Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates

Abstract

BackgroundCOPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing.AimThe aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD.Materials and methodologyWe retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90 days. We compared numbers, rates, and intervals of readmission and LOS during 2 years of active program delivery compared to 1 year prior to program implementation.ResultsA total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3 years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all causes showed a significant decline, with hazard ratios (HRs) of 0.55 (year 1) and 0.51 (year 2) of intervention (P<0.001). In addition, patients’ mean LOS (days) for COPD-related admissions declined significantly from 10.8 to 6.8 (P<0.05).ConclusionA comprehensive disease management program for COPD patients, including education, case management, and follow-up, was associated with significant reduction in hospital admissions and LOS.

Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review

“…Components of interventions included pharmacist-led interventions [48], nurse-driven interventions [49], case management [50], post-discharge telephone calls [51], heart-failure-specific follow-up, and early supported discharge for stroke patients [52]. RCTs also examined the use of a virtual ward model to promote inter-professional community care, nurse-led telephone support, nurse-based case management, and a discharge nurse led intervention to promote self-management of care at home.…”

Clinical variables predicting the risk of a hospital stay for longer than 7 days in patients with severe acute exacerbations of chronic obstructive pulmonary disease: a prospective study

“…Third, at hospital admission, a severe perception of dyspnoea (mMRC scale ≥2) and the presence of acute respiratory acidosis significantly increased the risk of a prolonged LHS. These three aspects of a presentation could help us focusing which patients are at risk of prolonged LHS and ultimately, providing tailored interventions [17–19].…”

Analysis of length of hospital stay using electronic health records: A statistical and data mining approach

“…Previous studies have examined effective management of LOS. Majority of these involved subjects stratified by condition or admitting unit, for example, patients admitted to specialized departments, such as psychiatric wards [ 3 ] or the intensive care unit (ICU) [ 4 , 5 ]; those with hip fractures[ 6 ] or undergoing coronary artery surgery[ 7 ]; or, those admitted with a specific diagnosis, such as heart failure [ 1 , 8 ] or pulmonary disease [ 9 ].…”