Predictors of Hospital Admission for Chronic Obstructive Pulmonary Disease Exacerbations in Canadian Emergency Departments

Rowe, Brian H.; Villa‐Roel, Cristina; Guttman, Alex; Ross, Scott W.; Mackey, Duncan; Sivilotti, Marco L.A.; Worster, Andrew; Stiell, Ian G.; Willis, V.; Borgundvaag, Bjug

doi:10.1111/j.1553-2712.2009.00366.x

Cited by 29 publications

(19 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some authors from the United States, such as Rowe et al 27 and Tsai et al, 28 reported higher admission rates (49.3 and 62%, respectively) than we did. The differences observed are most likely attributable to our cohort originating from primary care, where the average severity of the disease is lower.…”

Section: Discussioncontrasting

confidence: 37%

Predictive Model of Hospital Admission for COPD Exacerbation

Montserrat¹,

Godoy

Marsal

et al. 2015

Respir Care

View full text Add to dashboard Cite

BACKGROUND: The objective of this work was to determine predictive factors of hospital admission for exacerbation during primary care visits in patients with COPD. METHODS: A retrospective cohort study was undertaken to assess risk of hospital admission for COPD exacerbation in primary care patients from November 1, 2010 to October 31, 2013. Data sources were primary care electronic medical records and the hospital discharge minimum data set. A total of 2,501 subjects >40 y of age with a spirometry-based COPD diagnosis were included and followed up for 3 y. The dependent variable was hospital admission for exacerbation; independent variables were: clinical parameters, spirometry results, and severity of disease (according to Global Initiative for Chronic Obstructive Lung Disease criteria). The association of these variables with hospital admission was analyzed with the adjusted odds ratio using a logistic regression model. RESULTS: Mean age of subjects at the beginning of the study was 68.4 y (SD ‫؍‬ 11.6), and 75% were men. Severity was mild in 50.8% of subjects, moderate in 35.3%, severe in 9.4%, and very severe in 4.4%.

show abstract

Section: Discussioncontrasting

confidence: 37%

Predictive Model of Hospital Admission for COPD Exacerbation

Montserrat¹,

Godoy

Marsal

et al. 2015

Respir Care

View full text Add to dashboard Cite

show abstract

“…These have found higher odds of ED admission for age, 66,67 various markers of COPD severity and respiratory distress, 67,68 comorbidity and lower levels of social support, but not sex, although Vidal et al 68 did not retain comorbidity or social support in their final model. We also found effects of older age (although Vidal et al 68 did not, perhaps because of their detailed physiological variables) and comorbidity for the COPD group.…”

Section: Discussion Of Methods and Findingsmentioning

confidence: 99%

“…In 16 EDs across Canada, 49% of 501 patients with acute exacerbations of COPD who were interviewed had been admitted. 67 In a Spanish cohort also covering 16 EDs, 62% of patients were admitted on arrival for a COPD exacerbation. 68 For our two cohorts, approximately three in four ED visits for any reason within 30 days resulted in admission.…”

mentioning

confidence: 99%

Factors associated with hospital emergency readmission and mortality rates in patients with heart failure or chronic obstructive pulmonary disease: a national observational study

Bottle

Honeyford

Chowdhury

et al. 2018

Health Serv Deliv Res

View full text Add to dashboard Cite

BackgroundHeart failure (HF) and chronic obstructive pulmonary disease (COPD) lead to unplanned hospital activity, but our understanding of what drives this is incomplete.ObjectivesTo model patient, primary care and hospital factors associated with readmission and mortality for patients with HF and COPD, to assess the statistical performance of post-discharge emergency department (ED) attendance compared with readmission metrics and to compare all the results for the two conditions.DesignObservational study.SettingEnglish NHS.ParticipantsAll patients admitted to acute non-specialist hospitals as an emergency for HF or COPD.InterventionsNone.Main outcome measuresOne-year mortality and 30-day emergency readmission following the patient’s first unplanned admission (‘index admission’) for HF or COPD.Data sourcesPatient-level data from Hospital Episodes Statistics were combined with publicly available practice- and hospital-level data on performance, patient and staff experience and rehabilitation programme website information.ResultsOne-year mortality rates were 39.6% for HF and 24.1% for COPD and 30-day readmission rates were 19.8% for HF and 16.5% for COPD. Most patients were elderly with multiple comorbidities. Patient factors predicting mortality included older age, male sex, white ethnicity, prior missed outpatient appointments, (long) index length of hospital stay (LOS) and several comorbidities. Older age, missed appointments, (short) LOS and comorbidities also predicted readmission. Of the practice and hospital factors we considered, only more doctors per 10 beds [odds ratio (OR) 0.95 per doctor;p < 0.001] was significant for both cohorts for mortality, with staff recommending to friends and family (OR 0.80 per unit increase;p < 0.001) and number of general practitioners (GPs) per 1000 patients (OR 0.89 per extra GP;p = 0.004) important for COPD. For readmission, only hospital size [OR per 100 beds = 2.16, 95% confidence interval (CI) 1.34 to 3.48 for HF, and 2.27, 95% CI 1.40 to 3.66 for COPD] and doctors per 10 beds (OR 0.98;p < 0.001) were significantly associated. Some factors, such as comorbidities, varied in importance depending on the readmission diagnosis. ED visits were common after the index discharge, with 75% resulting in admission. Many predictors of admission at this visit were as for readmission minus comorbidities and plus attendance outside the day shift and numbers of admissions that hour. Hospital-level rates for ED attendance varied much more than those for readmission, but the omega statistics favoured them as a performance indicator.LimitationsData lacked direct information on disease severity and ED attendance reasons; NHS surveys were not specific to HF or COPD patients; and some data sets were aggregated.ConclusionsFollowing an index admission for HF or COPD, older age, prior missed outpatient appointments, LOS and many comorbidities predict both mortality and readmission. Of the aggregated practice and hospital information, only doctors per bed and numbers of hospital beds were strongly associated with either outcome (both negatively). The 30-day ED visits and diagnosis-specific readmission rates seem to be useful performance indicators.Future workHospital variations in ED visits could be investigated using existing data despite coding limitations. Primary care management could be explored using individual-level linked databases.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

“…With respect to progression to respiratory failure, select physiologic parameters such as arterial pH and Glasgow coma scale may indicate which subjects are likely to require endotracheal intubation [13][14][15]. Finally, for determining who requires hospitalizations, Rowe et al [16] observed that approximately half of those AECOPD presenting to the ED required hospitalization. Independent factors associated with need for admission included having ever required systemic corticosteroid therapy and being more severely ill [16].…”

Section: Discussionmentioning

confidence: 97%

“…Finally, for determining who requires hospitalizations, Rowe et al [16] observed that approximately half of those AECOPD presenting to the ED required hospitalization. Independent factors associated with need for admission included having ever required systemic corticosteroid therapy and being more severely ill [16]. Unfortunately, none of these investigations addressing issues ranging from mortality to need for hospitalization have created risk stratification tools for use in the management of AECOPD.…”

Section: Discussionmentioning

confidence: 98%