Abstract
Objectives
To test whether coordination of discharge from hospital reduces hospitalizations in
patients with chronic obstructive pulmonary disease (COPD).
Design
Randomized controlled clinical trial.
Setting
Specialized pulmonary hospital.
Participants
Patients hospitalized for an acute exacerbation of COPD.
Intervention
Care as usual included routine patient education, supervised inhaler use, respiratory
physiotherapy, and disease-related communication. The discharge coordinator intervention
added assessment of patient situation and homecare needs. Patients and caregivers
were actively involved and empowered in the discharge planning process, which was
communicated with community medical professionals to provide continuity of care at
home.
Measurements
The primary end-point of the study was the number of patients hospitalized because
of worsening COPD. Key secondary end-points were time-to-COPD hospitalization, all-cause
mortality, all-cause hospitalization, days alive and out of hospital, and health-related
quality of life.
Results
Of 253 eligible patients (71 ± 9 years, 72% men, 87% GOLD III/IV), 118 were assigned
to intervention and 135 to usual care. During a follow-up of 180 days, fewer patients
receiving intervention were hospitalized for COPD (14% versus 31%, P = .002) or for any cause (31% versus 44%, P = .033). In time-to-event analysis, intervention was associated with lower rates
of COPD hospitalizations (P = .001). A Cox model of proportional hazards, adjusted for sex, age, GOLD stage,
heart failure, malignant disease, and long-term oxygen treatment, demonstrated that
intervention reduced the risk of COPD hospitalization (hazard ratio 0.43, 95% confidence
interval 0.24–0.77, P = .002).
Conclusion
Among patients hospitalized for acute COPD exacerbation, discharge coordinator intervention
reduced both COPD hospitalizations and all-cause hospitalizations.
Keywords
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Article info
Publication history
Published online: April 25, 2013
Footnotes
Clinical trials registration: ClinicalTrials.gov - NCT0122562, No financial support was received for this trial.
The authors declare no conflicts of interest.
Identification
Copyright
© 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
