Risk Factors for Hospital Readmission in Patients with Chronic Obstructive Pulmonary Disease

Almagro, Pedro; Barreiro, Bienvenido; Echagüen, Anna Ochoa de; Quintana, Salvador; Carballeira, Mónica Rodríguez; Heredia, J.L. Pérez de; Garau, Javier

doi:10.1159/000088092

Cited by 182 publications

(167 citation statements)

References 57 publications

(57 reference statements)

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“…Consequently, the PaCO2 is regarded to be a poor prognostic indicator in general and has been demonstrated to be associated with the development of COPD-AE (1,7,(24)(25)(26)(27)(28)(29)(30). However, the majority of studies have focused on severely hypoxemic patients requiring NIV or patients who had previously experienced COPD-AE.…”

Section: Discussionmentioning

confidence: 99%

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2013

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Objective Predictors of the need to initiate noninvasive ventilation (NIV) in stable COPD outpatients with acute exacerbation of chronic obstructive pulmonary disease (COPD-AE) are insufficiently defined. The objective of this study was to investigate predictors of the need to initiate NIV in stable COPD-AE outpatients. Methods A total of 140 consecutive stable COPD outpatients who were hospitalized for COPD-AE for the first time were retrospectively examined. Demographic and clinical parameters measured in the stable state were evaluated, including data for arterial blood gases, the pulmonary function, body mass index and dyspnea scores. Results Of the 140 patients included, NIV was used in 32 (23%) patients. In a univariate Cox proportional hazards analysis, the baseline partial pressure of arterial carbon dioxide (PaCO2) (hazard ratio (HR), 1.14 per mmHg; 95% confidence interval (CI), 1.08-1.21) and forced expiratory volume in one second (FEV1)% predicted (HR, 1.03 per %; 95% CI, 1.01-1.05) were identified to be significant predictors. A multivariate logistic regression analysis showed only the PaCO2 (HR, 1.18 per mmHg; 95% CI, 1.12-1.26) to be a significant predictor. Conclusion Our results suggest that the PaCO2 measured in the stable state is an independent significant predictor of the need to initiate NIV in COPD-AE patients who are hospitalized for the first time.

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Section: Discussionmentioning

confidence: 99%

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

et al. 2013

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“…Some studies are focused on patients with specific conditions, limiting the generalizability of potential interventions. 9,32,33 In others, characteristics of patients with frequent hospital admissions are defined by retrospective or administrative data, 34 which lacks the depth and nuance of information obtained during interviews. In addition, definitions of being a "frequent" or "high" user of hospital services vary from study to study, and in many cases, frequent use is defined within a single year, rather than over a longer period of time.…”

Section: Discussionmentioning

confidence: 99%

Medicaid Patients at High Risk for Frequent Hospital Admission: Real-Time Identification and Remediable Risks

et al. 2008

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Patients with frequent hospitalizations generate a disproportionate share of hospital visits and costs. Accurate determination of patients who might benefit from interventions is challenging: most patients with frequent admissions in 1 year would not continue to have them in the next. Our objective was to employ a validated regression algorithm to case-find Medicaid patients at high-risk for hospitalization in the next 12 months and identify intervention-amenable characteristics to reduce hospitalization risk. We obtained encounter data for 36,457 Medicaid patients with any visit to an urban public hospital from 2001 to 2006 and generated an algorithm-based score for hospitalization risk in the subsequent 12 months for each patient (0=lowest, 100= highest). To determine medical and social contributors to the current admission, we conducted in-depth interviews with high-risk hospitalized patients (scores 950) and analyzed associated Medicaid claims data. An algorithm-based risk score 950 was attained in 2,618 (7.2%) patients. The algorithm's positive predictive value was equal to 0.67. During the study period, 139 high-risk patients were admitted: 60 met inclusion criteria and 50 were interviewed. Fifty-six percent cited the Emergency Department as their usual source of care or had none. Sixty-eight percent had 91 chronic medical conditions, and 42% were admitted for conditions related to substance use. Sixty percent were homeless or precariously housed. Mean Medicaid expenditures for the interviewed patients were $39,188 and $84,040 per patient for the years immediately prior to and following study participation, respectively. Findings including high rates of substance use, homelessness, social isolation, and lack of a medical home will inform the design of interventions to improve community-based care and reduce hospitalizations and associated costs.

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“…Previous studies have identified risk factors of hospital admission for COPD exacerbation [7][8][9][10][11][12] : a decrease in FEV 1 ; anxiety and depression; duration of disease; nutritional status; sex; age; socioeconomic level; comorbidities; quality of life; and, finally and most significantly, a previous admission for exacerbation. [7][8][9][10] More recently, biomarkers of inflammation have been considered important predictive factors of exacerbation (C-reactive protein, fibrinogen, leukocyte, eosinophil, and lymphocyte count; leukotrienes [B4, IL-6, IL-8, and TNF-a]; procalcitonin; endotelin; and adrenomedullin).…”

Section: Introductionmentioning

confidence: 99%

Predictive Model of Hospital Admission for COPD Exacerbation

Montserrat¹,

Godoy

Marsal

et al. 2015

Respir Care

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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%.

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Risk Factors for Hospital Readmission in Patients with Chronic Obstructive Pulmonary Disease

Cited by 182 publications

References 57 publications

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Predictors of the Need to Initiate Noninvasive Ventilation in Stable Outpatients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Medicaid Patients at High Risk for Frequent Hospital Admission: Real-Time Identification and Remediable Risks

Predictive Model of Hospital Admission for COPD Exacerbation

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