Predischarge Bundle for Patients With Acute Exacerbations of COPD to Reduce Readmissions and ED Visits A Randomized Controlled Trial
Predischarge Bundle for Patients With Acute Exacerbations of COPD to Reduce Readmissions and ED Visits A Randomized Controlled Trial
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DOI：
10.1378/chest.14-1123
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发表时间：
2015-05-01
期刊：
影响因子：
9.6
通讯作者：
Yessayan, Lenar
中科院分区：
文献类型：
--
作者：
Jennings, Jeffrey H.;Thavarajah, Krishna;Yessayan, Lenar
背景：COPD急性加重（AECOPD）再入院给医疗保健系统和患者带来负担。目前的知识差距是是否出院前筛查和教育工具管理COPD患者减少再入院和艾德visits.METHODS：一个单中心，随机试验的AECOPD患者入院亨利福特医院2010年2月至2013年4月。172例患者被随机分配到对照组（标准治疗）或捆绑组，其中患者接受戒烟咨询、胃食管反流病和抑郁或焦虑筛查、标准化吸入器教育和出院后48小时电话随访。主要终点是出院后30天内两组因AECOPD住院或艾德访视的复合风险差异。结果：在172例患者中，对照组79例中有18例（22.78%）在30天内再次入院，集束治疗组93例中有18例（19.35%）在30天内再次入院。30天内艾德就诊或住院的风险在两组之间没有差异（风险差异，-3.43%; 95% CI，-15.68%至8.82%; P = 0.58）。总体而言，在30天和90天的再入院时间组之间是相似的（对数秩检验P = 0.71和0.88，分别）。结论：AECOPD的出院前集束干预不足以降低30天的住院或艾德访视的风险。可能需要更多的资源来对再入院率产生可衡量的影响。
BACKGROUND: Hospital readmissions for acute exacerbations of COPD (AECOPDs) pose burdens to the health-care system and patients. A current gap in knowledge is whether a pre-discharge screening and educational tool administered to patients with COPD reduces readmissions and ED visits.METHODS: A single-center, randomized trial of admitted patients with AECOPDs was conducted at Henry Ford Hospital between February 2010 and April 2013. One hundred seventy-two patients were randomized to either the control (standard care) or the bundle group in which patients received smoking cessation counseling, screening for gastroesophageal reflux disease and depression or anxiety, standardized inhaler education, and a 48-h postdischarge telephone call. The primary end point was the difference in the composite risk of hospitalizations or ED visits for AECOPD between the two groups in the 30 days following discharge. A secondary end point was 90-day readmission rate.RESULTS: Of the 172 patients, 18 of 79 in the control group (22.78%) and 18 of 93 in the bundle group (19.35%) were readmitted within 30 days. The risk of ED visits or hospitalizations within 30 days was not different between the groups (risk difference, -3.43%; 95% CI, -15.68% to 8.82%; P = .58). Overall, the time to readmission in 30 and 90 days was similar between groups (log-rank test P = .71 and .88, respectively).CONCLUSIONS: A predischarge bundle intervention in AECOPD is not sufficient to reduce the 30-day risk of hospitalizations or ED visits. More resources may be needed to generate a measurable effect on readmission rates.