Effectiveness of Community-Based Management Models in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Miao Zhan^1*Chen Jing²Hongying Zhang^1*

• ¹The Affiliated Rehabilitation Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
• ²The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China

Background: Chronic obstructive pulmonary disease (COPD) is a common fatal disease with high morbidity, disability, and economic burden, and poses a major challenge to global public health. The limitations of the traditional hospital-based management models and lack of continuous professional guidance and support for people with COPD after discharge have led to repeated acute exacerbations of the disease and high rates of rehospitalization. Community-based management models have received attention because of their convenience, affordability, and accessibility; however, their effectiveness has not been comprehensively and systematically evaluated. Methods: This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) and comprehensively searched for randomized controlled trials (RCTs) in the China National Knowledge Infrastructure Wangfang Data, VIP Database, Sinomed, Cochrane Library, PubMed, and Web of Science from the inception to May 6, 2025. A control group received usual care and an experimental group received community-based management models (community-based integrated management or telemedicine management, respectively) with an intervention period of >6 months. Two researchers independently used the NoteExpress software for literature management, Cochrane Risk of Bias Assessment Tool for risk of bias assessment of the included studies, and RevMan5.4.1 for meta-analysis of outcome indicators. Results: Thirty-three RTCs, encompassing a cohort of 12,288 people with COPD were included in this study. The community-based management models demonstrated significant improvements in the 6-min walk test (mean difference [MD] = 39.73; 95% confidence interval [CI, 30.15, 49.32]; P<0.00001) and lung function parameters (forced expiratory volume in the first second/forced vital capacity [FEV1/FVC]: MD = 6.17; 95% CI [4.54, 7.79], P<0.00001; FEV1% predicted: MD = 4.91, 95% CI [3.96, 5.85], P < 0.00001). Additionally, it was associated with decreased breathing difficulties (MD = -0.72, 95% CI [-1.23, -0.21], P = 0.006) and COPD assessment test (CAT) score (MD = -4.46, 95% CI [-5.67, -3 .25], P<0.00001).