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Chow R, So OW, Im JHB, Chapman KR, Orchanian-Cheff A, Gershon AS, Wu R. Predictors of Readmission, for Patients with Chronic Obstructive Pulmonary Disease (COPD) - A Systematic Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2581-2617. [PMID: 38022828 PMCID: PMC10664718 DOI: 10.2147/copd.s418295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/08/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally and is responsible for over 3 million deaths annually. One of the factors contributing to the significant healthcare burden for these patients is readmission. The aim of this review is to describe significant predictors and prediction scores for all-cause and COPD-related readmission among patients with COPD. Methods A search was conducted in Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from database inception to June 7, 2022. Studies were included if they reported on patients at least 40 years old with COPD, readmission data within 1 year, and predictors of readmission. Study quality was assessed. Significant predictors of readmission and the degree of significance, as noted by the p-value, were extracted for each study. This review was registered on PROSPERO (CRD42022337035). Results In total, 242 articles reporting on 16,471,096 patients were included. There was a low risk of bias across the literature. Of these, 153 studies were observational, reporting on predictors; 57 studies were observational studies reporting on interventions; and 32 were randomized controlled trials of interventions. Sixty-four significant predictors for all-cause readmission and 23 for COPD-related readmission were reported across the literature. Significant predictors included 1) pre-admission patient characteristics, such as male sex, prior hospitalization, poor performance status, number and type of comorbidities, and use of long-term oxygen; 2) hospitalization details, such as length of stay, use of corticosteroids, and use of ventilatory support; 3) results of investigations, including anemia, lower FEV1, and higher eosinophil count; and 4) discharge characteristics, including use of home oxygen and discharge to long-term care or a skilled nursing facility. Conclusion The findings from this review may enable better predictive modeling and can be used by clinicians to better inform their clinical gestalt of readmission risk.
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Affiliation(s)
- Ronald Chow
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Olivia W So
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - James H B Im
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Kenneth R Chapman
- University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Andrea S Gershon
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Robert Wu
- University Health Network, University of Toronto, Toronto, ON, Canada
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Wang JM, Labaki WW, Murray S, Martinez FJ, Curtis JL, Hoffman EA, Ram S, Bell AJ, Galban CJ, Han MK, Hatt C. Machine learning for screening of at-risk, mild and moderate COPD patients at risk of FEV 1 decline: results from COPDGene and SPIROMICS. Front Physiol 2023; 14:1144192. [PMID: 37153221 PMCID: PMC10161244 DOI: 10.3389/fphys.2023.1144192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose: The purpose of this study was to train and validate machine learning models for predicting rapid decline of forced expiratory volume in 1 s (FEV1) in individuals with a smoking history at-risk-for chronic obstructive pulmonary disease (COPD), Global Initiative for Chronic Obstructive Lung Disease (GOLD 0), or with mild-to-moderate (GOLD 1-2) COPD. We trained multiple models to predict rapid FEV1 decline using demographic, clinical and radiologic biomarker data. Training and internal validation data were obtained from the COPDGene study and prediction models were validated against the SPIROMICS cohort. Methods: We used GOLD 0-2 participants (n = 3,821) from COPDGene (60.0 ± 8.8 years, 49.9% male) for variable selection and model training. Accelerated lung function decline was defined as a mean drop in FEV1% predicted of > 1.5%/year at 5-year follow-up. We built logistic regression models predicting accelerated decline based on 22 chest CT imaging biomarker, pulmonary function, symptom, and demographic features. Models were validated using n = 885 SPIROMICS subjects (63.6 ± 8.6 years, 47.8% male). Results: The most important variables for predicting FEV1 decline in GOLD 0 participants were bronchodilator responsiveness (BDR), post bronchodilator FEV1% predicted (FEV1.pp.post), and CT-derived expiratory lung volume; among GOLD 1 and 2 subjects, they were BDR, age, and PRMlower lobes fSAD. In the validation cohort, GOLD 0 and GOLD 1-2 full variable models had significant predictive performance with AUCs of 0.620 ± 0.081 (p = 0.041) and 0.640 ± 0.059 (p < 0.001). Subjects with higher model-derived risk scores had significantly greater odds of FEV1 decline than those with lower scores. Conclusion: Predicting FEV1 decline in at-risk patients remains challenging but a combination of clinical, physiologic and imaging variables provided the best performance across two COPD cohorts.
