1
|
Ruan H, Zhao H, Wang J, Zhang H, Li J. All-cause readmission rate and risk factors of 30- and 90-day after discharge in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Ther Adv Respir Dis 2023; 17:17534666231202742. [PMID: 37822218 PMCID: PMC10571684 DOI: 10.1177/17534666231202742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The readmission rate following hospitalization for chronic obstructive pulmonary disease (COPD) is surprisingly high, and frequent readmissions represent a higher risk of mortality and a heavy economic burden. However, information on all-cause readmissions in patients with COPD is limited. OBJECTIVE This study aimed to systematically summarize all-cause COPD readmission rates within 30 and 90 days after discharge and their underlying risk factors. METHODS Eight electronic databases were searched to identify relevant observational studies about COPD readmission from inception to 1 August 2022. Newcastle-Ottawa Scale was used for methodological quality assessment. We adopt a random effects model or a fixed effects model to estimate pooled all-cause COPD readmission rates and potential risk factors. RESULTS A total of 28 studies were included, of which 27 and 8 studies summarized 30- and 90-day all-cause readmissions, respectively. The pooled all-cause COPD readmission rates within 30 and 90 days were 18% and 31%, respectively. The World Health Organization region was initially considered to be the source of heterogeneity. We identified alcohol use, discharge destination, two or more hospitalizations in the previous year, and comorbidities such as heart failure, diabetes, chronic kidney disease, anemia, cancer, or tumor as potential risk factors for all-cause readmission, whereas female and obesity were protective factors. CONCLUSIONS Patients with COPD had a high all-cause readmission rate, and we also identified some potential risk factors. Therefore, it is urgent to strengthen early follow-up and targeted interventions, and adjust or avoid risk factors after discharge, so as to reduce the major health economic burden caused by frequent readmissions. TRIAL REGISTRATION This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022369894).
Collapse
Affiliation(s)
- Huanrong Ruan
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450003, People’s Republic of China
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, People’s Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, People’s Republic of China
| | - Hulei Zhao
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450003, People’s Republic of China
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, People’s Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, People’s Republic of China
| | - Jiajia Wang
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450003, People’s Republic of China
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, People’s Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, People’s Republic of China
| | - Hailong Zhang
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450003, People’s Republic of China
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, People’s Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, People’s Republic of China
| | - Jiansheng Li
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, People’s Republic of China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, People’s Republic of China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450003, People’s Republic of China
- Henan University of Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou, Henan 450046, People’s Republic of China
| |
Collapse
|
2
|
Anbesse ZK, Mega TA, Tesfaye BT, Negera GZ. Early readmission and its predictors among patients treated for acute exacerbations of chronic obstructive respiratory disease in Ethiopia: A prospective cohort study. PLoS One 2020; 15:e0239665. [PMID: 33022006 PMCID: PMC7537865 DOI: 10.1371/journal.pone.0239665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Significant numbers of chronic obstructive respiratory disease patients are readmitted for Acute Exacerbation (AE) within 30 days of discharge. And these early readmissions have serious clinical and socioeconomic consequences. The objective of our study was to determine the rate of readmission within 30 days of discharge and it’s predictors among patients treated for acute exacerbations of asthma and chronic obstructive pulmonary disease (COPD). Methods A prospective cohort study involving 130 patients (asthma = 59, COPD = 71) was conducted from April-September, 2019, in Jimma Medical Center (JMC), South-West Ethiopia. Socio-demographic, clinical, laboratory, and drug-related data were recorded at admission and during hospital stay. Cox regression analysis was performed to identify risk factors for readmissions following an AE of asthma and COPD. Results During the study period, 130 (male, 78(60%)) patients were admitted with AE of asthma and COPD. The median age was 59(IQR, 50–70) years. Of 130 patients, 21(18.10%) had a new AE of asthma and COPD that required hospitalization in the 30 days after discharge. The overall median survival time to 30-day readmission was 20 days (IQR, 16–29). Multivariate analysis revealed prolonged use of oxygen therapy (AHR = 4.972, 95% CI [1.041–23.736] and frequent hospital admissions (AHR = 11.482 [1.308–100.793]) to be independent risk factors for early readmissions. Conclusion Early hospital readmission rates for AE of asthma and COPD were alarmingly high. Frequent hospital admission and long-term oxygen therapy during hospital stay were independent predictors of 30-day readmission.
