UK National COPD Audit 2003: impact of hospital resources and organisation of care on patient outcome following admission for acute COPD exacerbation

Price, Laura; Lowe, Derek; Hosker, Harold; Anstey, K; Pearson, M; Roberts, C M

doi:10.1136/thx.2005.049940

Cited by 205 publications

(202 citation statements)

References 14 publications

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“…Moreover, the RHDCU may act as a step-down unit for post-ICU patients (for weaning and decannulation). [2][3][4][5][6] SEE THE RELATED EDITORIAL ON PAGE 1215 In North America, several levels of RHDCU have been running since the 1960s. 7,8 In Europe, RHDCUs were set up only in the late 1980s.…”

Section: Introductionmentioning

confidence: 99%

“…Respiratory high-dependence care units (RHDCUs) provide a specialized quality of care for patients recovering from acute respiratory failure (ARF), with health resources optimization (eg, lower nurse-to-patient ratio). [2][3][4][5][6] The RHDCU is an intermediatelevel respiratory care setting designed to manage singleorgan decompensations and to avoid the risk of inadequate intensity of care in a lower-level care environment (eg, ward) and the potentially wasteful provision of unnecessarily intensive care in an ICU. Moreover, the RHDCU may act as a step-down unit for post-ICU patients (for weaning and decannulation).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Increased Number and Expertise of Italian Respiratory High-Dependency Care Units: The Second National Survey

Scala¹,

Corrado

Confalonieri

et al. 2011

Respir Care

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.03), and the physician-to-patient mean ratio and the nurse-to-patient mean ratio per shift were lower (P ‫؍‬ .001 and P ‫؍‬ .002, respectively). Admissions for only monitoring decreased (P < .001), and admissions for active interventions increased: noninvasive ventilation (P ‫؍‬ .002), invasive ventilation (P < .001), weaning from invasive ventilation (P < .001), and tracheal decannulation (P < .001). The complexity of RHDCU patients' conditions increased: there was a reduction in the percentage of COPD patients (P < .001) and an increase in the percentage of patients with neuromyopathies (P < .001) and de novo hypoxemia (P ‫؍‬ .006). CONCLUSIONS: Between 1997 and 2007 there was an increase in the number and expertise of Italian RHDCUs, with a shift toward less expensive care, and greater complexity of interventions and patient dysfunctions. These findings support the crucial role of RHDCUs in the management of respiratory critical patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Increased Number and Expertise of Italian Respiratory High-Dependency Care Units: The Second National Survey

Scala¹,

Corrado

Confalonieri

et al. 2011

Respir Care

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show abstract

“…In reference to the UK National COPD Audit 2003, Price et al. examined the association between the outcomes of resources and the organisation of care provided by hospitals 38. They used logistic regression analysis to obtain a set of patient case mixed predictors and then entered these predictors into random effects logistic regression models; these models assessed the correlation of unit resources and organisation with the outcomes of inpatient mortality and readmissions during 90 days of follow‐up after the index admission, as well as the length of hospital stay.…”

Section: Discussionmentioning

confidence: 99%

Determinants of between‐hospital variations in outcomes for patients admitted with COPD exacerbations: findings from a nationwide clinical audit ( AUDIPOC ) in Spain

