Clinical Impact of Multidisciplinary Outpatient Care on Outcomes of Patients with COPD

Abstract

Sahar Mansoor,1 Zaid Obaida,1 Lorna Ballowe,1 Amanda R Campbell,1 James T Patrie,2 Timothy D Byrum,3,4 Yun M Shim1 1Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA; 2Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA; 3Rheumatology Associate of North Alabama, Huntsville, AL, USA; 4The Joint Commission, Oakbrook Terrace, IL, USACorrespondence: Yun M ShimDivision of Pulmonary and Critical Care Medicine, University of Virginia, PO Box 800546, Charlottesville, VA 22908-0546, USATel [phone]Fax [phone]Email [email protected]: Heterogeneous nature of Chronic Obstructive Pulmonary Disease (COPD) must be comprehensively addressed. It is unclear if integrative multidisciplinary disease management (IMDM) can optimize clinical outcomes of patients with COPD.Methods: A single-center, retrospective cohort observational study with a historical intervention was conducted in a clinic specialized for COPD care. Patients with a confirmed diagnosis of COPD were administered IMDM with measurement of BODE score on initial and follow-up visits. Primary outcomes were dynamic changes in BODE quartiles after receiving IMDM.Results: Of 124 patients, 21% were misdiagnosed with COPD. Patients with a confirmed diagnosis of COPD were 50% female, median age 64 years (IQR 57–70), 43% actively smoking and initial visit median BODE quartile 2 (IQR 1–3). Three subgroups were identified based on the changes in BODE quartiles: worsened (21%), unchanged (55%) and improved (24%). At baseline, mMRC (median [IQR]) was higher in improved subgroup vs worsened and unchanged subgroup (3 [3, 4] vs 2 [1, 2] vs 2 [1, 3], p value 0.002) respectively. Drop in all components of BODE score was noted in worsened group, but significant improvement in mMRC with preservation of spirometry values was noted in the improved group. The incidence of smoking cigarettes changed from 39% to 26% during follow-up.Conclusion: Our study demonstrates that IMDM can be potentially effective in a subgroup of COPD patients. In others precipitous drop in lung function, activity tolerance, and subjective symptoms seems inevitable with worsening BODE quartiles.Keywords: BODE, integrative multidisciplinary disease management, clinical outcome, outpatient care

Keywords

• bode
• integrative multidisciplinary disease management
• clinical outcome
• outpatient care