We sought to evaluate the effectiveness of a multi-component, case manager-led exacerbation prevention/management model for reducing emergency department visits. Secondary outcomes included hospitalisation, mortality, health-related quality of life, chronic obstructive pulmonary disease (COPD) severity, COPD self-efficacy, anxiety and depression. Two-centre randomised controlled trial recruiting patients with ≥2 prognostically important COPD-associated comorbidities. We compared our multi-component intervention including individualised care/action plans and telephone consults (12-weekly then 9-monthly) with usual care (both groups). We used zero-inflated Poisson models to examine emergency department visits and hospitalisation; Cox proportional hazard model for mortality. We randomised 470 participants (236 intervention, 234 control). There were no differences in number of emergency department visits or hospital admissions between groups. We detected difference in emergency department visit risk, for those that visited the emergency department, favouring the intervention (RR 0.74, 95% CI 0.63–0.86). Similarly, risk of hospital admission was lower in the intervention group for those requiring hospital admission (RR 0.69, 95% CI 0.54–0.88). Fewer intervention patients died (21 versus 36) (HR 0.56, 95% CI 0.32–0.95). No differences were detected in other secondary outcomes. Our multi-component, case manager-led exacerbation prevention/management model resulted in no difference in emergency department visits, hospital admissions and other secondary outcomes. Estimated risk of death (intervention) was nearly half that of the control. Multicomponent, case manager-led intervention led to fewer ED and hospital admissions and almost halved risk of death http://ow.ly/J6Y730fM2GC

中文翻译：

---

慢性阻塞性肺疾病和多种合并症 (PIC COPD +) 患者的综合护理计划：一项随机对照试验

我们试图评估多组成部分、病例经理主导的恶化预防/管理模型在减少急诊就诊方面的有效性。次要结果包括住院、死亡率、与健康相关的生活质量、慢性阻塞性肺疾病 (COPD) 严重程度、COPD 自我效能、焦虑和抑郁。两中心随机对照试验，招募患有≥2 种具有重要预后意义的 COPD 相关合并症的患者。我们将包括个性化护理/行动计划和电话咨询（12 周一次，然后 9 个月一次）在内的多组分干预与常规护理（两组）进行了比较。我们使用零膨胀泊松模型来检查急诊就诊和住院；死亡率的 Cox 比例风险模型。我们随机分配了 470 名参与者（236 名干预，234 名对照）。两组之间的急诊就诊次数或住院次数没有差异。我们检测到急诊科就诊风险的差异，对于那些就诊于急诊科的人，有利于干预（RR 0.74，95% CI 0.63–0.86）。同样，干预组需要住院的患者住院风险较低（RR 0.69，95% CI 0.54–0.88）。更少的干预患者死亡（21 对 36）（HR 0.56，95% CI 0.32–0.95）。在其他次要结果中未检测到差异。我们的多组成部分、病例经理主导的急性加重预防/管理模型在急诊就诊、入院和其他次要结果方面没有差异。估计的死亡风险（干预）几乎是对照组的一半。多组分，