In a group of patients with severe COPD and recurrent admissions, case management reduced the number of days in hospital while improving the quality of life. These findings need to be confirmed in a randomized, controlled trial.

Case management may reduce length of hospital stay in patients with recurrent admissions for chronic obstructive pulmonary disease POOLE PJ, CHASE B, FRANKEL A, BLACK PN. Respirology 2001; 6: 37-42. Objectives: The aim of the study was to determine whether the case management of patients with recurrent hospital admissions for chronic obstructive pulmonary disease (COPD) can reduce hospital days without reducing quality of life. Methodology: Sixteen subjects (mean forced expiratory volume in 1 second; FEV 1 0.64 L) with at least four admissions for COPD in the previous 2 years were case managed by a clinical nurse specialist. Admissions and hospital bed days were recorded before and after the introduction of case management, and compared with data for 16 controls at another hospital who received usual care. Quality of life was measured serially in the case-managed group. Results: In the first year of case management, the number of hospital bed days fell to eight per patient from 22 per patient in the previous year. This was mainly due to a reduction in the length of stay from 5.6 to 3.5 days. In the control group length of stay did not change. Admissions in both groups declined. Case-managed patients had a significant improvement in their quality-of-life scores. Conclusions: In a group of patients with severe COPD and recurrent admissions, case management reduced the number of days in hospital while improving the quality of life. These findings need to be confirmed in a randomized, controlled trial.Key words: case management, chronic obstructive pulmonary disease, health-care utilization, health status, hospital admission, quality of life.admission. 2 Administration of the immunostimulating bacterial extract OM-85 BV to subjects with stable COPD did not reduce the number of exacerbations; however, the number of days in hospital was halved. 3