Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease

Roberts, C M; Lowe, Derek; Bucknall, Christine; Ryland, I.; Kelly, Yvonne; Pearson, M

doi:10.1136/thorax.57.2.137

Cited by 218 publications

(180 citation statements)

References 19 publications

(14 reference statements)

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“…Data on the impact of age on stay in subjects hospitalized for a COPD exacerbation are controversial. Although there is evidence that age is an independent predictor of stay, 8,21,25 for subjects older than 80 y requiring longer hospitalizations compared with those 40 -59 y old, 8 it has been suggested that stay time was probably affected by the presence of multiple comorbidities, living alone, and the use of respiratory depressant drugs rather than age. 26 In agreement with the aforementioned study, age was not a predictor of late discharge in our group of subjects.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11] Factors associated with longer stay include increased dyspnea, 7 high breathing frequency, high P aCO 2 , 19,20 comorbidities, advanced age, poor performance status, low FEV 1 , 21 and cause of exacerbations (exacerbations due to infective causes were associated with longer stay). 8 Furthermore, socioeconomic deprivation 22 and comorbid depressive symptoms 23,24 in subjects with COPD have been also related to longer hospital stay.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of Hospitalization Stay in COPD Exacerbations: The AECOPD-F Score

et al. 2014

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BACKGROUND: Hospital admissions for COPD exacerbations account for 70% of total costs of COPD treatment, and the duration of hospital stay is directly related to this cost. The aim of this study was to investigate possible associations of demographic, clinical, laboratory, and functional parameters with stay of subjects admitted for COPD exacerbations and to provide a score for the prediction of the need for prolonged hospitalization. METHODS: We included 164 consecutive subjects admitted to 2 respiratory medicine departments of 2 tertiary hospitals for a COPD exacerbation, and we evaluated laboratory, clinical, and functional parameters possibly related to the duration of hospital stay. RESULTS: Seven parameters evaluated on subject admission (Antonisen type of exacerbation, number of Exacerbations in the previous year, Charlson index of comorbidities, Oxygenation, Partial pressure of P aCO 2 in arterial blood gases, Dyspnea according to the Borg dyspnea scale, and history of chronic respiratory Failure) were able to predict stay and were included in a simple score named AECOPD-F. The area under the curve of the score for the prediction of prolonged hospital stay is 0.960, and a cutoff point > 3 predicts prolonged stay with a sensitivity of 84.5% and a specificity of 92.5% (95% CI 0.917-0.984). The AECOPD-F score was validated in a second group of 88 subjects admitted to the hospital for a COPD exacerbation. In the validation group, subjects with a score > 3 required prolonged stay compared with those with a score < 3 (8.0 [6.0 -10.0] vs 6.5 [4.0 -9.0] d, respectively, P ‫؍‬ .007). CONCLUSION: The AECOPD-F score could accurately predict stay in hospitalized COPD subjects. The implementation of this score in clinical practice could be useful in the discharge planning of such subjects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prediction of Hospitalization Stay in COPD Exacerbations: The AECOPD-F Score

et al. 2014

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“…This contributes to over half of the total direct costs of COPD to the NHS. 3,15 Between 10% and 25% of patients admitted with HRF caused by COPD die in hospital. 16 Readmission for an exacerbation within 3 months is high, at over 30%, as is 30-day mortality.…”

