Effects of an integrated care intervention on risk factors of COPD readmission

Respir Med. 2007 Jul;101(7):1462-9. doi: 10.1016/j.rmed.2007.01.012. Epub 2007 Mar 6.


An integrated care intervention including education, coordination among levels of care, and improved accessibility, reduced hospital readmissions in chronic obstructive pulmonary disease (COPD) after 1 year. This study analyses the effectiveness of this intervention in terms of clinical and functional status, quality of life, lifestyle, and self-management, under the hypothesis that changes in these factors could explain the observed reduction in readmissions. A total of 113 exacerbated COPD patients (14% female, mean (SD) age 73(8) years, FEV(1) 1.2(0.5) l) were recruited after hospital discharge in Barcelona, Spain, and randomly assigned (1:2) to integrated care (IC) (n=44) or usual care (UC) (n=69). The intervention consisted of an individually tailored care plan at discharge shared with the primary care team and access to a specialized case manager nurse through a web-based call centre. After 1 year of intervention, subjects in the intervention group improved body mass index by 1.34 kg/m(2). Additionally, they scored better in self-management items: COPD knowledge 81% vs. 44%, exacerbation identification 85% vs. 22%, exacerbation early treatment 90% vs. 66%, inhaler adherence 71 vs. 37%, and inhaler correctness 86 vs. 24%. There were no differences in the evolution of dyspnea, lung function, quality of life scores, lifestyle factors, or medical treatment.

Conclusions: This IC trial improved disease knowledge, and treatment adherence, after 1 year of intervention, suggesting that these factors may play a role in the prevention of severe COPD exacerbations triggering hospital admissions.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Body Mass Index
  • Carbon Dioxide / blood
  • Delivery of Health Care, Integrated / methods*
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume
  • Health Knowledge, Attitudes, Practice
  • Hospitalization
  • Humans
  • Life Style
  • Male
  • Oxygen / blood
  • Partial Pressure
  • Patient Readmission*
  • Patient Satisfaction
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / prevention & control
  • Pulmonary Disease, Chronic Obstructive / rehabilitation*
  • Quality of Life
  • Risk Factors
  • Self Care
  • Spain
  • Vital Capacity


  • Carbon Dioxide
  • Oxygen