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Affiliation(s)
- Jennifer M. Wang
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Susan Murray
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | | | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Alexander J. Bell
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Craig J. Galban
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Charles Hatt
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Imbio Inc., Minneapolis, MN, United States
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Prognostic Role of Chronic Obstructive Pulmonary Disease and Asthma Physiology Score for in-Hospital and 1-year Mortality in Patients with Acute Exacerbations of COPD. Can Respir J 2022; 2022:4110562. [PMID: 35509893 PMCID: PMC9061051 DOI: 10.1155/2022/4110562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) often lead to high mortality. Chronic obstructive pulmonary disease and asthma physiology score (CAPS) is a simple clinical severity score. The aim of this study was to explore whether CAPS could be an effective predictor for in-hospital and 1-year mortality in AECOPD patients. Methods. We used CAPS to grade all patients and record their clinical characteristics. The receiver operator characteristic (ROC) curve was used to determine the cut-off of CAPS that discriminated survivors and non-survivors. Univariate and multivariate logistic regression analyses and Cox regression analyses were used to identify the risk factors for in-hospital and 1-year mortality, respectively. Results. 240 patients were enrolled in our study; 18 patients died during hospitalization and 29 patients died during the 1-year follow-up. Compared with in-hospital survivors, those who died were older (80.83 ± 6.06 vs. 76.94 ± 8.30 years old, P = 0.019) and had a higher percentage of congestive heart failure (61.1% vs. 14.4%, P < 0.001), higher CAPS levels (31.11 ± 10.05 vs. 16.49 ± 7.11 points, P < 0.001), and a lower BMI (19.48 ± 3.26 vs. 21.50 ± 3.86, P = 0.032). The area under the ROC curve of CAPS for in-hospital death was 0.91 (95% CI: 0.85–0.96) with a sensitivity of 0.889 and a specificity of 0.802 for a cut-off point of 21 points. CAPS ≥21 points was an independent risk factor for in-hospital mortality after adjustment for relative risk (RR) (RR = 13.28, 95% CI: 1.97–89.53, P = 0.008). Univariate Cox regression analysis showed that a CAPS ≥21 points (HR = 4.07, 95% CI: 1.97–8.44) was a risk factor for 1-year mortality. However, multivariate Cox regression analysis showed that CAPS (HR = 2.24, 95% CI: 0.90–5.53) was not associated with 1-year mortality. Conclusion: A CAPS ≥21 points was a strong and independent risk factor for in-hospital mortality in AECOPD patients and CAPS had no impact on the 1-year mortality in patients with acute exacerbations of COPD after discharge.
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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.
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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:
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5
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Adler D, Cavalot G, Brochard L. Comorbidities and Readmissions in Survivors of Acute Hypercapnic Respiratory Failure. Semin Respir Crit Care Med 2020; 41:806-816. [PMID: 32746468 DOI: 10.1055/s-0040-1710074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is defined by chronic airflow obstruction, but is presently considered as a complex, heterogeneous, and multicomponent disease in which comorbidities and extrapulmonary manifestations make important contributions to disease expression. COPD-related hospital readmission. In particular frequent intensive care unit (ICU) readmissions for exacerbations represent a major challenge and place a high burden on patient outcomes and health-related quality of life, as well as on the healthcare system.In this narrative review, we first address major and often undiagnosed comorbidities associated with COPD that could have an impact on hospital readmission after an index ICU admission for acute hypercapnic respiratory failure. Some guidance for treatment is discussed. Second, we present predictors of hospital and ICU readmission and discuss various strategies to reduce such events.There is a strong rationale to detect and treat major comorbidities early after index ICU admission for acute hypercapnic respiratory failure. It still remains unclear, however, if a comprehensive and holistic approach to comorbidities in frail patients surviving hypercapnic respiratory failure can efficiently reduce the readmission rate.