Collapse
Affiliation(s)
- Zenebe Kano Anbesse
- Clinical Pharmacy Unit, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teshale Ayele Mega
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Behailu Terefe Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Getandale Zeleke Negera
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| |
Collapse
|
3
|
Alqahtani JS, Njoku CM, Bereznicki B, Wimmer BC, Peterson GM, Kinsman L, Aldabayan YS, Alrajeh AM, Aldhahir AM, Mandal S, Hurst JR. Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis. Eur Respir Rev 2020; 29:29/156/190166. [PMID: 32499306 DOI: 10.1183/16000617.0166-2019] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/18/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Readmission rates following hospitalisation for COPD exacerbations are unacceptably high, and the contributing factors are poorly understood. Our objective was to summarise and evaluate the factors associated with 30- and 90-day all-cause readmission following hospitalisation for an exacerbation of COPD. METHODS We systematically searched electronic databases from inception to 5 November 2019. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesised a narrative from eligible studies and conducted a meta-analysis where this was possible using a random-effects model. RESULTS In total, 3533 abstracts were screened and 208 full-text manuscripts were reviewed. A total of 32 papers met the inclusion criteria, and 14 studies were included in the meta-analysis. The readmission rate ranged from 8.8-26.0% at 30 days and from 17.5-39.0% at 90 days. Our narrative synthesis showed that comorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital stay were the major risk factors for readmission at 30 and 90 days. Pooled adjusted odds ratios (95% confidence intervals) revealed that heart failure (1.29 (1.22-1.37)), renal failure (1.26 (1.19-1.33)), depression (1.19 (1.05-1.34)) and alcohol use (1.11 (1.07-1.16)) were all associated with an increased risk of 30-day all-cause readmission, whereas being female was a protective factor (0.91 (0.88-0.94)). CONCLUSIONS Comorbidities, previous exacerbations and hospitalisation, and increased length of stay were significant risk factors for 30- and 90-day all-cause readmission after an index hospitalisation with an exacerbation of COPD.
Collapse
Affiliation(s)
- Jaber S Alqahtani
- UCL Respiratory, University College London, London, UK .,Dept of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Chidiamara M Njoku
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Bonnie Bereznicki
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Barbara C Wimmer
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Gregory M Peterson
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Port Macquarie, Australia
| | - Yousef S Aldabayan
- UCL Respiratory, University College London, London, UK.,Dept of Respiratory Care, King Faisal University, Al Ahsa, Saudi Arabia
| | - Ahmed M Alrajeh
- UCL Respiratory, University College London, London, UK.,Dept of Respiratory Care, King Faisal University, Al Ahsa, Saudi Arabia
| | - Abdulelah M Aldhahir
- UCL Respiratory, University College London, London, UK.,Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Swapna Mandal
- UCL Respiratory, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| |
Collapse
|
4
|
Validation of the BOOST Risk Stratification Tool as a Predictor of Unplanned 30-Day Readmission in Elderly Patients. Qual Manag Health Care 2019; 28:96-102. [PMID: 30921282 DOI: 10.1097/qmh.0000000000000206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Risk stratification tools can identify patients at risk for 30-day readmission, but available tools lack predictive strength. One of these tools is the Better Outcomes by Optimizing Safe Transitions (BOOST) 8 P's tool. OBJECTIVES The primary objective of this study was to validate the 8 P's tool as well as measure the predictive strength of variables within this tool. METHODS This was a quantitative study that included 1 year of hospitalized elderly patients (n = 6849). Odds ratios were used to determine the strength of the association between variables individually with readmission. Multivariable logistic regression was used to evaluate the predictive strength of the BOOST risk stratification tool. RESULTS This study demonstrated that 5 of the 8 variables in the BOOST risk stratification tool showed significant association with 30-day readmission including the variables of health literacy (P = .030), depression (P = .003), problem medications (P = .001), physical limitations (P ≤ .001), and prior hospitalization (P ≤ .001). Combining variables using multivariable logistic regression, the BOOST 8 P's tool had limited predictive capability with a C-statistic of 0.631. CONCLUSION This study was the first attempt to validate the BOOST 8 P's tool and to utilize nursing documentation within an electronic medical record to capture social determinants of health.
