Application of appropriateness criteria for hospitalization in COPD exacerbation

García-Gutiérrez, Susana; Quintana, José M.; Barrio, Irantzu; Baré, Marisa; Fernández, N Sánchez; Vidal, Silvia M.; González, Nerea; Lafuente, Iratxe; Arteta, Estíbaliz López Herce; Esteban, Cristóbal; Pulido, Esther

doi:10.1007/s11739-013-0927-9

Cited by 11 publications

(7 citation statements)

References 27 publications

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“…The decision to admit may depend on the frailty of the patient, the severity of the COPD, whether the patient is in acute respiratory failure, and the presence or not of comorbidities. Any decision to admit may also be influenced by the patient’s ability to cope at home, 8 the speed of access to primary care, 9 and on local custom and practice, as some countries are more likely to admit a COPD patient than others. 10 In elderly COPD patients, an exacerbation might result in death.…”

Section: Definition Of Copd Exacerbationmentioning

confidence: 99%

The causes and consequences of seasonal variation in COPD exacerbations

Donaldson

Wedzicha

2014

COPD

101

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The time of year when patients experience exacerbations of chronic obstructive pulmonary disease is a much-overlooked feature of the disease. The higher incidence of exacerbations in winter has important consequences for patients in terms of increased morbidity and mortality. The seasonality also imposes a considerable burden on already-overloaded health care services, with both primary care consultations and hospital admissions increasing in number. The seasonality of exacerbations varies with latitude, and is greater in more temperate climates, where there may be less protection from outdoor and indoor cold exposure. The precise causes of the seasonality are unknown, but thought to be partly due to the increased prevalence of respiratory viral infections circulating in cold, damp conditions. Increased susceptibility to viral infection may also be a mechanism mediated through increased airway inflammation or possibly reduced vitamin D levels. The seasonality of exacerbations informs us about the triggers of exacerbations and suggests possible strategies to reduce their number.

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Section: Definition Of Copd Exacerbationmentioning

confidence: 99%

The causes and consequences of seasonal variation in COPD exacerbations

Donaldson

Wedzicha

2014

COPD

101

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“…Some patients, because affected with AECOPD particularly severe or because they need particular treatments not feasible at home or specialistic treatments like noninvasive ventilation (NIV), have to be hospitalized [ 47 , 48 ]. In this context, particularly important is the evaluation of whether and when to address the patient to hospital admission.…”

Section: Resultsmentioning

confidence: 99%

Standards of suitability for the management of chronic obstructive respiratory diseases

Sanguinetti¹,

Ambrosino²,

Andò

et al. 2014

Multidiscip Respir Med

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BackgroundChronic Obstructive Pulmonary Disease (COPD) ranks third as cause of mortality and disability-adjusted life years (DALY) worldwide and also in Italy it imposes a huge health, social and economic load. Early symptoms of COPD are often disregarded by patients and physicians, spirometry is underutilized, and the diagnosis is delayed till the disease has reached a distinct severity level. Despite the availability of various guidelines, the behavior of health workers involved in the management of COPD is still rather unlike. These considerations are the reason why in October 2013 AIMAR (Interdisciplinary Scientific Association for Research in Lung Disease) devised and organized a “Third Consensus Conference”, aimed at pointing out the standards of suitability for COPD management. In this context three important topics of discussion were identified: early and more widespread diagnosis, management of acute and subacute phases, long-term assistance to chronic patients.MethodsThe procedure recommended by the Italian Health Superior Institute (ISS) for Consensus Conferences organization was applied. The Conference was structured in three sessions, each dealing with one of the above mentioned topics and including a short update of the subject-matter and presentation, discussion and voting of some statements with a choice ranging from total agreement to total disagreement or no knowledge. The results of voting were eventually recorded in the document, reviewed by an independent jury, that forms the substance of this paper.ResultsThe essential role of spirometry, the need for distinguish between different COPD phenotypes, and the obligatoriness to base on the blood gas analysis findings the long-term oxygen therapy, were largely agreed, as well as the need for interventions aimed at decreasing the rate of acute exacerbations. More specific topics like the use of noninvasive ventilation, recognizing the factors affecting outcome and mortality, the choice of pharmacological and non pharmacological treatments in COPD patients led to lively discussing, but they did not always reach the total agreement, probably because of insufficient familiarity with these problems and of diversities in organization and instruments availability. The chronic respiratory assistance was treated with particular regard to smoking cessation, whose implementation is still insufficient. Many doubts rose due to uncertainty, lack of ability and standardization of procedures, insufficient institutional support, and difficulties to realize a network for assistance to chronic patients.ConclusionsThe results of this Third Consensus Conference revealed some certainties and many doubts and diversities of view also on topics whose importance is well demonstrated in scientific literature. Thus, there is still a long distance to cover before reaching a suitable standardization of COPD management and such situation urges the need for improving not only the health professional’s operativeness but also the organizational support by competent institutions. I...