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Affiliation(s)
- Dan Adler
- Division of Lung Diseases, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva Medical School, Geneva, Switzerland
| | - Giulia Cavalot
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.,Division of Internal Medicine, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
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Njoku CM, Alqahtani JS, Wimmer BC, Peterson GM, Kinsman L, Hurst JR, Bereznicki BJ. Risk factors and associated outcomes of hospital readmission in COPD: A systematic review. Respir Med 2020; 173:105988. [PMID: 33190738 DOI: 10.1016/j.rmed.2020.105988] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of unplanned readmission. There is need to identify risk factors for, and strategies to prevent readmission in patients with COPD. AIM To systematically review and summarise the prevalence, risk factors and outcomes associated with rehospitalisation due to COPD exacerbation. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Five databases were searched for relevant studies. RESULTS Fifty-seven studies from 30 countries met the inclusion criteria. The prevalence of COPD-related readmission varied from 2.6 to 82.2% at 30 days, 11.8-44.8% at 31-90 days, 17.9-63.0% at 6 months, and 25.0-87.0% at 12 months post-discharge. There were differences in the reported factors associated with readmissions, which may reflect variations in the local context, such as the availability of community-based services to care for exacerbations of COPD. Hospitalisation in the previous year prior to index admission was the key predictor of COPD-related readmission. Comorbidities (in particular asthma), living in a deprived area and living in or discharge to a nursing home were also associated with readmission. Relative to those without readmissions, readmitted patients had higher in-hospital mortality rates, shorter long-term survival, poorer quality of life, longer hospital stay, increased recurrence of subsequent readmissions, and accounted for greater healthcare costs. CONCLUSIONS Hospitalisation in the previous year was the principal risk factor for COPD-related readmissions. Variation in the prevalence and the reported factors associated with COPD-related readmission indicate that risk factors cannot be generalised, and interventions should be tailored to the local healthcare environment.
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Affiliation(s)
- Chidiamara M Njoku
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
| | - Jaber S Alqahtani
- UCL Respiratory, University College London, London, UK; Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Barbara C Wimmer
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Port Macquarie, New South Wales, Australia
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Bonnie J Bereznicki
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Zhang J, Yao W, You X, Liu T, Liu Y. Comparative analysis of medical expenditure with nebulized budesonide versus systemic corticosteroids in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease in China. Int J Chron Obstruct Pulmon Dis 2019; 14:1195-1207. [PMID: 31213797 PMCID: PMC6549719 DOI: 10.2147/copd.s182015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 04/25/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and is a leading cause of disability in China. Acute exacerbations of COPD (AECOPD) are a leading cause of hospitalizations, and account for a substantial proportion of medical expenditure. Corticosteroids are commonly used to manage AECOPD in hospitalized patients, so our objective was to analyze the total medical expenditure associated with nebulized budesonide (nBUD) vs. systemic corticosteroids (SCS) in this population. Patients and methods: A post-hoc analysis was carried out in 1,577 and 973 patients diagnosed with COPD who had received “any” nBUD or SCS regimen for AECOPD during hospitalization, respectively. Regimens included monotherapy, sequential therapy, and sequential-combination therapy. Comparative total medical expenditure was analyzed using a generalized linear model controlling for age, gender, comorbidities, smoking history, and respiratory failure or pneumonia on admission. Results: The total medical expenditure per capita with any nBUD or SCS regimen was CN¥11,814 (US$1,922) and CN¥12,153 (US$1,977), respectively. Any nBUD regimen was associated with a significant saving of 5.1% in expenditure compared with any SCS regimen (P=0.0341). Comorbidities, Type II respiratory failure, or pneumonia were patient factors associated with higher total medical expenditure (P<0.0001). In a subgroup analysis of the patients who received monotherapy, total medical expenditure was CN¥10,900 (US$1,773) for nBUD and CN¥11,581 (US$1,884) for SCS; nBUD was associated with a significant saving of 8.7% in expenditure compared with SCS (P=0.0013). Similarly, in patients with respiratory failure, treatment with any nBUD regimen was associated with a 10.6% saving in expenditure over any SCS regimen (P=0.0239); however, the same comparison was not significant in patients without respiratory failure (3.4%; P=0.2299). Conclusion: AECOPD is a leading cause of hospitalization in China, which places substantial burden on the healthcare system. This post-hoc analysis suggests that nBUD regimens are associated with lower medical expenditure than SCS regimens in hospitalized patients with AECOPD, and may reduce the financial burden of COPD. However, prospective studies evaluating the effectiveness of nBUD therapies are warranted.
