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Comprehensive care programme for patients with chronic obstructive pulmonary disease: a randomised controlled trial
  1. Fanny W S Ko1,
  2. N K Cheung2,
  3. Timothy H Rainer2,
  4. Christopher Lum3,
  5. Ivor Wong4,
  6. David S C Hui1
  1. 1Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
  2. 2Accident and Emergency Department, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  3. 3Department of Medicine, Shatin Hospital, Hong Kong, Hong Kong
  4. 4Physiotherapy Department, Prince of Wales Hospital, Hong Kong, Hong Kong
  1. Correspondence to Professor David S C Hui, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong; dschui{at}cuhk.edu.hk

Abstract

Background There have been no randomised controlled trials that specifically evaluate the effect of a comprehensive programme with multidisciplinary input on patients who have just been discharged from hospital after treatment of acute exacerbation of COPD (AECOPD). The aim of this study was to assess whether a comprehensive care programme would decrease hospital readmissions and length of hospital stay (LOS) for patients with COPD.

Methods Patients discharged from hospital after an episode of AECOPD were randomised to an intervention group (IG) or usual care group (UG). The IG received a comprehensive, individualised care plan which included education from a respiratory nurse, physiotherapist support for pulmonary rehabilitation, 3-monthly telephone calls by a respiratory nurse over 1 year, and follow-up at a respiratory clinic with a respiratory specialist once every 3 months for 1 year. The UG were managed according to standard practice. The primary outcome was hospital readmission rate at 12 months.

Results 180 patients were recruited (IG, N=90; UG, N=90; mean±SD age 74.7±8.2 years, 172 (95.6%) men; mean±SD FEV1 45.4±16.6% predicted). At 12 months, the adjusted relative risk of readmission was 0.668 (95% CI 0.449 to 0.995, p=0.047) for the IG compared with the UG. At 12 months, the IG had a shorter LOS (4.59±7.16 vs 8.86±10.24 days, p≤0.001), greater improvement in mean Modified Medical Research Council Dyspnoea Scale (−0.1±0.6 vs 0.2±0.6, p=0.003) and St George's Respiratory Questionnaire score (−6.9±15.3 vs −0.1±13.8, p=0.003) compared with the UG.

Conclusions A comprehensive COPD programme can reduce hospital readmissions for COPD and LOS, in addition to improving symptoms and quality of life of the patients.

Trial registration number NCT 01108835, Results.

  • COPD Exacerbations

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Footnotes

  • Contributors FWSK, THR and DSCH designed the study. FWSK, NKC, THR, CL and DSCH recruited the subjects and supervised the study. FWSK assessed the patients in the doctor's clinic. IW arranged and supervised the physiotherapy for the patients. FWSK and DSCH analysed the data. All authors contributed to writing of the manuscript.

  • Competing interests None declared.

  • Ethics approval The Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committee (CREC 2008.442-T).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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