Examining 30-day COPD readmissions through the emergency department
| Autor: | Bonita Nuanez, Jeffrey Ditkoff, Michael E. Rezaee, Alexandra Halalau, Charlotte E. Ward, Daniel A Rezaee |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Time Factors Logistic regression Pulmonary Disease Chronic Obstructive 0302 clinical medicine Risk Factors Epidemiology Odds Ratio Electronic Health Records Medicine 030212 general & internal medicine observation study Original Research Fluticasone Aged 80 and over COPD General Medicine Middle Aged 3. Good health epidemiology Female Salmeterol Emergency Service Hospital Algorithms medicine.drug medicine.medical_specialty emergency department Clinical Decision-Making International Journal of Chronic Obstructive Pulmonary Disease Patient Readmission Decision Support Techniques 03 medical and health sciences length of stay Humans Aged Retrospective Studies readmission business.industry Retrospective cohort study Emergency department Odds ratio dyspnea medicine.disease hospital admission Logistic Models 030228 respiratory system Multivariate Analysis Emergency medicine business |
| Zdroj: | International Journal of Chronic Obstructive Pulmonary Disease |
| ISSN: | 1178-2005 |
| Popis: | Michael E Rezaee,1 Charlotte E Ward,2,3 Bonita Nuanez,1 Daniel A Rezaee,4 Jeffrey Ditkoff,1,5 Alexandra Halalau1,6 1Oakland University William Beaumont School of Medicine, Rochester, MI, 2Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, 3Center for Health Statistics, University of Chicago, Chicago, IL, 4Primary Care, Brigham and Women’s Hospital, Boston, MA, 5Emergency Medicine, 6Internal Medicine, Beaumont Health, Royal Oak, MI, USA Background: Thirty-day readmission in COPD is common and costly, but potentially preventable. The emergency department (ED) may be a setting for COPD readmission reduction efforts.Objective: To better understand COPD readmission through the ED, ascertain factors associated with 30-day readmission through the ED, and identify subgroups of patients with COPD for readmission reduction interventions.Patients and methods: A retrospective cohort study was conducted from January 2009 to September 2015 in patients with COPD of age ≥18 years. Electronic health record data were abstracted for information available to admitting providers in the ED. The primary outcome was readmission through the ED within 30 days of discharge from an index admission for COPD. Logistic regression was used to examine the relationship between potential risk factors and 30-day readmission.Results: The study involved 1,574 patients who presented to the ED within 30 days on an index admission for COPD. Of these, 82.2% were readmitted through the ED. Charlson score (odds ratio [OR]: 3.6; 95% CI: 2.9–4.4), a chief complaint of breathing difficulty (OR: 1.6; 95% CI: 1.1–2.6), outpatient utilization of albuterol (OR: 4.1; 95% CI: 2.6–6.4), fluticasone/salmeterol (OR: 2.3; 95% CI: 1.3–4.2), inhaled steroids (OR: 3.8; 95% CI: 1.3–10.7), and tiotropium (OR: 1.8; 95% CI: 1.0–3.2), as well as arterial blood gas (OR: 4.4; 95% CI: 1.3–15.1) and B-type natriuretic peptide (OR: 2.2; 95% CI: 1.4–3.5) testing in the ED were associated with readmission (c-statistic =0.936). Seventeen-point-eight percent of patients with COPD presented to the ED and were discharged home; 56% presented with a complaint other than breathing difficulty; and 16% of those readmitted for breathing difficulty had a length of stay |
| Databáze: | OpenAIRE |
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