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Affiliation(s)
- Jing Zhang
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wanzhen Yao
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xuedan You
- Medical Affairs, AstraZeneca, Beijing, People's Republic of China
| | - Tianyi Liu
- Medical Affairs, AstraZeneca, Beijing, People's Republic of China
| | - Yuantao Liu
- Medical Affairs, AstraZeneca, Shanghai, People's Republic of China
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8
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Gershon AS, Thiruchelvam D, Aaron S, Stanbrook M, Vozoris N, Tan WC, Cho E, To T. Socioeconomic status (SES) and 30-day hospital readmissions for chronic obstructive pulmonary (COPD) disease: A population-based cohort study. PLoS One 2019; 14:e0216741. [PMID: 31112573 PMCID: PMC6528994 DOI: 10.1371/journal.pone.0216741] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/26/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) are more likely to be readmitted than patients with other chronic medical conditions, yet knowledge regarding such readmissions is limited. We aimed to determine factors associated with readmission within 30 days of a COPD hospitalization or death with an emphasis on examining aspects of socioeconomic status and specific comorbidities. METHODS A population-based cohort study was conducted using health administrative data from Ontario, Canada. All hospitalizations for COPD between 2004 and 2014 were considered. The primary exposures were socioeconomic status as measured by residential instability (an ecologic variable), and comorbidities such as cardiovascular disease and cancer. Other domains of socioeconomic status were considered as secondary exposures. Logistic regression with generalized estimating equations was used to examine the effect of exposures, adjusting for other patient factors, on 30-day readmission or death. RESULTS There were 126,013 patients contributing to 252,756 index COPD hospitalizations from 168 Ontario hospitals. Of these hospitalizations, 19.4% resulted in a readmission and 2.8% resulted in death within 30 days. After adjusting for other factors, readmissions or death were modestly more likely among people with the highest residential instability compared to the lowest (OR 1.05, 95% CI 1.01-1.09). Comorbidities such as cardiovascular disease and cancer, as well as other aspects of low socioeconomic status also increased readmission or death risk. INTERPRETATION Socioeconomic status, measured in various ways, and many comorbidities predict 30-day readmission or death in patients hospitalized for COPD. Strategies that address these factors may help reduce readmissions and death.
