Predicting and preventing hospital readmission for exacerbations of COPD

Abstract

More than a third of patients hospitalised for acute exacerbation of COPD are readmitted to hospital within 90 days. Healthcare professionals and service providers are expected to collaboratively drive efforts to improve hospital readmission rates, which can be challenging due to the lack of clear consensus and guidelines on how best to predict and prevent readmissions. This review identifies these risk factors, highlighting the contribution of multimorbidity, frailty and poor socioeconomic status. Predictive models of readmission that address the multifactorial nature of readmissions and heterogeneity of the disease are reviewed, recognising that in an era of precision medicine, in-depth understanding of the intricate biological mechanisms that heighten the risk of COPD exacerbation and re-exacerbation is needed to derive modifiable biomarkers that can stratify accurately the highest risk groups for targeted treatment. We evaluate conventional and emerging strategies to reduce these potentially preventable readmissions. Here, early recognition of exacerbation symptoms and the delivery of prompt treatment can reduce risk of hospital admissions, while patient education can improve treatment adherence as a key component of self-management strategies. Care bundles are recommended to ensure high-quality care is provided consistently, but evidence for their benefit is limited to date. The search continues for interventions which are effective, sustainable and applicable to a diverse population of patients with COPD exacerbations. Further research into mechanisms that drive exacerbation and affect recovery is crucial to improve our understanding of this complex, highly prevalent disease and to advance the development of more effective treatments.

A randomised controlled feasibility trial of E-health application supported care vs usual care after exacerbation of COPD: the RESCUE trial

“…The association of the myCOPD app intervention with improvement in a number of clinical parameters is welcome but unexpected in a trial of this size. Previous studies of a range of digital interventions have failed to demonstrate significant effects on readmission rates for AECOPD in particular 7 , 31 . The exact mechanism by which the intervention manifests this effect is uncertain but may be linked to a number of aspects of improved self-management and medication usage.…”

“…In the UK alone over 140,000 admissions occur on an annual basis driving over 1 million bed days, which is a significant contribution to NHS cost 1 , 6 . Despite improving approaches to acute management, COPD patients are often readmitted to hospital within weeks of discharge 7 . The UK RCP COPD audit identified that readmission rates were as high as 43% within 3 months of hospital discharge for patients with acute exacerbations 8 .…”

A New Dyspnea Evaluation System Focusing on Patients’ Perceptions of Dyspnea and Their Living Disabilities: The Linkage between COPD and Frailty

“…This is because patients with COPD also have a high prevalence of prefrailty, which is likely to move towards frailty. The comprehensive management of patients with COPD with frailty that includes multidisciplinary teamwork and a community-based integrated care system, is crucial for the realization of a long healthy life expectancy society [42][43][44][45][46][47]. Since COPD is a very common disease, it is ideal for the frailty assessment to be comprehensively and easily assessed by primary care providers, pulmonary specialists, and other physicians.…”

Effect of chronic obstructive pulmonary disease combined with ventilator‑associated pneumonia on patient outcomes: A systematic review and meta‑analysis

“…Patients with COPD frequently encounter exacerbations during the course of the disease, which require respiratory support and hospitalization ( 28 ). Non-invasive ventilation is usually the standard of care during such periods, but in certain cases, endotracheal intubation may be required to reduce mortality ( 4 ).…”