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Rationale: Despite substantial progresses on standard of care recommendations, management of Chronic Obstructive Pulmonary (COPD) patients show potential for improvement provided that patients’ heterogeneities are better understood. Objectives: To perform a population-based analysis of the COPD patients in Catalonia (ES) (7,5 M citizens) aiming at exploring the potential of the health registry information to enhance risk assessment and stratification in the clinical arena. Methods: The characteristics of 264,830 COPD cases registered in 2014 in the Health Surveillance System were assessed. Multiple logistic regression analysis was used to elaborate predictive models for four health indicators: (i) mortality, (ii) unplanned hospitalizations (all and COPD-related hospitalizations), (iii) multiple exacerbators, and, (iv) high users of healthcare resources. No clinical, nor forced spirometry data were available. Main Results: Multimorbidity, expressed by GMA (adjusted morbidity groups) scoring, was the covariate with highest impact in the four predictive models. This score explained a substantial percentage of interindividual variability (AUC): (i) mortality (0.763); (ii) unplanned hospitalizations (0.829); (iii) multiple exacerbators (0.766); and, (iv) higher use of healthcare resources (0.803). Patients above the 85 percentile in terms of healthcare costs per year represented 59% of the overall costs of COPD patients. Conclusions: The predictive models stress the explanatory role of the covariate multimorbidity. The results highly encourage further developments fostering interoperability between health registries and electronic health records to enhance clinical risk prediction.

COPD exacerbations worsen quality of life and increase cost. There is evidence of the impact of non-pharmacological treatment in the prevention of exacerbations. Therapeutic Education Programs (TEP) is a key component in the Integrated Care Models (ICM). To evaluate the effectiveness of TEP in preventing exacerbations after discharge. RCT (1:1), 6-m follow-up. Two hospitals: a) exclusively TEP and b) TEP as part of ICM. Recruitment: 12 m. Assessment using 5 domains (WHO). At 6 m we evaluated hospital admissions, emergency room visits and mortality. Intervention: 5 TEP group sessions. Material: “Controlling COPD”. 223 p (FEV 1 (44.7% (17) pred, 121 controls (CG) and 112 intervention (IG)). Age 73.3 (9.3), 17% smokers. Charlson index 5.2 (7.9), 45% LTOT. No differences between groups and centres at baseline. At 3 m (Hospital admission (23.5%), Emergency room visits (25.5%) exitus (6.2%)). The joint analysis of both centres showed a decrease in emergency room visits and hospital admissions, in comparison with the CG group, although it was not significant. When the two groups were analyzed separately, the patients in the IG with exclusive TEP showed no differences in emergency room visits and hospital admissions. Patients in the IG with TEP as part of an ICM showed a decrease in the number of emergency room visits (p=0.001) compared to the CG. The number of hospital admissions did not decrease but we observed a change in the management and type of admission, with 80% of the admissions being programmed (directly from home to ward). TEP by itself has no impact on the use of health resources. The assessment proposed by the WHO, is useful for COPD.Partially supported by SEPAR (191/2013).