Disease Management Program for Chronic Obstructive Pulmonary Disease

Rice, Kathryn; Dewan, Naresh A.; Bloomfield, Hanna E.; Grill, Joseph P.; Schult, Tamara M.; Nelson, David B.; Kumari, Sarita; Thomas, Mel; Geist, Lois J.; Beaner, Caroline; Caldwell, Michael S.; Niewoehner, Dennis E.

doi:10.1164/rccm.200910-1579oc

Cited by 274 publications

(221 citation statements)

References 28 publications

(34 reference statements)

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“…The greatest association between sputum colour and bacterial presence was found with darker (green and yellow) sputum. The change in colour of sputum in the course of an exacerbation can be used in self-management plans [30,31], leading to early antimicrobial therapy that may reduce the duration of the exacerbation and improve outcomes [32,33]. In addition, avoiding the use of antimicrobials to treat exacerbations when sputum is white will reduce inappropriate antibiotic prescribing in the community and help slow down the development of bacterial resistance [1].…”

Section: Resultsmentioning

confidence: 99%

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Miravitlles

Kruesmann²,

Haverstock³

et al. 2011

Eur Respir J

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We examined the correlation between sputum colour and the presence of potentially pathogenic bacteria in acute exacerbations of chronic bronchitis (AECBs).Data were pooled from six multicentre studies comparing moxifloxacin with other antimicrobials in patients with an AECB. Sputum was collected before antimicrobial therapy, and bacteria were identified by culture and Gram staining. Association between sputum colour and bacteria was determined using logistic regression.Of 4,089 sputum samples, a colour was reported in 4,003; 1,898 (46.4%) were culture-positive. Green or yellow sputum samples were most likely to yield bacteria (58.9% and 45.5% of samples, respectively), compared with 18% of clear and 39% of rust-coloured samples positive for potentially pathogenic microorganisms. Factors predicting a positive culture were sputum colour (the strongest predictor), sputum purulence, increased dyspnoea, male sex and absence of fever. Green or yellow versus white sputum colour was associated with a sensitivity of 94.7% and a specificity of 15% for the presence of bacteria.Sputum colour, particularly green and yellow, was a stronger predictor of potentially pathogenic bacteria than sputum purulence and increased dyspnoea in AECB patients. However, it does not necessarily predict the need for antibiotic treatment in all patients with AECB.

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Section: Resultsmentioning

confidence: 99%

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Miravitlles

Kruesmann²,

Haverstock³

et al. 2011

Eur Respir J

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show abstract

“…Our findings, however, are consistent with this previous report, and we were unable to identify intervention to reduce 30-day rehospitalizations in patients with COPD exacerbations; our findings also indicate that there do not appear to be interventions that consistently reduce rehospitalizations at subsequent time points (e.g., 6 or 12 months post discharge). Other randomized controlled trials that enrolled ambulatory patients or patients presenting to the emergency department with COPD exacerbations (but not hospitalized) also found inconsistent benefits of interventions designed to reduce hospitalizations (37)(38)(39)(40). Although there appear to be a large number of studies examining strategies to reduce rehospitalizations, the lack of a standard approach to defining patient populations, study interventions and comparators, outcomes, timeframe for assessing outcomes, and settings in which the study was conducted are barriers to cross-study syntheses of evidence.…”

Section: Systematic Reviewmentioning

confidence: 99%

Interventions to Reduce Rehospitalizations after Chronic Obstructive Pulmonary Disease Exacerbations. A Systematic Review

Prieto-Centurion¹,

Markos

Ramey³

et al. 2014

Annals ATS

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Rationale: Approximately 20% of patients hospitalized for COPD exacerbations in the United States will be readmitted within 30 days. The Centers for Medicare and Medicaid Services has recently proposed to revise the Hospital Readmissions Reduction Program to financially penalize hospitals with high all-cause 30-day rehospitalization rates after a hospitalization for COPD exacerbation on or after October 1, 2014.Objectives: To report the results of a systematic review of randomized clinical trials evaluating interventions to reduce the rehospitalizations after COPD exacerbations.Methods: Multiple electronic databases were systematically searched to identify relevant studies published between January 1966 and June 2013. Titles, abstracts, and, subsequently, full-text articles were assessed for eligibility. Each study was appraised using predefined criteria.Measurements and Main Results: Among 913 titles and abstracts screened, 5 studies (1,393 participants) met eligibility criteria. All studies had a primary outcome of rehospitalization at 6 or 12 months. No study examined 30-day rehospitalization as the primary outcome. Each study tested a different set of interventions. Two studies (one conducted in Canada and one conducted in Spain and Belgium) showed a decrease in all-cause rehospitalization over 12 months in the intervention group versus comparator group (mean number of hospitalizations per patient, 1.0 vs. 1.8; P = 0.01; percent hospitalized, 45 vs. 67%; P = 0.028; respectively). The only study conducted in the United States found a greater than twofold higher risk of mortality in the intervention group (17 vs. 7%, P = 0.003) but no significant difference in rehospitalizations. It was unclear which set of interventions was effective or harmful. Conclusions:The evidence base is inadequate to recommend specific interventions to reduce rehospitalizations in this population and does not justify penalizing hospitals for high 30-day rehospitalization rates after COPD exacerbations.

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“…7,8 More recently, disease management programs for COPD have also been studied. 9,10 However, the previous studies did not assess a mixed population representative of the general case mix cared for in most United States hospitals, including both males and females, individuals with and without health insurance, and non-veterans. Therefore, we performed a study to determine whether an RT disease management program could reduce re-hospitalization and emergency department visits for subjects hospitalized with an exacerbation of COPD.…”

Section: See the Related Editorial On Page 133mentioning

confidence: 99%

A Respiratory Therapist Disease Management Program for Subjects Hospitalized With COPD

et al. 2016

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Disease Management Program for Chronic Obstructive Pulmonary Disease

Abstract: A relatively simple disease management program reduced hospitalizations and ED visits for COPD. Clinical trial registered with www.clinicaltrials.gov (NCT00126776).

Cited by 274 publications

References 28 publications

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Interventions to Reduce Rehospitalizations after Chronic Obstructive Pulmonary Disease Exacerbations. A Systematic Review

A Respiratory Therapist Disease Management Program for Subjects Hospitalized With COPD

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