Impact of proactive integrated care on chronic obstructive pulmonary disease

Abstract

Background. Up to 50% of COPD patients do not receive recommended care for COPD. To address this issue, we developed Proactive Integrated Care (Proactive iCare), a healthcare 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 healthcare utilization. Patients were allocated to Proactive iCare (n = 352) or Usual Care (n = 159), and were examined for changes in quality of life using the St. George’s Respiratory Questionnaire (SGRQ), symptoms, guideline-based care, and healthcare 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 subjects (p < 0.0001), identified unreported exacerbations, and decreased smoking (p = 0.01). Proactive iCare also improved symptoms, the 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 COVID-19.