Chest
Volume 147, Issue 5, May 2015, Pages 1227-1234
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Original Research: COPD
Predischarge Bundle for Patients With Acute Exacerbations of COPD to Reduce Readmissions and ED Visits: A Randomized Controlled Trial

https://doi.org/10.1378/chest.14-1123Get rights and content

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 predischarge 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.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT02135744; URL: www.clinicaltrials.gov

Section snippets

Setting and Participants

We conducted a single-center, two-group, randomized trial of patients with AECOPDs admitted to Henry Ford Hospital between February 2010 and April 2013. Inclusion criteria were a diagnosis of COPD with the presence of an acute exacerbation, age > 40 years, and current or ex-smoker with a history equivalent to at least 20 pack-years.

The diagnosis of COPD was made based on spirometric testing in the prior year that demonstrated airflow obstruction (FEV1/FVC < 70% and FEV1 < 80%) based on GOLD

Results

A total of 1,225 patients were screened for inclusion into the study (Fig 1). Of these, 1,054 were excluded for the following reasons: admitting diagnosis determined not to be an AECOPD (n = 304), discharged prior to bundle (n = 4), language barrier (n = 9), nursing home resident (n = 10), ICU admission or transfer (n = 14), age < 40 years (n = 18), presence of a tracheostomy (n = 23), lack of medical insurance (n = 34), cancer (n = 52), altered mental status or dementia (n = 122), declined to

Discussion

Up to 65% of the patients hospitalized for AECOPDs have an increased risk for readmission to the hospital in the year following admission.1, 2 An important goal in reducing readmissions is to identify risk factors for exacerbation or recurrence of the initial cause for hospitalization and to intervene prior to discharge. In this study, we examined the effects of a predischarge patient education and screening tool on the rate of ED visits or hospital readmissions for COPD exacerbations. The

Acknowledgments

Author contributions: J. H. J. is the guarantor of the manuscript and takes responsibility for the integrity of the data and the accuracy of the data analysis. J. H. J. is the principal investigator of the study. J. H. J., K. T., M. P. M., M. E., and L. Y. contributed to the study concept and design, data acquisition and analysis, data interpretation, drafting of the manuscript, and approval of the final manuscript and P. K. contributed to the data interpretation, drafting of the manuscript,

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    FUNDING/SUPPORT: This study was supported by the Breech Chair for Health Care Quality Improvement [Grant J90002].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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