The effectiveness of coordinated care for people with chronic respiratory disease

The document attached has been archived with permission from the editor of the Medical Journal of Australia (10 January 2008). An external link to the publisher’s copy is included.Objectives: To evaluate the effectiveness of coordinated care for chronic respiratory disease. Design and setting: Community-based geographical control study, in western (intervention) and northern (comparison) metropolitan Adelaide (SA). Participants: 377 adults (223 intervention; 154 comparison) with chronic obstructive pulmonary disease, asthma or other chronic respiratory condition, July 1997 to December 1999. Intervention: Coordinated care (includes care coordinator, care guidelines, service coordinator and care mentor). Main outcome measures: Hospital admissions (any, unplanned and respiratory), functionality (activities of daily living) and quality of life (SF-36 and Dartmouth COOP). Results: At entry to the study, intervention and comparison subjects were dissimilar. The intervention group was 10 years older (P < 0.001), less likely to smoke (P = 0.014), had higher rates of hospitalisation in the previous 12 months (P < 0.001) and had worse self-reported quality of life (SF-36 physical component summary score [P < 0.001] and four of nine COOP domains [P = 0.002–0.013]). After adjustment for relevant baseline characteristics, coordinated care was not associated with any difference in hospitalisation, but was associated with some improvements in quality of life (SF-36 mental component summary score [P = 0.023] and three of nine COOP domains [P = 0.008–0.031]) compared with the comparison group. Conclusions: Coordinated care given to patients with chronic respiratory disease did not affect hospitalisation, but it was associated with an improvement in some quality-of-life measures.Brian J Smith, Heather J McElroy, Richard E Ruffin, Peter A Frith, Adrian R Heard, Malcolm W Battersby, Adrian J Esterman, Peter Del Fante and Peter J McDonal