| Summary: | Aidi Zhang,1 Lianhong Wang,2 Lu Long,1 Jin Yan,1,3 Chun Liu,4 Sucui Zhu,1 Xiaowan Wang5 1Nursing Department, Third Xiangya Hospital of Central South University, Changsha 410013, People’s Republic of China; 2The First Affiliated Hospital of Zunyi Medical University, Zunyi 563003, People’s Republic of China; 3Xiang Ya Nursing School of Central South University, Changsha 410013, People’s Republic of China; 4Respiratory Department, Third Xiangya Hospital of Central South University, Changsha 410013, People’s Republic of China; 5Center for Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People’s Republic of ChinaCorrespondence: Jin Yan Email yanjin0163@163.comObjective: Hospital-outreach pulmonary rehabilitation (PR) can improve health status and reduce health-care utilization by patients with chronic obstructive pulmonary disease (COPD). However, its long-term effects and costs versus benefits are still not clear. This study was conducted to develop, deliver, and evaluate the effects and monetary savings of a hospital-outreach PR program for patients with COPD.Methods: A randomized controlled trial was conducted. Patients with COPD (n=208) were randomly assigned to the hospital-outreach PR program (treatment) or treatment as usual (control). The treatment group received a 3-month intensive intervention, including supervised physical exercise, smoking cessation, self-management education, and psychosocial support, followed by long-term access to a nurse through telephone follow-up and home visits up to 24 months. The control group received routine care, including discharge education and a self-management education brochure. Main outcomes were collected at 3, 6, 12, and 24 -months postrandomization. Primary outcomes included health-care utilization (ie, readmission rates, times, and days, and emergency department visits) and medical costs. Secondary outcomes included lung function (ie, FEV1, FEV1% predicted, FVC), dyspnea (mMCR), exercise capacity (6MWD), impact on quality of life (CAT), and self-management (CSMS).Results: At the end of 24 months, 85 (81.7%) in the treatment group and 89 (85.6%) in the control group had completed the whole program. Compared with the control group, patients in the treatment group had lower readmission rates, times, and days at 6 and 12 months and during 12– 24 months. Regarding costs during the 2 years, the program achieved CN¥ 3,655.94 medical savings per patient per year, and every ¥ 1 spent on the program led to ¥ 3.29 insavings. Patients in the treatment group achieved improvements in FEV1, FEV1% predicted, exercise capacity, and self-management. It also achieved relief of dyspnea symptoms and improvement in COPD’s impact on quality of life.Conclusion: The hospital-outreach PR program for patients with COPD achieved reductions in health-care utilization, monetary savings, and improvements in patient health outcomes. The effects of the program were sustained for at least 2 years.Trial Registration: This trial was registered at the Chinese Clinical Trial Registry (ChiCTR-TRC-14005108).Keywords: chronic obstructive pulmonary disease, savings, effects, hospital-outreach intervention, pulmonary rehabilitation
|
|---|
