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

Background: 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. Methods: 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 FEV Results: 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. Conclusion: 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.