Case management may reduce length of hospital stay in patients with recurrent admissions for chronic obstructive pulmonary disease

Abstract

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

Medicaid Patients at High Risk for Frequent Hospital Admission: Real-Time Identification and Remediable Risks

“…In addition, definitions of being a "frequent" or "high" user of hospital services vary from study to study, and in many cases, frequent use is defined within a single year, rather than over a longer period of time. 7,12,16 To our knowledge, this is the first study to employ a validated predictive casefinding algorithm to identify, in real time, patients at risk of future hospital admission. Our algorithm was developed to promote accurate patient identification, an important feature if it is to provide a basis for interventions targeting patients with frequent hospital admissions.…”

“…However, the majority of published trials of interventions to reduce recurrent hospitalizations and ED visits by high frequency users do not employ predictive methodology. [14][15][16] This can result in misclassification bias, with interventions being directed to patients who may not benefit because their heavy use of costly health care services would have regressed on its own, with no intervention. Because health care resources are limited, it is essential that interventions target patients whose heavy use of the hospital will continue.…”

Design, and participant enrollment, of a randomized controlled trial evaluating effectiveness and cost-effectiveness of a community-based case management intervention, for patients suffering from COPD

“…However, when evaluating new interventions it is important not only to evaluate the effectiveness but also to address the associated costs of an intervention. Despite more or less successful attempts to estimate the costs of case management for COPD, 5,11,14,15,18 there exists no full health economic evaluation to date, and it is therefore unknown if it is a cost-effective disease management strategy for this patient group. The cost-effectiveness of health technologies might vary from place to place due to factors such as clinical practice patterns, the availability of health care resources, and unit costs.…”

“…This is in contrast to the majority of studies evaluating case management for COPD patients, where case management is offered when the patient becomes so ill that they contact the hospital. [4][5][6]10,13,14 Our setting was believed to be optimal in order to promote self-care and preserve autonomy, and thereby prevent deterioration of the disease, which is the pivot of the intervention. The authors believe that potential differences in outcome measures and costs will be detectable within the chosen follow-up period.…”

“…To date, numerous studies evaluating interventions of case management for COPD exist, which differ in relation to setting, organizational approach, providers, level of coordination of health care and social services, patient selfmanagement education, etc. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] The substantial heterogeneity of content and methods used makes it difficult to identify the key components of an effective model. Furthermore, with the exception of a few studies, work procedures such as real time spent with patients and degree of coordination with other health care professionals, are often also not accounted for which keeps the reader in the dark as to the character and intensity of the case management intervention.…”