Implementation of an integrated care model for fragile COPD patients: a controlled prospective study

Background: Fragile COPD (f-COPD) associated with frequent hospital admissions have high morbidity, mortality and use of health resources. These patients should be managed in personalized integrated care models (ICM). Objectives: To evaluate the long-term effectiveness of a f-COPD ICM on emergency room (ER) visits, hospital admissions, days of hospitalization, mortality and improvement of health status. Methods: Prospective-controlled study with analysis of a cohort of f-COPD patients assigned to ICM and followed-up for maximally 7 years that were compared to a parallel cohort who received standard care. All patients had a confirmed diagnosis of COPD with a history of ≥2 hospital admissions due to exacerbations in the year before enrollment. The change in CAT score and mMRC dyspnea scale, hospital admissions, ER visits, days of hospitalization, and mortality were analyzed. Results: 141 patients included in the ICM were compared to 132 patients who received standard care. The ICM reduced hospitalizations by 38.2% and ER visits by 69.7%, with reduction of hospitalizations for COPD exacerbation, ER visits and days of hospitalization (p 17 was the strongest independent risk factor for mortality and hospitalization among ICM patients. Conclusions: An ICM for f-COPD patients effectively decreases ER and hospital admissions and improves health status, but not mortality.