Hospital at home for acute exacerbations of chronic obstructive pulmonary disease

Jeppesen, Elisabeth; Brurberg, Kjetil Gundro; Vist, Gunn Elisabeth; Wedzicha, Jadwiga A.; Wright, John; Greenstone, Michael; Walters, Julia

doi:10.1002/14651858.cd003573.pub2

Cited by 127 publications

(145 citation statements)

References 28 publications

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“…Figure 2 highlights the complex conditions that patients seen by the team experience and demonstrates that patients are more likely to be admitted to hospital if they have severe comorbidities or are in current receipt of LTOT ( Table 2). Similar problems were identified by Jeppesen et al (2012).…”

Section: Discussionsupporting

confidence: 73%

“…A systematic review of eight randomised controlled trials with 870 patients concluded that hospitalat-home schemes were safe and demonstrated a significant reduction in readmission rates and a trend towards reduced mortality rate when compared with conventional inpatient treatment of acute exacerbations of COPD (Jeppesen et al, 2012). The systematic review did, however, identify a lack of evidence of patient satisfaction in either setting and the need for future research to determine which medical professionals are most appropriate to deliver hospital-at-home services.…”

Section: Introductionmentioning

confidence: 99%

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Avoiding hospital admission in COPD: impact of a specialist nursing team

et al. 2017

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Avoiding hospital admission in COPD: impact of a specialist nursing team

et al. 2017

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“…Previous systematic reviews in patients with COPD have studied self-management education (11,12), integrated care (13)(14)(15), shared management between specialists and primary care physicians (16), and home care (17) in patients with stable COPD, or hospital at home for acutely ill patients with COPD exacerbations (18) or other conditions (19). Previous reviews on care transitions from hospital to home have focused on other patient populations (ie, not patients with COPD exacerbations) (20)(21)(22).…”

mentioning

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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“…In our trust, the COPD nurses have an instrumental role involving liaison with community respiratory teams and facilitating early supported discharge and hospital at home schemes. These reduce LoS, re-admissions, and mortality for selected patients [23,24]. Failure to ensure review of some patients by the hospital COPD nurse may have limited opportunities for post-discharge integrated care with community COPD services.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Chronic Obstructive Pulmonary Disease Patients with a Long Length of Stay: A Retrospective Observational Cohort Study

Madani¹,

Saigal²,

Sunny³

et al. 2017

Turk Thorac J

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OBJECTIVES:Chronic obstructive pulmonary disease (COPD) exacerbation is one of the most common reasons for hospital admission. Patients with COPD with a long length of stay (LoS) occupy a disproportionately high fraction of hospital bed-days. The objective of this study was to identify associations of long LoS in patients admitted with COPD exacerbation. MATERIAL AND METHODS:From December 2012 until June 2013, 499 patients were admitted to Queens Hospital, Romford, UK, with COPD exacerbation. Mean LoS was 7 days, with a median of 5 days, and a 90th percentile of 14 days. In this retrospective observational cohort study, 64 patients with a short LoS were compared with 62 patients with a long LoS. RESULTS:Relative to the short LoS, patients with long LoS had significantly lower arterial blood pH, higher arterial PaCO2 and HCO3, higher white cell count, higher globulin and more frequent chest X-ray changes, lower albumin levels, and lower Barthel and Braden scores. They were less likely to have seen the hospital COPD specialist nurse, more likely to require escalation of social care on discharge, and more likely to die during admission. Nearly 66% of the long LoS patients remained in hospital beyond the time of being medically fit for discharge. Commonly cited reasons for delayed discharge were the wait for therapy and social services assessments and the wait for commencement of community social care. CONCLUSION:Meticulous targeting of features peculiar to long LoS patients has the potential to reduce future hospital bed-days for patients with COPD in our and other hospitals. KEYWORDS:Chronic obstructive pulmonary diseases, length of stay INTRODUCTIONChronic obstructive pulmonary disease (COPD) is a common chronic disease in the UK with a likely prevalence of 3 million people or 4% of the population [1]. Episodic exacerbations are usual and often require hospital admission. COPD exacerbation is the second most common reason for emergency admission to hospital behind circulatory disease and is associated with considerable risks of re-admission, death, and expense. Each COPD hospital admission is estimated to cost NHS commissioners £1960 [2].Estimates of typical length of stay (LoS) vary in the published literature. A British Thoracic Society study found a mean value of 7.1 days, whereas in Norway, it was 8.9 days, and a study in Blackpool reported 9.8 days [3][4][5]. Importantly, there is significant variation across England and Wales between many aspects of service provision and clinical outcomes for patients with respiratory disease. The NHS Atlas of Variation in Healthcare 2010 highlighted a four-fold variation in hospital bed-days occupied by COPD patients [6]. In London, there is a variation in LoS between hospitals by nearly 5 days [7]. Those patients with long LoS also occupy disproportionately more bed-days, and 50% of bed-days have been shown to be occupied by the minority of patients who stay at least 11 days [8]. Previously described associations of long LoS in COPD include poor organization of care, lack...

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Hospital at home for acute exacerbations of chronic obstructive pulmonary disease

Cited by 127 publications

References 28 publications

Avoiding hospital admission in COPD: impact of a specialist nursing team

Avoiding hospital admission in COPD: impact of a specialist nursing team

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

Characterization of Chronic Obstructive Pulmonary Disease Patients with a Long Length of Stay: A Retrospective Observational Cohort Study

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