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Affiliation(s)
- Andrea S. Gershon
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- * E-mail:
| | - Deva Thiruchelvam
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Shawn Aaron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Matthew Stanbrook
- Asthma & Airway Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Nicholas Vozoris
- Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Wan C. Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eunice Cho
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Teresa To
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
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Tang FWK, Lee DTF. A Phenomenological Study of Hospital Readmissions of Chinese Older People With COPD. THE GERONTOLOGIST 2018; 57:1113-1122. [PMID: 27789524 DOI: 10.1093/geront/gnw134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 07/22/2016] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study Hospital readmission is prevalent among older people with chronic obstructive pulmonary disease (COPD). Studies in this area have primarily identified the associated factors. A thorough understanding of the issue can be achieved by interpreting the related experiences in its context. This study aimed to explore the lived experience of hospital readmissions of Chinese older people with COPD. Design and Methods The lived experience of hospital readmissions was acquired through descriptive phenomenology. Unstructured interviews were conducted with 22 Chinese older people readmitted to a hospital for COPD. Narrative descriptions were analyzed using the phenomenological method described by Giorgi. Results Six constituents emerged from the general structure of the lived experience. "Refraining from unnecessary readmissions" describes how older people manage COPD in relation to hospital readmissions. "Craving for survival" explains why they seek hospital readmissions. "Feeling disregarded and powerless" and "being conscious of relieving burden to families" characterize their experience of hospital readmissions. "Resigning to hospital readmissions" illustrates how they understand the phenomenon, and "living for the moment" illuminates how they live with these experiences. These constituents are interrelated in meaningful ways and comprise the whole phenomenon of hospital readmissions. Implications The Chinese older people's experience revealed that hospital readmissions are complex experiences shaped by their sociocultural context. Older people appear to accept and cope well with hospital readmissions. However, this study uncovered their unmet needs, which may undermine their dignity. The findings of this study offer implications for promoting wellness among Chinese older people with COPD.
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Affiliation(s)
- Fiona Wing-Ki Tang
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, China
| | - Diana Tze-Fan Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, China
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Wei X, Ma Z, Yu N, Ren J, Jin C, Mi J, Shi M, Tian L, Gao Y, Guo Y. Risk factors predict frequent hospitalization in patients with acute exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2017; 13:121-129. [PMID: 29343951 PMCID: PMC5749567 DOI: 10.2147/copd.s152826] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose COPD is a heterogeneous disease, and the available prognostic indexes are therefore limited. This study aimed to identify the factors associated with acute exacerbation leading to hospitalization. Patients and methods This was a retrospective study of consecutive patients with COPD (meeting the Global Initiative for Chronic Obstructive Lung Disease [GOLD] diagnostic criteria) hospitalized at the Ninth Hospital of Xi’an Affiliated Hospital of Xi’an Jiaotong University between October 2014 and September 2016. During follow-up after first hospitalization, the patients who had been rehospitalized within 1 year for acute exacerbation were grouped into the frequent exacerbation (FE) group, while the others were grouped into the infrequent exacerbation (IE) group. The baseline demographic, clinical, laboratory, pulmonary function, and imaging data were compared between the two groups. Results Compared with the IE group, the FE group had lower forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) (P=0.005), FEV1%pred (P=0.002), maximal mid-expiratory flow (MMEF25–75%pred) (P=0.003), and ratio of carbon monoxide diffusion capacity to alveolar ventilation (DLCO/VA) (P=0.03) and higher resonant frequency (Fres; P=0.04). According to generations of bronchi, the percentage of the wall area (%WA) of lobes was found to be higher in the FE group. Emphysema index (EI), mean emphysema density (MED)whole and MEDleft lung in the FE group were significantly worse than in the IE group (P<0.05). Using logistic regression, exacerbation hospitalizations in the past year (odds ratio [OR] 14.4, 95% CI 6.1–34.0, P<0.001) and EI >10% (OR 2.9, 95% CI 1.2–7.1, P=0.02) were independently associated with frequent acute exacerbation of COPD (AECOPD) hospitalization. Conclusion Exacerbation hospitalizations in the past year and imaging features of emphysema (EI) were independently associated with FE hospitalization.
