Hospital re-admission in patients with acute exacerbation of chronic obstructive pulmonary disease

Lau, Arthur Chun‐Wing; Yam, Loretta Yin‐Chun; Poon, Edwin

doi:10.1053/rmed.2001.1180

Cited by 63 publications

(63 citation statements)

References 21 publications

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“…Many disease-specific models fail to account for the multiple comorbidity often witnessed in hospitalized general medical patients. [13][14][15][16][17][18][19][20][21] It is fortunate that increased hospitalization and lengthy hospital stays are useful proxies for disease severity and multiple comorbidities, which are more difficult to quantify.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies looking at hospital readmissions are disease specific. [13][14][15][16][17][18][19][20][21] There are relatively few studies examining the risk factors for readmission among all primary care patients, and many of these were performed outside the United States or in hospitalist practices. 10,[22][23][24][25] It is well known that a small proportion of patients account for a disproportionate number of hospital admissions and health care costs.…”

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confidence: 99%

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Predictors of Thirty-Day Readmission Among Hospitalized Family Medicine Patients

Garrison

Mansukhani

Bohn

2013

The Journal of the American Board of Family Medicine

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Purpose: Hospital readmissions within 30 days of initial discharge occur frequently. In studies of elderly patients receiving Medicare, readmissions have been associated with poor-quality inpatient care, ineffective hospital-to-home transitions, patient characteristics, disease burden, and socioeconomic status. Among adult family medicine patients spanning a wide age range, we hypothesize that previous hospitalizations, length of stay, number of discharge medications, medical comorbidities, and patient demographics are associated with a greater risk of hospital readmission within 30 days.Methods: A retrospective case-control study of 276 family medicine inpatients was conducted to determine the factors associated with 30-day readmission. Bivariate statistics were computed and a multivariate analysis using logistic regression was performed to determine the independent effects of each factor.Results: Patients readmitted within 30 days had more hospitalizations, more emergency department visits, longer hospital stays, more comorbidities, and more discharge medications and were less likely to be married. Multivariate logistic regression found that hospitalization within the previous 12 months (odds ratio, 2.71) and long hospital stays (odds ratio, 2.16) were associated with 30-day readmission; being married (odds ratio, 0.54) had a protective effect.Conclusions: This study demonstrates that factors previously found to be associated with 30-day readmission among elderly patients receiving Medicare also apply to family medicine patients of all ages. It also demonstrates prior hospitalizations, length of stay, and marital status are useful proxies for many more complicated factors, such as disease burden, medical complexity, and social issues, that influence hospital readmission. (J Am Board Fam Med 2013;26:71-77.)

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Predictors of Thirty-Day Readmission Among Hospitalized Family Medicine Patients

Garrison

Mansukhani

Bohn

2013

The Journal of the American Board of Family Medicine

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“…A retrospective study from Hong Kong on 551 patients showed a 59.35% re-admission rate after 12 months [28]. In the prospective EFRAM study, 63% of 340 patients were readmitted during the 1yr follow-up time [4].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression

Guðmundsson¹,

Gíslason²,

Janson³

et al. 2005

Eur Respir J

323

238

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The aim of the present study was to analyse the risk of rehospitalisation in patients with chronic obstructive pulmonary disease and associated risk factors.This prospective study included 416 patients from a university hospital in each of the five Nordic countries. Data included demographic information, spirometry, comorbidity and 12 month followup for 406 patients. The hospital anxiety and depression scale and St. George's Respiratory Questionnaire (SGRQ) were applied to all patients.The number of patients that had a re-admission within 12 months was 246 (60.6%). Patients that had a re-admission had lower lung function and health status. A low forced expiratory volume in one second (FEV1) and health status were independent predictors for re-admission. Hazard ratio (HR; 95% CI) was 0.82 (0.74-0.90) per 10% increase of the predicted FEV1 and 1.06 (1.02-1.10) per 4 units increase in total SGRQ score. The risk of rehospitalisation was also increased in subjects with anxiety (HR 1.76 (1.16-2.68)) and in subjects with low health status (total SGRQ score .60 units). When comparing the different subscales in the SGRQ, the closest relation between the risk of rehospitalisation was seen with the activity scale (HR 1.07 (1.03-1.11) per 4 unit increase).In patients with low health status, anxiety is an important risk factor for rehospitalisation. This may be important for patient treatment and warrants further studies. KEYWORDS: Anxiety, chronic obstructive pulmonary disease, depression, health status, rehospitalisation, risk factors C hronic obstructive pulmonary disease (COPD) is associated with intermittent exacerbations characterised by acute deterioration in the symptoms of chronic dyspnoea, cough and sputum production. Hospitalisations because of acute exacerbations are an important part of the care of patients with COPD. Multiple studies have been conducted in order to identify risk factors for COPD hospitalisations and there is also an increasing interest in modifying the risk factors in order to reduce the rate of rehospitalisation [5]. Risk factors that have been identified in previous studies are as follows: 1) low lung function [4,6,7]; 2) increasing age [7]; 3) poor quality of life [1,8,9]; 4) low physical function [4,8]; 5) history of frequent past exacerbations [1]; 6) history of previous admissions [4,6]; 7) under prescription of long-term oxygen therapy [6]; 8) hypercapnoea; and 9) pulmonary hypertension [10]. Interventions that decrease the risk of hospitalisations in COPD patients include vaccinations for influenza [11], smoking cessation [12] and pulmonary rehabilitation [13]. A study by DAHLÉ N and JANSON [14] found that anxiety and depression were related to a higher risk of relapse in patients with asthma and COPD that were admitted for emergency treatment. There is, however, limited data available regarding the level of anxiety and depression and the risk for hospital re-admission for COPD. There is also a lack of data on re-admission rates of COPD from Northern Europe and many previous s...

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“…[9][10][11] However, these studies included patients with compensated respiratory acidosis and decompensated respiratory acidosis, which was aforesaid found to be a poor prognostic factor. Some respirologists believe that the absolute value of PaCO2 is not as critical as the pH, with the latter being a better predictor of disease severity as it reflects the magnitude and changes of PaCO2.…”

Section: Introductionmentioning

confidence: 99%

Differences in baseline factors and survival between normocapnia, compensated respiratory acidosis and decompensated respiratory acidosis in COPD exacerbation: A pilot study

et al. 2015

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Hospital re-admission in patients with acute exacerbation of chronic obstructive pulmonary disease

Cited by 63 publications

References 21 publications

Predictors of Thirty-Day Readmission Among Hospitalized Family Medicine Patients

Predictors of Thirty-Day Readmission Among Hospitalized Family Medicine Patients

Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression

Differences in baseline factors and survival between normocapnia, compensated respiratory acidosis and decompensated respiratory acidosis in COPD exacerbation: A pilot study

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