RT Journal
A1 Linderman DJ, Koff PB, Freitag TJ, Min S, Vandivier R
T1 EFfect of integrated care on advanced chronic obstructive pulmonary disease in high-mortality rural areas
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2011
FD December 12
VO 171
IS 22
SP 2059
OP 2061
DO 10.1001/archinternmed.2011.576
UL http://dx.doi.org/10.1001/archinternmed.2011.576
AB 
Guideline-based care only reaches approximately 50% of patients with chronic illnesses, including chronic obstructive pulmonary disease (COPD),1 suggesting that implementation strategies are flawed. Inadequate care for COPD is likely to be greatest in rural areas where access to care is limited and COPD-related mortality is high.2 Disease education and management programs have been developed to enhance patient knowledge, improve delivery of guideline-based care, and maximize early identification and treatment of exacerbations. In a small, prospective randomized clinical trial, we showed that a proactive model of integrated care (PIC) results in dramatic improvements of quality of life and effectively identifies COPD exacerbations.3 PIC differs from other self-management or integrated care models by combining disease-specific education and self-management principles with a simple remote monitoring platform (Health Buddy; Robert Bosch Healthcare, Palo Alto, California). We hypothesized that our novel disease management program would improve quality of life and increase guideline-based care4 in a predominantly rural group of patients with exceptionally high COPD-related mortality.