et al. 2015

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SummaryBackgroundPrevious studies have demonstrated significant variability in the processes of care and outcomes of chronic obstructive pulmonary disease (COPD) exacerbations. The AUDIPOC is a Spanish nationwide clinical audit that identified large between‐hospital variations in care and clinical outcomes. Here, we test the hypothesis that these variations can be attributed to either patient characteristics, hospital characteristics and/or the so‐called hospital‐clustering effect, which indicates that patients with similar characteristics may experience different processes of care and outcomes depending on the hospital to which they are admitted.MethodsA clinical audit of 5178 COPD patients consecutively admitted to 129 Spanish public hospitals was performed, with a 90‐day follow‐up. Multilevel regression analysis was conducted to model the probability of patients experiencing adverse outcomes. For each outcome, an empty model (with no independent variables) was fitted to assess the clustering effect, followed by a model adjusted for the patient‐ and hospital‐level covariables. The hospital‐clustering effect was estimated using the intracluster correlation coefficient (ICC); the cluster heterogeneity was estimated with the median odds ratio (MOR), and the coefficients of predictors were estimated with the odds ratio (OR).ResultsIn the empty models, the ICC (MOR) for inpatient mortality and the follow‐up mortality and readmission were 0.10 (1.80), 0.08 (1.65) and 0.01 (1.24), respectively. In the adjusted models, the variables that most represented the patients’ clinical conditions and interventions were identified as outcome predictors and further reduced the hospital variations. By contrast, the resource factors were primarily unrelated with outcomes.ConclusionsThis study demonstrates a noteworthy reduction in the observed crude between‐hospital variation in outcomes after accounting for the hospital‐cluster effect and the variables representing patient's clinical conditions. This emphasises the predictor importance of the patients’ clinical conditions and interventions, and understates the impacts of hospital resources and organisational factors.

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“…Die jährlichen Therapiekosten der COPD sind enorm [2,3] und die Gesamtzahl der akutstationä-ren Aufenthalte aufgrund einer COPD nehmen jährlich zu [4]. Nach erfolgter akut exazerbierter COPD (AECOPD) ist mit einer über 30 prozentigen Rezidivquote innerhalb der ersten drei Monate oder einer erneuten Hospitalisierung zu rechnen [5,6]. Exazerbationen sind durch eine Verstärkung der Dyspnoe gekennzeichnet und mit einer eingeschränkten Lebensqualität sowie einer reduzierten Leistungsfähigkeit verknüpft [7,8].…”

Section: Introductionunclassified

Eine pneumologische Rehabilitation nach akuter Exazerbation der COPD senkt die Rate erneuter Exazerbationen

Spielmanns

Meier

Winkler

et al. 2017

Dtsch med Wochenschr

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Ziel der Studie Die akute Exazerbation einer COPD (AECOPD) stellt für die Patienten ein erhebliches Risiko dar und ist für die Prognose mitentscheidend. Bisherige Ergebnisse über die Auswirkungen einer pneumologischen Rehabili-tation (PR) auf die Exazerbationsfrequenz nach AECOPD sind uneinheitlich. Es wurde eine prospektive, fallkontrollierte Studie mit dem Ziel durchgeführt, den Einfluss der PR auf die Exazerbationsfrequenz nach AECOPD zu messen. Patienten und Methoden Eine PR wurde bei 57 COPD-Patienten nach AE-COPD durchgeführt. Davon konnten 30 nach einem Jahr nachuntersucht werden und wurden mit 32 Kontrollpatienten (KG = hospitalisiert wegen AECOPD ohne PR) verglichen. Die Anzahl der Exazerbationen wurde innerhalb der Gruppen und zwischen den Gruppen analysiert. Registrierung: DRKS Nr. 00 006 847.

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UK National COPD Audit 2003: impact of hospital resources and organisation of care on patient outcome following admission for acute COPD exacerbation

Abstract: Abbreviations: COPD, chronic obstructive pulmonary disease; FEV 1 , forced expiratory volume in 1 second; LOS, length of stay 837 www.thoraxjnl.com

Cited by 205 publications

References 14 publications

Increased Number and Expertise of Italian Respiratory High-Dependency Care Units: The Second National Survey

Increased Number and Expertise of Italian Respiratory High-Dependency Care Units: The Second National Survey

Determinants of between‐hospital variations in outcomes for patients admitted with COPD exacerbations: findings from a nationwide clinical audit ( AUDIPOC ) in Spain

Eine pneumologische Rehabilitation nach akuter Exazerbation der COPD senkt die Rate erneuter Exazerbationen

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