Chest
Original Research: COPDPredischarge Bundle for Patients With Acute Exacerbations of COPD to Reduce Readmissions and ED Visits: A Randomized Controlled Trial
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].
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