Impact of a care pathway for COPD on adherence to guidelines and hospital readmission: a cluster randomized trial

Vanhaecht, Kris; Lodewijckx, Cathy; Sermeus, Walter; Decramer, Marc; Deneckere, Svin; Leigheb, Fabrizio; Boto, Paulo; Kül, Seval; Seys, Deborah; Panella, Massimiliano

doi:10.2147/copd.s119849

Cited by 31 publications

(33 citation statements)

References 29 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Affecting approximately 250 million people worldwide [1], Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease characterized by progressive airway obstruction, deterioration in lung function and increased mortality. As a leading cause of hospital admissions, COPD is one of the most significant public health concerns [1][2][3]. With the progression of the disease, acute exacerbations of COPD increase, resulting in an intensive healthcare utilization with frequent physician visits, recurrent emergency department (ED) visits and hospitalizations, and a deterioration of the patient's health condition and quality of life [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Healthcare utilization after a first hospitalization for COPD: a new approach of State Sequence Analysis based on the '6W' multidimensional model of care trajectories

Vanasse

Courteau

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

Background: Published methods to describe and visualize Care Trajectories (CTs) as patterns of healthcare use are very sparse, often incomplete, and not intuitive for non-experts. Our objectives are to propose a typology of CTs one year after a first hospitalization for Chronic Obstructive Pulmonary Disease (COPD), and describe CT types and compare patients' characteristics for each CT type. Methods: This is an observational cohort study extracted from Quebec's medico-administrative data of patients aged 40 to 84 years hospitalized for COPD in 2013 (index date). The cohort included patients hospitalized for the first time over a 3-year period before the index date and who survived over the follow-up period. The CTs consisted of sequences of healthcare use (e.g. ED-hospital-home-GP-respiratory therapists, etc.) over a one-year period. The main variable was a CT typology, which was generated by a 'tailored' multidimensional State Sequence Analysis, based on the "6W" model of Care Trajectories. Three dimensions were considered: the care setting ("where"), the reason for consultation ("why"), and the speciality of care providers ("which"). Patients were grouped into specific CT types, which were compared in terms of care use attributes and patients' characteristics using the usual descriptive statistics.

show abstract

Section: Introductionmentioning

confidence: 99%

Healthcare utilization after a first hospitalization for COPD: a new approach of State Sequence Analysis based on the '6W' multidimensional model of care trajectories

Vanasse

Courteau

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…The median number of hospitalization days we found compares favorably not only to control regions in the Netherlands but also to 2016 data from Belgium, Italy, and Portugal in a cluster-randomized trial. 27 Actually, the median number of days per hospitalization was 12 in their study and five in ours. An important difference in design was the fact that the latter study was hospital-based only, as opposed to ours.…”

Section: Discussionmentioning

confidence: 48%

<p>Reducing the Number of Hospitalization Days for COPD: Setting up a Transmural-Care Pathway</p>

Westbroek¹,

Klijnsma²,

Salomé³

et al. 2020

COPD

View full text Add to dashboard Cite

Background: Many patients with chronic obstructive pulmonary disease (COPD) experience exacerbations of symptoms, leading to a large burden on patients and the health system and costs to society. To address this burden, a 25% reduction in number of hospitalization days for COPD exacerbations was recently declared a national goal in the Netherlands, to be achieved in 5 years. Methods: A national care pathway was designed following an established managed clinical pathway setup, which involved prior national surveys and the identification of ten key elements. The concept was discussed, made locally applicable, and finally tested in eight regions containing eleven hospitals and surrounding primary-care groups in a prospective cohort study. All patients were followed for 1 year, starting at hospitalization. Results: In total, 752 patients gave informed consent and participated (mean age 70 years, 58% female). Of these, 120 (16%) died within a year. The median length of index hospitalization was 5 days, and 43% had at least one rehospitalization within 1 year (range 0-8). There was a 19.4% reduction in number of total hospitalization days, without a decrease in health-related quality of life or perceived quality of care. Elements that contributed significantly to the reduction were contact in the first week after hospitalization, and during the year of follow-up pharmacological and nonpharmacological smoking-cessation guidance, checks on inhalation technique, and discussion of lung-attack plan. Discussion: With concerted action between patients and health workers in the hospital and in the community, a large reduction in number of hospitalization days can be achieved. The program was quite demanding for both patients and health workers. In our subsequent national implementation plan after this pilot study, we have named the major contributors to success and advocate the stepwise introduction of the elements in light of feasibility.

show abstract

“… 20 Care pathways for in-hospital management of exacerbated COPD exist, with positive effects on 30-day readmission rate. 21 The present study shows that a systematic approach seems to be beneficial for all patients with asthma as well as COPD referred to secondary care pulmonology. However, we based our conclusions on a limited number of patients who were evaluated with the systematic approach.…”

Section: Discussionmentioning

confidence: 63%

A systematic diagnostic evaluation combined with an internet-based self-management support system for patients with asthma or COPD

Buul¹,

Wildschut²,

Bonten³

et al. 2018

COPD

View full text Add to dashboard Cite

IntroductionAn (inter)national systematic approach for patients with asthma COPD referred to secondary care is lacking. Therefore, a novel systematic approach was designed and tested in clinical practice.MethodsThis was a retrospective observational study of data from the electronic record system of the Leiden University Medical Center. Asthma and COPD patients were included if they were evaluated with a novel systematic approach or if they had a new record for asthma or COPD and received usual care. The novel systematic approach consisted of a predefined diagnostic evaluation combined with an optional internet-based self-management support system. Diagnostic tests, final diagnosis, lifestyle advices, symptoms and individual care plans in the electronic records, number of patients referred back to primary care, and time to referral back to primary care were compared between the systematic approach and usual care groups using t-tests and chi-squared tests.ResultsA total of 125 patients were included, of which 22 (21.4%) were evaluated with the systematic approach. Mean (±SD) age was 48.8 (±18.4) years and 59.2% were women. Mean (±SD) number of diagnostic tests was higher in the systematic approach group compared with the usual care group (7.6±1.0 vs 5.5±1.8, P<0.001). Similarly, in the systematic approach group, more lifestyle advices (81.8% vs 29.1%), symptom scores (95.5% vs 21.4%), and individual care plans (50.0% vs 7.8%) were electronically recorded (P<0.001), and more patients were referred back to primary care (81.8% vs 56.3%, P=0.03). There were no differences in the final diagnoses and time to referral back.ConclusionOur study suggested that not all tests that were included in the systematic approach are regularly needed in the diagnostic work-up. In addition, a designated systematic approach stimulates physicians to record lifestyle advices, symptoms, and individual care plans. Thus, this approach could increase the number of patients referred back to primary care.

show abstract

Impact of a care pathway for COPD on adherence to guidelines and hospital readmission: a cluster randomized trial

Cited by 31 publications

References 29 publications

Healthcare utilization after a first hospitalization for COPD: a new approach of State Sequence Analysis based on the '6W' multidimensional model of care trajectories

Healthcare utilization after a first hospitalization for COPD: a new approach of State Sequence Analysis based on the '6W' multidimensional model of care trajectories

<p>Reducing the Number of Hospitalization Days for COPD: Setting up a Transmural-Care Pathway</p>

A systematic diagnostic evaluation combined with an internet-based self-management support system for patients with asthma or COPD

Contact Info

Product

Resources

About