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The effectiveness of coordinated care for people with chronic respiratory disease

Med J Aust 2002; 177 (9): 481-485.

Summary

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.

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  • Brian J Smith1
  • Heather J McElroy2
  • Richard E Ruffin3
  • Adrian R Heard4
  • Peter A Frith5
  • Malcolm W Battersby6
  • Adrian J Esterman7
  • Peter Del Fante8
  • Peter J McDonald9

  • 1 The Queen Elizabeth Hospital, Adelaide, SA.
  • 2 Repatriation General Hospital, Daw Park, SA.
  • 3 Flinders Medical Centre, Adelaide, SA.
  • 4 Adelaide Western Division of General Practice, Adelaide, SA.
  • 5 SA HealthPlus, Adelaide, SA.


Acknowledgements: 

We thank Peter Michaels, Phillip Widdas, Dawn Kroemer, Elizabeth Kalucy, Chris McGowan and Jesia Berry for their considerable contribution to the study. We also recognise the input of the various participants, service coordinators, care coordinators, and HealthPlus team members. This study was primarily funded by the Commonwealth Department of Health and Aged Care, Coordinated Care Trials, Canberra, in conjunction with the Department of Human Services, SA. We wish to thank the staff of the Acute Care Section, Department of Health and Aged Care, the Information Management Division of the Health Insurance Commission and Health Systems Development Services of the SA Department of Human Services.

Competing interests:

None identified.

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