Background Severe exacerbation of chronic obstructive pulmonary disease (COPD) is a trajectory-changing life event for patients and a major contributor to health system costs. This study evaluates the real-world impact of a primary care, integrated disease management (IDM) programme on acute health service utilisation (HSU) in the Canadian health system. Methods Interrupted time series analysis using retrospective health administrative data, comparing monthly HSU event rates 3 years prior to and 3 years following the implementation of COPD IDM. Primary outcomes were COPD-related hospitalisation and emergency department (ED) visits. Secondary outcomes included hospital bed days and all-cause HSU. Results There were 2451 participants. COPD-related and all-cause HSU rates increased in the 3 years prior to IDM implementation. With implementation, there was an immediate decrease (month 1) in COPD-related hospitalisation and ED visit rates of −4.6 (95% CI: −7.76 to –1.39) and −6.2 (95% CI: –11.88, –0.48) per 1000 participants per month, respectively, compared with the counterfactual control group. After 12 months, COPD-related hospitalisation rates decreased: −9.1 events per 1000 participants per month (95% CI: –12.72, –5.44) and ED visits −19.0 (95% CI: –25.50, –12.46). This difference nearly doubled by 36 months. All-cause HSU also demonstrated rate reductions at 12 months, hospitalisation was −10.2 events per 1000 participants per month (95% CI: –15.79, –4.44) and ED visits were −30.4 (95% CI: –41.95, –18.78). Conclusions Implementation of COPD IDM in a primary care setting was associated with a changed trajectory of COPD-related and all-cause HSU from an increasing year-on-year trend to sustained long-term reductions. This highlights a substantial real-world opportunity that may improve health system performance and patient outcomes. Data may be obtained from a third party and are not publicly available. We are not able to provide a minimal dataset for this study due to privacy, legal, prescribed entity designations and ethical restrictions. All data used in this study are securely housed at ICES, Ontario, Canada in coded form and are subject to their privacy, legal, prescribed entity designations and ethical governance, and are available at www.ices.on.ca/Data-and-Privacy/Privacy-at-ICES (email: privacy@ices.on.ca). While legal data sharing agreements between ICES and data providers (eg, healthcare organisations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access; available at (email: das@ices.on.ca).

中文翻译：

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量化基于初级保健的 COPD 综合疾病管理的持续卫生系统效益：一项 6 年间断时间序列研究


背景 慢性阻塞性肺疾病（COPD）的严重恶化是改变患者生活轨迹的事件，也是卫生系统成本的主要贡献者。本研究评估了初级保健综合疾病管理 (IDM) 计划对加拿大卫生系统急性卫生服务利用 (HSU) 的实际影响。方法 使用回顾性健康管理数据进行间断时间序列分析，比较实施 COPD IDM 之前 3 年和实施后 3 年的每月 HSU 事件发生率。主要结局是慢性阻塞性肺病相关的住院治疗和急诊科 (ED) 就诊。次要结局包括住院天数和全因 HSU。结果 共有 2451 名参与者。在实施 IDM 之前的 3 年内，慢性阻塞性肺疾病 (COPD) 相关的和全因 HSU 的发生率有所上升。实施后，COPD 相关住院率和急诊就诊率立即下降（第 1 个月），分别为 -4.6（95% CI：-7.76 至 –1.39）和 -6.2（95% CI：–11.88，–0.48）。与反事实对照组相比，每月分别有 1000 名参与者。 12 个月后，COPD 相关住院率下降：每月每 1000 名参与者 −9.1 次事件（95% CI：–12.72，–5.44），急诊就诊次数 −19.0（95% CI：–25.50，–12.46）。这一差异几乎翻倍了 36 个月。全因 HSU 还显示 12 个月时发生率下降，每月每 1000 名参与者住院率为 -10.2 次（95% CI：–15.79，–4.44），急诊就诊率为 -30.4 次（95% CI：–41.95，–18.78） 。结论 在初级保健机构中实施 COPD IDM 与 COPD 相关和全因 HSU 的轨迹变化相关，从逐年增加趋势到持续长期减少。 这凸显了现实世界中存在的巨大机遇，可以改善卫生系统绩效和患者治疗结果。数据可能从第三方获得，并且不公开。由于隐私、法律、规定的实体指定和道德限制，我们无法为本研究提供最小的数据集。本研究中使用的所有数据均以编码形式安全地存放在加拿大安大略省 ICES，并受其隐私、法律、规定实体指定和道德治理的约束，可在 www.ices.on.ca/Data-and- 上获取。隐私/ICES 隐私（电子邮件：privacy@ices.on.ca）。虽然 ICES 和数据提供商（例如医疗机构和政府）之间的合法数据共享协议禁止 ICES 公开数据集，但可以向符合预先指定的保密访问标准的人员授予访问权限；可以在（电子邮件：das@ices.on.ca）。