Journal
CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION
Volume 8, Issue 1, Pages 100-116Publisher
COPD FOUNDATION
DOI: 10.15326/jcopdf.2020.0139
Keywords
disease management; telemedicine; acute exacerbations of COPD; patient education; self-care; primary care
Categories
Funding
- Colorado Cancer, Cardiovascular Disease and Chronic Pulmonary Disease Prevention, Early Detection and Treatment Program
- National Institutes of Health [HL129938-03]
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The Proactive iCare model, which combines integrated care with remote monitoring, significantly improves the quality of life for COPD patients, reducing symptoms, improving exercise tolerance, and decreasing respiratory infections.
Background: Up to 50% of chronic obstructive pulmonary disease (COPD) patients do not receive recommended care for COPD. To address this issue, we developed Proactive Integrated Care (Proactive iCare), a health care delivery model that couples integrated care with remote monitoring. Methods: We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD or a recent COPD exacerbation, to test whether Proactive iCare impacts patient-centered outcomes and health care utilization. Patients were allocated to Proactive iCare (n=352) or Usual Care (=159) and were examined for changes in quality of life using the St George's Respiratory Questionnaire (SGRQ), symptoms, guideline-based care, and health care utilization. Findings: Proactive iCare improved total SGRQ by 7 9 units (p<0.0001), symptom SGRQ by 9 units (p<0.0001), activity SGRQ by 6 7 units (p<0.001) and impact SGRQ by 7 11 units (p<0.0001) at 3, 6 and 9 months compared with Usual Care. Proactive iCare increased the 6-minute walk distance by 40 m (p<0.001), reduced annual COPD-related urgent office visits by 76 visits per 100 participants (p<0.0001), identified unreported exacerbations, and decreased smoking (p=0.01). Proactive iCare also improved symptoms, the body mass indexairway obstruction-dyspnea-exercise tolerance (BODE) index and oxygen titration (p<0.05). Mortality in the Proactive iCare group (1.1%) was not significantly different than mortality in the Usual Care group (3.8% p=0.08). Interpretation: Linking integrated care with remote monitoring improves the lives of people with advanced COPD, findings that may have been made more relevant by the coronavirus 2019 (COVID-19) pandemic.
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