Coordinated care for patients with copd reduces health care costs and can improve health outcomes

Patients with COPD create a high demand for primary and tertiary health services. The Council of Australian Governments (COAG) approved the development of a national Co-ordinated Care trial with primary aims a) provide an outcomes based approach to health care b) be patient focused with shared decision making c) use a service model which promotes preventative care and d) achieve better integration of services and flexible purchasing arrangements. The primary hypothesis is that co-ordinating patient care which identifies problems and set goals will improve quality of life and health outcomes for no additional cost. Methods: A sample of 225 patients-with a diagnosis of COPD from the Southern region of Adelaide were randomly allocated to either the co-ordinated care intervention (I) (n=145) or the control (C) group (standard medical care, n=80). Patients in the I group received a psycho-behavioural assessment, a medical review (following COPD treatment Guidelines), an individualised care planning session and ongoing service co-ordination. All patients were administered an SF-36 health status questionnaire, a respiratory disease questionnaire and had their Medical Benefits, Pharmaceutical Benefits Scheme (MBS & PBS) and hospital in-patient data tracked for 2 years prior and up to 1 year after enrolment. Results: SF-36 Mental and Physical Health scores were more than 2 standard deviations lower than population norms. There was a total increase of $2 400 in MBS and a $14 500 decrease in PBS utilisation in the I group compared to the C group and a $73 000 reduction in hospital admission costs in the I group compared to Cs during the live phase of the trial. Analysis of patients with a hospital admission in the 12 months prior to activation date showed a net saving of $1 185 per capita in the I group. Qualitative analysis showed that co-ordinated care empowered patients to be more independent, improved motivation, assisted in the achievement of goals and increased awareness of available services. Conclusion: The data to date suggest that co-ordinated care model can improve health outcomes and reduce costs in service utilisation for a proportion of patients with COPD.