Pre-Discharge Bundle for Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease to Reduce Readmissions and Emergency Department Visits: a Randomized, Controlled Trial.

Link to article at PubMed

Pre-Discharge Bundle for Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease to Reduce Readmissions and Emergency Department Visits: a Randomized, Controlled Trial.

Chest. 2014 Dec 24;

Authors: Jennings JH, Thavarajah K, Mendez M, Eichenhorn M, Kvale P, Yessayan L

Abstract
Background: Hospital readmissions for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) pose burdens to the healthcare 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 emergency department (ED) visits.
Methods: A single center, randomized trial of patients admitted with AECOPD was conducted at Henry Ford Hospital between February 2010 and April 2013. One hundred seventy-two patients were randomized either to the control (standard care) or bundle group in which patients received smoking cessation counseling, screening for gastroesophageal reflux disease and depression or anxiety, standardized inhaler teaching, and a 48-hour post-discharge phone call. The primary endpoint was the difference in the composite risk of hospitalizations or ED visits for AECOPD between the 2 groups in the 30 days following discharge. A secondary endpoint included 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% confidence interval = -15.68%-8.82%; p= 0.58). Overall, the time to readmission in 30 days and 90 days was similar between groups (log-rank test p= 0.71 and p= 0.88, respectively).
Conclusion: A pre-discharge bundle intervention in AECOPD is not sufficient to reduce the 30-day risk of hospitalizations or ED visits. Increased resources may be needed to generate a measurable effect on readmission rates.

PMID: 25539496 [PubMed - as supplied by publisher]

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