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Systematic Review of the Chronic Care Model in Chronic Obstructive Pulmonary Disease Prevention and Management
Sandra G. Adams, MD, MS;
Paulla K. Smith, RRT;
Patrick F. Allan, MD;
Antonio Anzueto, MD;
Jacqueline A. Pugh, MD;
John E. Cornell, PhD
Arch Intern Med. 2007;167(6):551-561.
Background Implementation of the chronic care model (CCM) has been shown to be an effective preventative strategy to improve outcomes in diabetes mellitus, depression, and congestive heart failure, but data are lacking regarding the effectiveness of this model in preventing complications in patients with chronic obstructive pulmonary disease.
Methods We searched the MEDLINE, CINAHL, and Cochrane databases from inception to August 2005 and included English-language articles that enrolled adults with chronic obstructive pulmonary disease and (1) contained intervention(s) with CCM component(s), (2) included a comparison group or measures at 2 points (before/after), and (3) had relevant outcomes. Two reviewers independently extracted data.
Results Symptoms, quality of life, lung function, and functional status were not significantly different between the intervention and control groups. However, pooled relative risks (95% confidence intervals) for emergency/unscheduled visits and hospitalizations for the group that received at least 2 CCM components were 0.58 (0.42-0.79) and 0.78 (0.66-0.94), respectively. The weighted mean difference (95% confidence interval) for hospital stay was –2.51 (–3.40 to –1.61) days shorter for the group that received 2 or more components. There were no significant differences for those receiving only 1 CCM component.
Conclusions Limited published data exist evaluating the efficacy of CCM components in chronic obstructive pulmonary disease management. However, pooled data demonstrated that patients with chronic obstructive pulmonary disease who received interventions with 2 or more CCM components had lower rates of hospitalizations and emergency/unscheduled visits and a shorter length of stay compared with control groups. The results of this review highlight the need for well-designed trials in this population.
Author Affiliations: Department of Medicine (Drs Adams, Anzueto, and Pugh and Ms Smith) and Division of Pulmonary Diseases/Critical Care Medicine (Drs Adams and Anzueto and Ms Smith), The University of Texas Health Science Center at San Antonio; VERDICT (Drs Adams, Pugh, and Cornell and Ms Smith) and Geriatric Research, Education, and Clinical Center (Dr Cornell), South Texas Veterans Health Care System, and Pulmonary Medicine, Wilford-Hall Medical Center (Dr Allan), San Antonio, Tex.
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