BMC Pulm Med. 2026 Jun 26. doi: 10.1186/s12890-026-04428-3. Online ahead of print.
ABSTRACT
BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are frequently complicated by multimorbidity, particularly cardiovascular and metabolic disorders such as heart failure and diabetes. These coexisting conditions create therapeutic conflicts and increase the risk of poor outcomes. Effective management strategies addressing both pulmonary and associated disorders in this high-risk population are urgently needed. This study aimed to evaluate whether a Doctor-Nurse Integrated Management (DNIM) model is associated with better clinical outcomes compared to routine care in AECOPD patients with multimorbidity.
METHODS: We conducted a retrospective cohort study at a tertiary hospital in China, screening electronic medical records of patients admitted for AECOPD with confirmed multimorbidity (defined as Charlson Comorbidity Index ≥ 2 or documented cardiac/metabolic comorbidities) between January 2022 and January 2025. Patients were allocated to either a DNIM group, receiving structured collaborative care including joint ward rounds, integrated care plans addressing both pulmonary and comorbid conditions, and collaborative discharge planning, or a routine care (RC) group. Propensity score matching (1:1) was employed to balance baseline characteristics. The primary outcome was a composite of all-cause mortality or readmission for cardiopulmonary events within one year. Secondary outcomes included length of stay (LOS), improvement in COPD Assessment Test (CAT) scores, and in-hospital complications.
RESULTS: After propensity score matching, 104 patients (52 pairs) with well-balanced baseline characteristics were included. The DNIM group demonstrated a significantly lower associated risk of the one-year composite endpoint compared to the RC group (Hazard Ratio [HR] 0.58, 95% Confidence Interval [CI] 0.35-0.96, P = 0.034). Patients in the DNIM group also had a shorter mean length of stay (8.4 ± 2.1 vs. 11.2 ± 3.4 days, P < 0.001) and greater improvement in CAT scores (ΔCAT - 6.2 ± 2.5 vs. -4.1 ± 2.2, P < 0.01). Furthermore, the DNIM model was linked to fewer in-hospital complications (11.5% vs. 28.8%, P = 0.028), particularly hyperglycemia and acute heart failure.
CONCLUSION: The Doctor-Nurse Integrated Management model was associated with a better one-year prognosis, reduced length of stay, and decreased in-hospital complications in AECOPD patients with multimorbidity. This integrated approach addresses the complex interplay between COPD and its associated comorbidities, supporting its implementation in respiratory clinical practice to enhance patient-centered outcomes.
PMID:42363145 | DOI:10.1186/s12890-026-04428-3