Section: Exacerbationsmentioning

confidence: 99%

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

Dretzke

Blissett

Dave

et al. 2015

Health Technol Assess

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BackgroundChronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease characterised by non-reversible airflow obstruction. Exacerbations are a key cause of morbidity and mortality and place a considerable burden on health-care systems. While there is evidence that patients benefit from non-invasive ventilation (NIV) in hospital during an acute exacerbation, evidence supporting home use for more stable COPD patients is limited. In the UK, domiciliary NIV is considered on health economic grounds in patients after three hospital admissions for acute hypercapnic respiratory failure.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of domiciliary NIV by systematic review and economic evaluation.Data sourcesBibliographic databases, conference proceedings and ongoing trial registries up to September 2014.MethodsStandard systematic review methods were used for identifying relevant clinical effectiveness and cost-effectiveness studies assessing NIV compared with usual care or comparing different types of NIV. Risk of bias was assessed using Cochrane guidelines and relevant economic checklists. Results for primary effectiveness outcomes (mortality, hospitalisations, exacerbations and quality of life) were presented, where possible, in forest plots. A speculative Markov decision model was developed to compare the cost-effectiveness of domiciliary NIV with usual care from a UK perspective for post-hospital and more stable populations separately.ResultsThirty-one controlled effectiveness studies were identified, which report a variety of outcomes. For stable patients, a modest volume of evidence found no benefit from domiciliary NIV for survival and some non-significant beneficial trends for hospitalisations and quality of life. For post-hospital patients, no benefit from NIV could be shown in terms of survival (from randomised controlled trials) and findings for hospital admissions were inconsistent and based on limited evidence. No conclusions could be drawn regarding potential benefit from different types of NIV. No cost-effectiveness studies of domiciliary NIV were identified. Economic modelling suggested that NIV may be cost-effective in a stable population at a threshold of £30,000 per quality-adjusted life-year (QALY) gained (incremental cost-effectiveness ratio £28,162), but this is associated with uncertainty. In the case of the post-hospital population, results for three separate base cases ranged from usual care dominating to NIV being cost-effective, with an incremental cost-effectiveness ratio of less than £10,000 per QALY gained. All estimates were sensitive to effectiveness estimates, length of benefit from NIV (currently unknown) and some costs. Modelling suggested that reductions in the rate of hospital admissions per patient per year of 24% and 15% in the stable and post-hospital populations, respectively, are required for NIV to be cost-effective.LimitationsEvidence on key clinical outcomes remains limited, particularly quality-of-life and long-term (> 2 years) effects. Economic modelling should be viewed as speculative because of uncertainty around effect estimates, baseline risks, length of benefit of NIV and limited quality-of-life/utility data.ConclusionsThe cost-effectiveness of domiciliary NIV remains uncertain and the findings in this report are sensitive to emergent data. Further evidence is required to identify patients most likely to benefit from domiciliary NIV and to establish optimum time points for starting NIV and equipment settings.Future work recommendationsThe results from this report will need to be re-examined in the light of any new trial results, particularly in terms of reducing the uncertainty in the economic model. Any new randomised controlled trials should consider including a sham non-invasive ventilation arm and/or a higher- and lower-pressure arm. Individual participant data analyses may help to determine whether or not there are any patient characteristics or equipment settings that are predictive of a benefit of NIV and to establish optimum time points for starting (and potentially discounting) NIV.Study registrationThis study is registered as PROSPERO CRD42012003286.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…have suggested that a hospital's resources and organisational factors are potential components of the unexplained variation in outcomes 35; the authors reported that higher mortality was associated with fewer doctors and fewer patients under the care of a specialist physician 37. In reference to the UK National COPD Audit 2003, Price et al.…”

Section: Discussionmentioning

confidence: 99%

Determinants of between‐hospital variations in outcomes for patients admitted with COPD exacerbations: findings from a nationwide clinical audit ( AUDIPOC ) in Spain

et al. 2015

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SummaryBackgroundPrevious studies have demonstrated significant variability in the processes of care and outcomes of chronic obstructive pulmonary disease (COPD) exacerbations. The AUDIPOC is a Spanish nationwide clinical audit that identified large between‐hospital variations in care and clinical outcomes. Here, we test the hypothesis that these variations can be attributed to either patient characteristics, hospital characteristics and/or the so‐called hospital‐clustering effect, which indicates that patients with similar characteristics may experience different processes of care and outcomes depending on the hospital to which they are admitted.MethodsA clinical audit of 5178 COPD patients consecutively admitted to 129 Spanish public hospitals was performed, with a 90‐day follow‐up. Multilevel regression analysis was conducted to model the probability of patients experiencing adverse outcomes. For each outcome, an empty model (with no independent variables) was fitted to assess the clustering effect, followed by a model adjusted for the patient‐ and hospital‐level covariables. The hospital‐clustering effect was estimated using the intracluster correlation coefficient (ICC); the cluster heterogeneity was estimated with the median odds ratio (MOR), and the coefficients of predictors were estimated with the odds ratio (OR).ResultsIn the empty models, the ICC (MOR) for inpatient mortality and the follow‐up mortality and readmission were 0.10 (1.80), 0.08 (1.65) and 0.01 (1.24), respectively. In the adjusted models, the variables that most represented the patients’ clinical conditions and interventions were identified as outcome predictors and further reduced the hospital variations. By contrast, the resource factors were primarily unrelated with outcomes.ConclusionsThis study demonstrates a noteworthy reduction in the observed crude between‐hospital variation in outcomes after accounting for the hospital‐cluster effect and the variables representing patient's clinical conditions. This emphasises the predictor importance of the patients’ clinical conditions and interventions, and understates the impacts of hospital resources and organisational factors.

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Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease

Cited by 218 publications

References 19 publications

Prediction of Hospitalization Stay in COPD Exacerbations: The AECOPD-F Score

Prediction of Hospitalization Stay in COPD Exacerbations: The AECOPD-F Score

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

Determinants of between‐hospital variations in outcomes for patients admitted with COPD exacerbations: findings from a nationwide clinical audit ( AUDIPOC ) in Spain

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