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The effectiveness of coordinated care for people with chronic respiratory disease
Brian J Smith1, Heather J McElroy, Richard E Ruffin
1The Queen Elizabeth Hospital, 28 Woodville Road, Woodville, Adelaide, SA 5011, Australia. brian.smith@nwahs.sa.gov.au
Objectives:
To evaluate the effectiveness of coordinated care for chronic respiratory disease.
Design And Setting:
Community-based geographical control study, in western (intervention) and northern (comparison) metropolitan Adelaide (SA).
Participants:
377 adults (223 intervention; 154 comparison) with chronic obstructive pulmonary disease, asthma or other chronic respiratory condition, July 1997 to December 1999.
Intervention:
Coordinated care (includes care coordinator, care guidelines, service coordinator and care mentor).
Main Outcome Measures:
Hospital admissions (any, unplanned and respiratory), functionality (activities of daily living) and quality of life (SF-36 and Dartmouth COOP).
Results:
At entry to the study, intervention and comparison subjects were dissimilar. The intervention group was 10 years older (P < 0.001), less likely to smoke (P = 0.014), had higher rates of hospitalisation in the previous 12 months (P < 0.001) and had worse self-reported quality of life (SF-36 physical component summary score [P < 0.001] and four of nine COOP domains [P = 0.002-0.013]). After adjustment for relevant baseline characteristics, coordinated care was not associated with any difference in hospitalisation, but was associated with some improvements in quality of life (SF-36 mental component summary score [P = 0.023] and three of nine COOP domains [P = 0.008-0.031]) compared with the comparison group.
Conclusions:
Coordinated care given to patients with chronic respiratory disease did not affect hospitalisation, but it was associated with an improvement in some quality-of-life measures.