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“…The following data were extracted from the Registry of Management of the HED: waiting times; triage category; and destination at discharge. The necessity of hospital admission was evaluated using the ADIEPOC tool used in the Research on Results and Health Services (IRYSS) COPD project [ 6 ] ;this tool takes into account variables such as the partial pressure of oxygen and carbon dioxide in the arterial blood (PaO 2 and PaCO 2 , respectively), degree of dyspnea, and level of consciousness. Finally, the following data were obtained from the information available in the primary care electronic medical record (ECAP): time to first PC assessment after AECOPD; number of readmissions at 30 and 90 days; and mortality at 30 and 90 days.…”

Section: Methodsmentioning

confidence: 99%

“…Different factors influencing the admission and management of COPD patients have been studied, [ 5 ] and tools such as the ADIEPOC, [ 6 ] that allows for assessment of whether an admission from the HED is needed, have been developed. Similarly, the efficient use of alternative routes to conventional hospitalization, such as home hospitalization programs (HH), has demonstrated a significant impact on hospital dynamics (bed availability) and costs associated with AECOPD while maintaining high patient care and satisfaction standards.…”

Section: Introductionmentioning

confidence: 99%

Exacerbations of chronic obstructive pulmonary disease

et al. 2018

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To describe the characteristics of patients visiting a Hospital Emergency Department (HED) due to chronic obstructive pulmonary disease (COPD) exacerbation (AECOPD) and to evaluate their management.A cross-sectional study of the first 219 patients with AECOPD visiting the HED of the University Hospital Arnau de Vilanova, Lleida, Spain, was performed from January to May 2016. The data collected included the following: main patient characteristics, diagnostic tests, applied treatments, response times, discharge destination, need for hospital admission, and re-admissions and deaths at 90 days. Comparisons were made according to sex and need for hospitalization.The patients consisted of 84% men, with a mean age (standard deviation [SD]) of 75.9 (11) years and a FEV1/FVC of 56 (13)%; 63% were ex-smokers. The median time (P25–P75) in the HED was 6 (4–10) hours, with shorter waiting times for severe patients. Additionally, 74% of patients required hospital admission. The percentages of re-admissions and mortality at 90 days were 25% and 14%, respectively. Among female patients, 63% never consumed tobacco, and the most frequent clinical phenotype was asthma combined with COPD; female patients visited the family doctor sooner after AECOPD than men (4 vs 7 days). Overall, the following areas of improvement were identified: use of sputum culture (performed in 3% of patients); documentation of variables; patient care times; and reduction in the time until first medical check-up.The overall quality of care provided to AECOPD patients was satisfactory and consistent with current clinical guidelines. Nevertheless, improving the quality of care at the HED requires establishing protocols that ensure that the necessary diagnostic tests are performed, optimize response times and guarantee that all relevant information is collected.

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Application of appropriateness criteria for hospitalization in COPD exacerbation

Cited by 11 publications

References 27 publications

The causes and consequences of seasonal variation in COPD exacerbations

The causes and consequences of seasonal variation in COPD exacerbations

Standards of suitability for the management of chronic obstructive respiratory diseases

Exacerbations of chronic obstructive pulmonary disease

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