Predictors of Rehospitalization and Death After a Severe Exacerbation of COPD

McGhan, Ryan; Radcliff, Tiffany A.; Fish, Ron; Sutherland, E. Rand; Welsh, Carolyn H.; Make, Barry J.

doi:10.1378/chest.06-3018

Cited by 262 publications

(227 citation statements)

References 39 publications

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Section: Discussionsupporting

confidence: 65%

“…The lower risk of readmission and post-discharge mortality associated with diabetes confirmed the findings of previous smaller studies [32,33], but does not elucidate the possible underlying mechanisms. The thesis of the protective potential of a higher body mass index in diabetic patients has been discussed by MCGHAN et al [32], but is still speculative. Another explanation model is that comorbidities may include unidentified treatment options which in diabetes therapy might lead to less blood sugar escalation caused by systemic corticosteroid therapy considered harmful in the studies of BAKER et al [34] and CHAKRABARTI et al [35].…”

Section: Discussionsupporting

confidence: 65%

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Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

et al. 2015

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Studies report high in-hospital and post-discharge mortality of chronic obstructive pulmonary disease (COPD) exacerbations varying depending upon patient characteristics, hospital resources and treatment standards. This study aimed to investigate the patient, resource and organisational factors associated with in-hospital and 90-day post-discharge mortality and readmission of COPD exacerbations within the European COPD Audit. The audit collected data of COPD exacerbation admissions from 13 European countries.On admission, only 49.7% of COPD patients had spirometry results available and only 81.6% had blood gases taken. Using logistic regression analysis, the risk associated with in-hospital and post-discharge mortality was higher age, presence of acidotic respiratory failure, subsequent need for ventilatory support and presence of comorbidity. In addition, the 90-day risk of COPD readmission was associated with previous admissions. Only the number of respiratory specialists per 1000 beds, a variable related to hospital resources, decreased the risk of post-discharge mortality.The European COPD Audit identifies risk factors associated with in-hospital and post-discharge mortality and COPD readmission. Addressing the deficiencies in acute COPD care such as making spirometry available and measuring blood gases and providing noninvasive ventilation more regularly would provide opportunities to improve COPD outcomes. @ERSpublications Hospital-admitted COPD exacerbation needs better risk stratification: spirometry and gas analysis improve outcomes http://ow.ly/RTbdk

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Section: Discussionsupporting

confidence: 65%

Section: Discussionsupporting

confidence: 65%

Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

et al. 2015

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“…2,3 Exacerbations account for 35%À45% of the total per capita health-care cost of COPD. 4 The relationship between respiratory status in patients with chronic lung diseases and meteorological conditions has been previously described, 5 as falls in environmental temperature have been associated with increased COPD exacerbations that contribute to the high levels of cold-related morbidity from COPD.…”

Section: Introductionmentioning

confidence: 99%

The effect of COPD health forecasting on hospitalisation and health care utilisation in patients with mild-to-moderate COPD

et al. 2011

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Exacerbations are a major cause of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD) as well as having a large impact on health care utilisation (HCU). They are more frequent during periods of cold weather with a corresponding increase in hospital admissions. It has been hypothesised that COPD exacerbations and admissions can be reduced by predicting periods of cold weather coupled with patients' alerts and education. Healthy Outlook 1 service provided by the Meteorological Office, UK, was used in patients with mild-to-moderate COPD who consented to participate from three primary care practices. Outcome measures included data relating to hospital admissions for acute exacerbations as well as HCU for these patients during the intervention period (1 Nov 2008À31 Mar 2009) and compared for the same patients and same period 12 months earlier (1 Nov 2007À31 Mar 2008. A cost analysis comparing treatment cost per patient for the two periods was also conducted. A total of 157 (34% of target COPD population) patients took part in the project, with five weather alerts generated (first alert reached 150 patients; second reached 146; third reached 138 patients; fourth reached 137 patients; and the fifth reached 125 patients) during the intervention period. There was a non-statistically-significant increase in hospital admissions per patient (0.07À0.076; p ¼ 0.83). The number of general practice visits per patient dropped from 4.9 to 3.8 (p ¼ 0.001), with drop in average number of visits to patients by out-of-hours services from 0.52À0.14 (p ¼ 0.013). The average number of home consultations provided by general practice increased from 0.05 to 0.92 (p ¼ 0.001). Cost per patient increased by an average of £142 (95% CI -£128 to £412). This anticipatory care model was not associated with reduction in admissions from COPD exacerbations. Further research is required to fully understand its role in the management of patients with COPD.

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“…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%

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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Predictors of Rehospitalization and Death After a Severe Exacerbation of COPD

Cited by 262 publications

References 39 publications

Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit

The effect of COPD health forecasting on hospitalisation and health care utilisation in patients with mild-to-moderate COPD

Predictors of Thirty-Day Readmission Among Hospitalized Family Medicine Patients

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