Background

There was around three million people dead from Chronic obstructive pulmonary disease (COPD) worldwide annually. In 2018, COPD was the 7^th leading cause of death in Taiwan. COPD is a chronic, progressive airway disease with multiple comorbidities. The hospital mortality rate was 4%, and annual mortality rate after discharge was 22% if patients admitted due to COPD acute exacerbation by national health insurance (NHI) research database in Taiwan. Without adequate treatment, higher risk of exacerbation and hospital admission will deteriorate pulmonary function and increase risk of death. “National health insurance COPD case payment improvement program” was promoted by Bureau of national health insurance. The program is established as patient-centered, continuous case management and care strategy. The interdisciplinary team, including pulmonary physicians, case managers, pharmacists and respiratory therapists, provides the knowledge and information of COPD individually. This program helps COPD patients to improve disease cognition and selfcare.

Methods

We enrolled the patients diagnosed as COPD by typical symptoms and pulmonary function change (FEV1/FVC < 70%) from July 2017 to December 2018. The patients were referred to COPD case manager after explained by pulmonary physician. The care strategy included disease introduction, risk factors education, management for acute exacerbations by case manager; inhaler device education by pharmacist to improve drug adherence; pulmonary rehabilitation by respiratory therapists; tobacco smoking cessation education by tobacco cessation case manager. We also referred the patients to dietitian if the Body mass index (BMI) ≦ 21. We evaluate the efficacy of COPD care program by annual emergency department (ER) visit and hospital readmission, since this two markers are related to COPD exacerbation.

Results

During July 2017 to December 2018, there were total 1,385 patients visited E-DA hospital due to COPD. 212 patients were enrolled in COPD case management strategy. The rate of annual ER visit was 7.23% and the rate of annual hospital readmission was 5.24% for case management group, comparing with 12.46% ER visit and 6.69% hospital readmission for the COPD patients under usual care.

Conclusion