Decrease in Readmissions after Hospitalisation for COPD Exacerbation through a Home Care Model.

Autor:	Sánchez-Mellado D; Pulmonology Department, IIS Fundación Jiménez Díaz, Madrid, Spain., Villar-Álvarez F; Pulmonology Department, IIS Fundación Jiménez Díaz, Madrid, Spain.; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.; Universidad Autónoma of Madrid, Madrid, Spain., Fernández Ormaechea I; Pulmonology Department, IIS Fundación Jiménez Díaz, Madrid, Spain.; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain., Naya Prieto A; Pulmonology Department, IIS Fundación Jiménez Díaz, Madrid, Spain., Armenta Fernández R; Pulmonolgy Department, IIS Fundación Jiménez Díaz, Madrid, Spain., Gómez Del Pulgar Murcia T; Pulmonolgy Department, IIS Fundación Jiménez Díaz, Madrid, Spain., Mahillo-Fernández I; Biostatistics and Epidemiology Unit, IIS Fundación Jiménez Díaz, Madrid, Spain., Peces-Barba Romero G; Pulmonology Department, IIS Fundación Jiménez Díaz, Madrid, Spain.; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.; Universidad Autónoma of Madrid, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Open respiratory archives [Open Respir Arch] 2022 Jun 19; Vol. 4 (3), pp. 100190. Date of Electronic Publication: 2022 Jun 19 (Print Publication: 2022).
DOI:	10.1016/j.opresp.2022.100190
Abstrakt:	Objective: To decrease readmissions at 30 and 90 days post-discharge from a hospital admission for chronic obstructive pulmonary disease exacerbation (COPDE) through the home care model of the Ambulatory Chronic Respiratory Care Unit (ACRCU), increase patient survival at one year, and validate our readmission risk scale (RRS). Materials and Methods: This was an observational study, with a prospective data collection and a retrospective data analysis. A total of 491 patients with a spirometry diagnosis of chronic obstructive pulmonary disease (COPD) requiring hospitalisation for an exacerbation were included in the study. Subjects recruited within the first year (204 cases) received conventional care (CC). In the following year a home care (HC) programme was implemented and of those recruited that year (287) 104 were included in the ACRCU, administered by a specialised nurse. Results: In the group of patients included in the home care model of the Ambulatory Chronic Respiratory Care Unit (ACRCU) a lower number of readmissions was observed at 30 and 90 days after discharge (30.5% vs. 50%, p  = 0.012 and 47.7% vs. 65.2%, p  = 0.031, respectively) and a greater one-year survival (85.3% vs. 59.1%, p  < 0.001). The validation of our RRS revealed that the tool's capacity to predict readmissions at both 30 and 90 days was not high (AUC = 0.69 and AUC = 0.66, respectively). Conclusions: The inclusion of exacerbator or fragile COPD patients in the ACRCU could achieve a decrease in readmissions and an increase in survival. The number of episodes of exacerbation within the 12 months prior to the hospital admission is the variable that best predicts the risk of readmission. (© 2022 Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Published by Elsevier España, S.L.U.)
Databáze:	MEDLINE
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