Collapse
|
5
|
Kurpas D, Szwamel K, Lenarcik D, Guzek M, Prusaczyk A, Żuk P, Michalowska J, Grzeda A, Mroczek B. Effectiveness of Healthcare Coordination in Patients with Chronic Respiratory Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1040:47-62. [PMID: 28801791 DOI: 10.1007/5584_2017_84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Coordination of healthcare effectively prevents exacerbations and reduces the number of hospitalizations, emergency visits, and the mortality rate in patients with chronic respiratory diseases. The purpose of this study was to determine clinical effectiveness of ambulatory healthcare coordination in chronic respiratory patients and its effect on the level of healthcare services as an indicator of direct medical costs. We conducted a retrospective health record survey, using an online database of 550 patients with chronic respiratory diseases. There were decreases in breathing rate, heart rate, and the number of cigarettes smoked per day, and forced vital capacity (FVC) and forced expired volume in 1 s (FEV1) increased after the implementation of the coordinated healthcare structure. These benefits were accompanied by increases in the number of visits to the pulmonary outpatient clinic (p < 0.001), diagnostic costs (p < 0.001), and referrals to other outpatient clinics (p < 0.003) and hospitals (p < 0.001). The advantageous effects of healthcare coordination on clinical status of respiratory patients above outlined persisted over a 3-year period being reviewed.
Collapse
Affiliation(s)
- Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, 1 Syrokomli St., 51-141, Wroclaw, Poland.
- Opole Medical School, 68 Katowicka Street, 45-060, Opole, Poland.
| | - Katarzyna Szwamel
- Department of Family Medicine, Wroclaw Medical University, 1 Syrokomli St., 51-141, Wroclaw, Poland
- Opole Medical School, 68 Katowicka Street, 45-060, Opole, Poland
| | - Dorota Lenarcik
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | - Marika Guzek
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | - Artur Prusaczyk
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | - Paweł Żuk
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | | | - Agnieszka Grzeda
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | - Bożena Mroczek
- Department of Humanities in Medicine, Pomeranian Medical University, 11 Generała Chlapowskiego Street, 70-204, Szczecin, Poland
| |
Collapse
|
6
|
Post hospitalization management of patients with COPD. Nurs Manag (Harrow) 2017; 49:14-21. [PMID: 29287045 DOI: 10.1097/01.numa.0000527713.06404.d1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
de Miguel-Díez J, Jiménez-García R, Hernández-Barrera V, Carrasco-Garrido P, Puente Maestu L, Ramírez García L, López de Andrés A. Readmissions following an initial hospitalization by COPD exacerbation in Spain from 2006 to 2012. Respirology 2015; 21:489-96. [DOI: 10.1111/resp.12705] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/02/2015] [Accepted: 09/15/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Javier de Miguel-Díez
- Pneumology Department, Hospital General Universitario Gregorio Marañón; Universidad Complutense de Madrid; Madrid Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences; Universidad Rey Juan Carlos; Madrid Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences; Universidad Rey Juan Carlos; Madrid Spain
| | - Pilar Carrasco-Garrido
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences; Universidad Rey Juan Carlos; Madrid Spain
| | - Luis Puente Maestu
- Pneumology Department, Hospital General Universitario Gregorio Marañón; Universidad Complutense de Madrid; Madrid Spain
| | - Laura Ramírez García
- Pneumology Department, Hospital General Universitario Gregorio Marañón; Universidad Complutense de Madrid; Madrid Spain
| | - Ana López de Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences; Universidad Rey Juan Carlos; Madrid Spain
| |
Collapse
|