001), and there were less hospital admissions due to exacerbations with I2 compared to I1 (P<.003]). Conclusions: Both interventions achieved significant improvements, and no overall worsening of a chronic and progressive disease as is COPD (AU)
Subject(s)
Humans , Male , Aged , Pulmonary Disease, Chronic Obstructive/epidemiology , Clinical Governance/organization & administration , Life Style , Quality of Life , Primary Health Care/organization & administration , Evaluation of the Efficacy-Effectiveness of Interventions , Follow-Up Studies , Spain/epidemiology , Spirometry/statistics & numerical data , Spirometry , Nebulizers and VaporizersABSTRACT
BACKGROUND AND OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is characterized by a systemic inflammation. The aim of this study was to evaluate the association between systemic inflammation, measured with C reactive protein (CRP), and clinical and functional outcomes of the disease. PATIENTS AND METHODS: A randomized sample of 413 COPD patients from 31 primary health care centers of Barcelona was evaluated. Medical history, anthropometric measurements, toxic habits, treatments, Chronic Respiratory Questionnaire (CRQ) and dyspnea were registered. Spirometry, exhaled CO concentration and CRP in capillary blood were performed. RESULTS: Median (standard deviation) of the age was 72 (8.4) years and forced expiratory volume in one second (FEV(1)) postbronchodilatador 1.65 (0.65) l. The correlation was negative between CRP and FEV(1) postbronchodilatador(r=-0.25, P<0.001) and between CRP and CRQ scores (r=-0.098, P=0.048) and positive between CRP and CO (r=0.1, P=0.039). The ratio of patients with elevated CRP was higher in advanced GOLD stage (P<0.001), worst dyspnea (P=0.042), patients treated with inhaled corticosteroids (P=0.018) and if they had been hospitalized during the last year (P=0.026). The multivariant analysis showed, as independent factors of elevated CRP, FEV(1) postbronchodilator and CO concentration. CONCLUSION: In COPD patients, active smoking habit and the airway's obstruction degree are associated with a greater intensity of the inflammatory systemic response measured by the CRP.
Subject(s)
C-Reactive Protein/metabolism , Inflammation/etiology , Pulmonary Disease, Chronic Obstructive/physiopathology , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Female , Forced Expiratory Volume , Humans , Inflammation/blood , Logistic Models , Male , Middle Aged , Multivariate Analysis , Prognosis , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/etiology , Severity of Illness Index , Smoking/adverse effects , SpirometryABSTRACT
Las hospitalizaciones por exacerbación aguda de EPOC (EAEPOC) generan un elevado consumo de recursos sanitarios, frecuentes reingresos y una alta mortalidad. El estudio MAG-1 pretende identificar aquellos puntos críticos y mejorables en el proceso asistencial de la EAEPOC que requiere ingreso hospitalario. Metodología: Estudio observacional, de revisión de historias clínicas de pacientes ingresados en hospitales de la red pública por EAEPOC. Los centros se clasificaron en 3 grupos según el número de altas/año. Se analizaron datos demográficos y descriptivos del año previo, tratamiento farmacológico, atención durante la hospitalización y proceso de alta, así como mortalidad y reingresos a los 30 y 90 días. Resultados: Se estudió a 910 pacientes (83% varones), con una edad media de 74,3 (+10,1) años y una tasa de respuesta del 70%. Solo constaba el hábito tabáquico actual en un 45% de los casos y de estos un 9,8% eran fumadores activos. En un 31% de los casos no constaban datos espirométricos previos. La mediana de la estancia fue de 7 días (RIQ: 4-10), aumentando con la complejidad del centro. La mortalidad observada desde el ingreso a los 90 días fue del 12,4% con una tasa de reingresos del 49%. Se observó una relación inversa entre los días de estancia hospitalaria y las readmisiones a 90 días. Conclusiones: En un elevado número de historias clínicas no consta adecuadamente el hábito tabáquico ni las pruebas de función pulmonar. La estancia media aumenta con la complejidad del hospital, aunque mayores estancias parecen asociarse con menor mortalidad en el seguimiento
