Evidence map›Paper›PMID 25856791›Full record

Trial reportNPJ primary care respiratory medicine2015

Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial.

Carme Hernández, Albert Alonso, Judith Garcia-Aymerich, Ignasi Serra, Dolors Marti, Robert Rodriguez-Roisin, Georgia Narsavage, Maria Carmen Gomez, Josep Roca, NEXES consortium

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in NPJ primary care respiratory medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

34 citing papers in PubMed, 8 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Carme HernándezMedical and Nursing Direction, Hospital Clinic de Barcelona. CIBER en Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Albert AlonsoInformation System Department, Hospital Clinic de Barcelona, CIBER en Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Judith Garcia-AymerichCentre for Research in Environmental Epidemiology (CREAL), CIBER Epidemiologia y Salud Pública (CIBERESP), Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
Ignasi SerraCentre for Research in Environmental Epidemiology (CREAL), CIBER Epidemiologia y Salud Pública (CIBERESP), Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
Dolors MartiPrograma d'Atenció Domiciliaria i Equips de Suport (PADES), Grup MUTUAM, Barcelona, Spain.
Robert Rodriguez-RoisinMedical and Nursing Direction, Hospital Clinic de Barcelona. CIBER en Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Georgia NarsavageInterprofessional Education, West Virginia University, Morgantown, WV, USA.
Maria Carmen GomezNursing Direction, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
Josep RocaMedical and Nursing Direction, Hospital Clinic de Barcelona. CIBER en Enfermedades Respiratorias (CIBERES), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
NEXES consortium

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundChronic obstructive pulmonary disease (COPD) generates a high burden on health care, and hospital admissions represent a substantial proportion of the overall costs of the disease. Integrated care (IC) has shown efficacy to reduce hospitalisations in COPD patients at a pilot level. Deployment strategies for IC services require assessment of effectiveness at the health care system level.

aimsThe aim of this study was to explore the effectiveness of a community-based IC service in preventing hospitalisations and emergency department (ED) visits in stable frail COPD patients.

methodsFrom April to December 2005, 155 frail community-dwelling COPD patients were randomly allocated either to IC (n=76, age 73 (8) years, forced expiratory volume during the first second, FEV1 41(19) % predicted) or usual care (n=84, age 75(9) years, FEV1 44 (20) % predicted) and followed up for 12 months. The IC intervention consisted of the following: (a) patient's empowerment for self-management; (b) an individualised care plan; (c) access to a call centre; and (d) coordination between the levels of care. Thereafter, hospital admissions, ED visits and mortality were monitored for 6 years.

resultsIC enhanced self-management (P=0.02), reduced anxiety-depression (P=0.001) and improved health-related quality of life (P=0.02). IC reduced both ED visits (P=0.02) and mortality (P=0.03) but not hospital admission. No differences between the two groups were seen after 6 years.

conclusionThe intervention improved clinical outcomes including survival and decreased the ED visits, but it did not reduce hospital admissions. The study facilitated the identification of two key requirements for adoption of IC services in the community: appropriate risk stratification of patients, and preparation of the community-based work force.

Indexed as

AgedAged, 80 and overDisease ProgressionEmergency Service, HospitalFemaleFrail ElderlyHospitalizationHumansIntention to Treat AnalysisMalePatient Care TeamPulmonary Disease, Chronic ObstructiveQuality of Health CareRisk Assessment

Identifiers

PMID25856791
PMCPMC4532156

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.