• Maurizio Rizzi, Mario Grassi, Marica Pecis, Arnaldo Andreoli, Anna Eugenia Taurino, Margherita Sergi, and Francesco Fanfulla.
• Servizio di Fisiopatologia Respiratoria, Ospedale Luigi Sacco, Via Grassi, Milano, Italy.
• Arch Phys Med Rehabil. 2009 Mar 1;90(3):395-401.

ObjectivesTo analyze the influence of a home care (HC) program on outcomes of patients with chronic obstructive pulmonary disease (COPD) receiving long-term oxygen therapy (LTOT) in comparison with outcomes of patients receiving standard care (SC).DesignA 10-year follow-up study with 2 parallel cohorts (HC vs SC).SettingUniversity hospital.ParticipantsOne hundred and eight patients in the HC program and 109 patients managed conventionally.InterventionsThe HC program consisted of outpatient clinical and functional evaluations every 6 months, and domiciliary assessments by a specific team including a pneumologist, a respiratory nurse, and a rehabilitation therapist every 2 to 3 months or more, as needed.Main Outcome MeasuresMortality; exacerbation, hospital and intensive care unit admission rate.ResultsOne hundred and eight patients entered the HC program and 109 patients were managed conventionally. The 2 groups of patients did not differ for age, sex, body mass index, COPD severity or comorbid conditions. The overall mortality during the follow-up was 63% and the median survival was 96+/-38 months. The survival curves for HC and SC patients were statistically significantly different (log-rank, -16.04; P=.0001). In the Cox proportional hazards model, inclusion in the HC program was associated with an increased survival rate, whereas comorbid conditions and requirement of mechanical ventilation during the follow-up were associated with a decreased survival rate. During the entire follow-up, HC patients had a lower number of exacerbations/year than SC patients.ConclusionsA disease-oriented HC program is effective in reducing mortality and hospital admissions in COPD patients requiring LTOT.

20 keywords...

hide…