Hospitalizations for acute exacerbation of COPD (AECOPD) generate high consumption of health resources,frequent readmissions andhighmortality. TheMAG -1 study aims to identify criticalpoints to improve the care process of severe AECOPD requiring hospitalization. Methods: Observational study, with review of clinical records of patients admitted to hospitals of the Catalan public network for AECOPD. The centers were classified into 3 groups according to the number of discharges/year. Demographic and descriptive data of the previous year, pharmacological treatment, care during hospitalization and discharge process and follow-up, mortality and readmission at 30 and 90 days were analyzed. Results: A total of 910 patients (83% male) with a mean age of 74.3 (+10.1) years and a response rate of 70% were included. Smoking habit was determined in only 45% of cases, of which 9% were active smokers. In 31% of cases, no previous lung function data were available. Median hospital stay was 7 days (IQR 4-10), increasing according the complexity of the hospital. Mortality from admission to 90 days was 12.4% with a readmission rate of 49%. An inverse relationship between length of hospital stay and readmission within 90 days was observed. Conclusions: In a large number of medical records, smoking habit and lung function tests were not appropriately reported. Average hospital stay increases with the complexity of the hospital, but longer stays appear to be associated with lower mortality at follow-up
Subject(s)
Aged , Humans , Male , Clinical Audit/organization & administration , Clinical Audit/standards , Clinical Audit , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnosis , Acute Disease/epidemiology , Hospitalization/trends , Pulmonary Disease, Chronic Obstructive/drug therapy , Length of Stay/economics , Patient ReadmissionABSTRACT
Fundamento y objetivo: La enfermedad pulmonar obstructiva crónica (EPOC) es un proceso que cursa con inflamación sistémica. El objetivo del estudio fue evaluar la asociación entre la inflamación sistémica, medida con la concentración de proteína C reactiva (PCR) en sangre capilar, y distintos parámetros clínico-funcionales de la enfermedad. Pacientes y método: Se evaluó una muestra aleatoria de 413 pacientes con EPOC atendidos en 31 centros de salud de Barcelona. Se registraron antecedentes, variables antropométricas, hábitos tóxicos, tratamientos, Chronic Respiratory Questionnaire (CRQ, «Cuestionario de Enfermedades Respiratorias Crónicas») y escala de disnea. Se realizó una espirometría y se determinó la concentración de CO en aire espirado y de la PCR en sangre capilar. Resultados: La media (desviación estándar) de edad fue 72 (8,4) años y la del volumen espirado en el primer segundo (FEV1) posbroncodilatador de 1,65 (0,65) l. La correlación fue negativa entre PCR y FEV1 posbroncodilatador (r=-0,25, p<0,001), así como entre PCR y puntuación en el CRQ (r=-0,098, p=0,048), y fue positiva entre PCR y CO en aire espirado (r=0,1, p=0,039). La proporción de pacientes con PCR elevada fue superior en los estadios GOLD más avanzados (p<0,001), en aquellos con más disnea (p=0,042), en los tratados con glucocorticoides inhalados (p=0,018) y en aquellos que habían ingresado por agudización en el último año (p=0,026). El análisis multivariante indicó como determinantes independientes de la PCR el FEV1 posbroncodilatador y la concentración de CO en aire espirado. Conclusión: En los pacientes con EPOC, el tabaquismo activo y el grado de la obstrucción al flujo aéreo se asocian a una mayor intensidad de la respuesta inflamatoria sistémica medida por la PCR (AU)
Background and objetive: Chronic obstructive pulmonary disease (COPD) is characterized by a systemic inflammation. The aim of this study was to evaluate the association between systemic inflammation, measured with C reactive protein (CRP), and clinical and functional outcomes of the disease. Patients and methods: A randomized sample of 413 COPD patients from 31 primary health care centers of Barcelona was evaluated. Medical history, anthropometric measurements, toxic habits, treatments, Chronic Respiratory Questionnaire (CRQ) and dyspnea were registered. Spirometry, exhaled CO concentration and CRP in capillary blood were performed. Results: Median (standard deviation) of the age was 72 (8.4) years and forced expiratory volume in one second (FEV1) postbronchodilatador 1.65 (0.65) l. The correlation was negative between CRP and FEV1 postbronchodilatador(r=-0.25, P<0.001) and between CRP and CRQ scores (r=-0.098, P=0.048) and positive between CRP and CO (r=0.1, P=0.039). The ratio of patients with elevated CRP was higher in advanced GOLD stage (P<0.001), worst dyspnea (P=0.042), patients treated with inhaled corticosteroids (P=0.018) and if they had been hospitalized during the last year (P=0.026). The multivariant analysis showed, as independent factors of elevated CRP, FEV1 postbronchodilator and CO concentration. Conclusion: In COPD patients, active smoking habit and the airway's obstruction degree are associated with a greater intensity of the inflammatory systemic response measured by the CRP (AU)