Integrated Care for COPD in the Elderly: Impact on Healthcare Utilization Across Healthcare Settings

Elderly COPD patients present unique challenges due to multimorbidity and diminished self-management capacity. Taiwan's COPD integrated disease management (IDM) program-comprising multidisciplinary care, patient education, and routine follow-up-has exerted a positive net effect on reducing COPD exacerbations. Whether similar benefits extend to elderly patients across different healthcare settings remain unclear. This study evaluated pre-post changes in ED visits and hospitalizations across four healthcare setting.

A retrospective cohort study was conducted using data from the Taiwan COPD Pay-for-Performance registry and National Health Insurance claims database. Elderly COPD patients (≥65 years) enrolled in the IDM program were included. COPD severity was classified according to GOLD grade based on FEV₁% predicted. Patients were stratified by healthcare level (medical centers, regional hospitals, district hospitals, and primary care clinics). Primary outcomes were pre-post changes in ED visits and hospitalizations within one year. Generalized estimating equations (GEE) were used to assess changes in healthcare utilization. Multivariable logistic regression was performed to identify factors associated with improvement.

A total of 1454 elderly COPD patients were analyzed (mean age 74.8±6.3 years; 90.7% male, mean Post-BD FEV1/FVC 56.95±11.00). District hospitals demonstrated the most significant reduction in both COPD-related ED visits (from 35.2% to 25.1%; p = 0.011) and hospitalizations (from 28.6% to 22.5%; p = 0.002) compared with primary care clinics. In contrast, medical centers showed increased hospitalizations rates (from 18.1% to 18.9%; p = 0.008). Factors independently associated with significantly greater reductions in the rate of both ED visits and hospitalizations included advanced age and greater COPD severity.

Integrated COPD care reduced ED visits and hospitalizations most significantly at district hospitals. Patients with GOLD 3 and GOLD 4 grades, disproportionately represented at district hospitals, showed significantly greater reductions. These findings demonstrate that benefit magnitude varies across healthcare settings based on patient severity profiles.