Impact of Proactive Integrated Care on Chronic Obstructive Pulmonary Disease

Background. Up to 50% of COPD patients do not receive recommended care for COPD. To address this important issue, we developed Proactive Integrated Care (Proactive iCare), a healthcare delivery model that couples integrated care with remote monitoring. Methods. We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD, or a recent COPD exacerbation, to test whether Proactive iCare impacts patient- centered outcomes and healthcare utilization. Patients were allocated to Proactive iCare (n =352) or Usual Care (n = 159), and were examined for changes in quality of life using the St. Georges Respiratory Questionnaire (SGRQ), symptoms, guideline-based care, and healthcare utilization. Findings. Proactive iCare improved the total SGRQ by 7-9 units (p<0.0001), symptom SGRQ by 9 units (p<0.0001), activity SGRQ by 6-7 units (p<0.001) and impact SGRQ by 7-11 units (p<0.0001) at 3, 6 and 9 months, compared with Usual Care. Proactive iCare increased the 6-minute walk distance by 40 m (p<0.001), reduced COPD-related urgent office visits by 76 visits per 100 subjects (p<0.0001), identified unreported exacerbations, and decreased smoking (p = 0.01). Proactive iCare also improved cough, sputum, shortness of breath, the BODE index and oxygen titration (p<0.05). Mortality in the Proactive iCare group (1.1%) was not significantly different than mortality in the Usual Care group (3.8%; p = 0.08). Interpretation. Results suggest that linking integrated care with remote monitoring improves the lives of people with advanced COPD.