Hospital readmissions following initiation of nebulized arformoterol tartrate or nebulized short-acting beta-agonists among inpatients treated for COPD.
Hospital readmissions following initiation of nebulized arformoterol tartrate or nebulized short-acting beta-agonists among inpatients treated for COPD.
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DOI：
10.2147/copd.s52557
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发表时间：
2013
影响因子：
2.8
通讯作者：
Braman SS
中科院分区：
文献类型：
--
作者：
Bollu V;Ernst FR;Karafilidis J;Rajagopalan K;Robinson SB;Braman SS
慢性阻塞性肺疾病（COPD）住院是一个巨大的经济负担，占直接医疗费用的一半以上。减少30天的再入院可以节省医疗资源，同时改善患者护理。最近，《患者保护和平价医疗法案》授权减少对因急性心肌梗死、心力衰竭和肺炎而再次入院的医院的医疗保险支付。从2014年10月开始，医院也将因过度的COPD再入院而受到处罚。这项回顾性数据库研究调查了在住院期间使用阿福特罗（一种雾化长效β受体激动剂）与使用雾化短效β受体激动剂（SABA、沙丁胺醇或左沙丁胺醇）治疗相比，是否具有不同的30天全因再入院率。使用美国全国代表性医院数据库研究2006年1月至2010年3月期间出院并诊断为COPD的≥40岁成人。将治疗开始后≥80%天数接受阿福特罗治疗的患者与住院期间接受雾化SABA的患者进行比较。阿福特罗和雾化SABA患者的年龄、性别、住院严重程度和原发性/继发性COPD诊断匹配（1：2）。Logistic回归分析比较了再入院的几率，同时调整了年龄、性别、种族、入院类型、严重程度、主要/次要诊断、其他呼吸药物使用、呼吸治疗使用、氧气使用、医院规模和教学状况。这项回顾性研究比较了812名阿福特罗患者和1,651名雾化SABA患者，这些患者从最初的COPD住院中出院。在阿福特罗患者中，入住重症监护室更为常见（32.1%对18.4%，P<0.001），表明首次入院时症状更严重。观察到的阿福特罗患者的再入院率显著低于雾化吸入SABA患者（8.7% vs 11.9%，P=0.017），调整后的再入院几率也是如此（比值比0.69，95%置信区间0.51-0.92）。在调整患者和医院特征之前和之后，阿福特罗患者的全因30天再入院率均显著低于雾化吸入SABA患者。
Inpatient admissions for chronic obstructive pulmonary disease (COPD) represent a significant economic burden, accounting for over half of direct medical costs. Reducing 30-day readmissions could save health care resources while improving patient care. Recently, the Patient Protection and Affordable Care Act authorized reduced Medicare payments to hospitals with excess readmissions for acute myocardial infarction, heart failure, and pneumonia. Starting in October 2014, hospitals will also be penalized for excess COPD readmissions. This retrospective database study investigated whether use of arformoterol, a nebulized long-acting beta agonist, during an inpatient admission, had different 30-day all-cause readmission rates compared with treatment using nebulized short-acting beta agonists (SABAs, albuterol, or levalbuterol). A US nationally representative hospital database was used to study adults aged ≥40 years, discharged between January, 2006 and March, 2010, and with a diagnosis of COPD. Patients receiving arformoterol on ≥80% of days following treatment initiation were compared with patients receiving a nebulized SABA during hospitalization. Arformoterol and nebulized SABA patients were matched (1:2) for age, sex, severity of inpatient admission, and primary/secondary COPD diagnosis. Logistic regression compared the odds of readmission while adjusting for age, sex, race, admission type, severity, primary/secondary diagnosis, other respiratory medication use, respiratory therapy use, oxygen use, hospital size, and teaching status. This retrospective study compared 812 arformoterol patients and 1,651 nebulized SABA patients who were discharged from their initial COPD hospital admission. An intensive care unit stay was more common among arformoterol patients (32.1% versus 18.4%, P<0.001), suggesting more severe symptoms during the initial admission. The observed readmission rate was significantly lower for arformoterol patients than for nebulized SABA patients (8.7% versus 11.9%, P=0.017), as were the adjusted odds of readmission (odds ratio 0.69, 95% confidence interval 0.51–0.92). All-cause 30-day readmission rates were significantly lower for arformoterol patients than nebulized SABA patients, both before and after adjusting for patient and hospital characteristics.