Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial.

Community-based integrated care (IC) for chronic obstructive pulmonary disease (COPD) improves outcomes but does not reduce hospitalization. Spanish researchers led by Carme Hernandez at the University of Barcelona conducted a randomized controlled trial to explore the effectiveness of a community-based IC service in preventing hospitalizations and emergency department visits. The service consisted of assessment and education, individualized care plans, call center access and coordination between different levels of care. Seventy-six stable frail COPD patients received the IC intervention for 12 months, while 84 received usual care. Hospital admissions, emergency department visits and mortality were then monitored for six years after return to normal care. The intervention improved clinical outcomes and decreased emergency department visits, but did not reduce hospital admissions. Patient risk analysis and workforce preparation were identified as key requirements for developing IC services.