Vincent S. Fan, MD, MPH; Dennis E. Niewoehner, MD; Robert Lew, PhD
Potential Conflicts of Interest: Disclosures can be viewed at https://www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1426.
Fan VS, Niewoehner DE, Lew R. A Comprehensive Care Management Program to Prevent Chronic Obstructive Pulmonary Disease Hospitalizations. Ann Intern Med. 2012;157:530-531. doi: 10.7326/0003-4819-157-7-201210020-00019
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Published: Ann Intern Med. 2012;157(7):530-531.
We thank Dr. Vandivier and coworkers for their thoughtful comments on our study and for focusing on the communication between patients and their case managers in care management programs for COPD. In the education sessions in our trial, the case managers reviewed an individualized action plan with patients that advised them to start therapy within 48 hours of onset of symptoms consistent with an exacerbation. Patients also were advised to call their case manager when they started treatment for an exacerbation and if symptoms did not improve.
As reported in our article, 600 exacerbations were reported by the 217 patients in the intervention group during the first 12 months of follow-up. Case managers proactively contacted patients at regular intervals during follow-up. They also completed a case report form for each unplanned contact between patients and case managers during this period. Twenty-seven intervention patients contacted their case manager because they were having an exacerbation (5 contacts were in-person and 22 were via telephone call). An additional 19 patients contacted case managers for reasons other than an exacerbation during follow-up. Case managers were available during business hours, and patients were instructed to call the 24-hour telenurse line if they had breathing problems at night or during the weekend; we did not collect data on after-hours telenurse communications.
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