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Affiliation(s)
- Xia Wei
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University.,Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - Zhengquan Ma
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - Nan Yu
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Jingting Ren
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - Chenwang Jin
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University
| | - Jiuyun Mi
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - Meijuan Shi
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University
| | - Libin Tian
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an
| | - Yanzhong Gao
- Department of Radiology, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Youmin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University
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Riesco JA, Alcázar B, Trigueros JA, Campuzano A, Pérez J, Lorenzo JL. Active smoking and COPD phenotype: distribution and impact on prognostic factors. Int J Chron Obstruct Pulmon Dis 2017; 12:1989-1999. [PMID: 28740378 PMCID: PMC5505548 DOI: 10.2147/copd.s135344] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Smoking can affect both the phenotypic expression of COPD and factors such as disease severity, quality of life, and comorbidities. Our objective was to evaluate if the impact of active smoking on these factors varies according to the disease phenotype. PATIENTS AND METHODS This was a Spanish, observational, cross-sectional, multicenter study of patients with a diagnosis of COPD. Smoking rates were described among four different phenotypes (non-exacerbators, asthma-COPD overlap syndrome [ACOS], exacerbators with emphysema, and exacerbators with chronic bronchitis), and correlated with disease severity (body mass index, obstruction, dyspnea and exacerbations [BODEx] index and dyspnea grade), quality of life according to the COPD assessment test (CAT), and presence of comorbidities, according to phenotypic expression. RESULTS In total, 1,610 patients were recruited, of whom 46.70% were classified as non-exacerbators, 14.53% as ACOS, 16.37% as exacerbators with emphysema, and 22.40% as exacerbators with chronic bronchitis. Smokers were predominant in the latter 2 groups (58.91% and 57.67%, respectively, P=0.03). Active smoking was significantly associated with better quality of life and a higher dyspnea grade, although differences were observed depending on clinical phenotype. CONCLUSION Active smoking is more common among exacerbator phenotypes and appears to affect quality of life and dyspnea grade differently, depending on the clinical expression of the disease.
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Affiliation(s)
- Juan Antonio Riesco
- Pulmonology Department, Hospital San Pedro de Alcántara
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Cáceres
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Caballero A, Pinilla MI, Mendoza ICS, Peña JRA. [Hospital readmission rate and associated factors among health services enrollees in Colombia]. CAD SAUDE PUBLICA 2017; 32:S0102-311X2016000705009. [PMID: 27462855 DOI: 10.1590/0102-311x00146014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/18/2016] [Indexed: 11/22/2022] Open
Abstract
Hospital readmissions are common and expensive, and there is little information on the problem in Colombia. The objective was to determine the frequency of 30-day all-cause hospital readmissions and associated factors. This was a retrospective analytical cohort study of 64,969 hospitalizations from January 2008 to January 2009 in 47 Colombian cities. 6,573 hospital readmissions, prevalence: 10.1% (men 10.9%, women 9.5%), 44.7% > 65 years of age. Hospital readmissions was associated with higher mortality (5.8% vs. 1.8%). There was an increase in the Hospital readmissions rate in patients with diseases of the circulatory system. Hospital readmissions was more likely in hematological diseases and neoplasms. Mean length of stay during the first readmission was 7 days in patients that were readmitted and 4.5 in those without readmission. Greater total cost of hospital readmissions (USA 21,998,275): 15.8% of the total cost of hospitalizations. Higher prevalence rates in referred patients (18.8%) and patients from the outpatient clinic (13.7%). Hospital readmissions is common and is associated with longer length of hospital stay and higher mortality and cost. Increased risk of hospital readmissions in men > 65 years, patients referred from other institutions, and in hematological diseases and neoplasms.
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Alshabanat A, Otterstatter MC, Sin DD, Road J, Rempel C, Burns J, van Eeden SF, FitzGerald JM. Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates. Int J Chron Obstruct Pulmon Dis 2017; 12:961-971. [PMID: 28356728 PMCID: PMC5367737 DOI: 10.2147/copd.s124385] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing. Aim The aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD. Materials and methodology We retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90 days. We compared numbers, rates, and intervals of readmission and LOS during 2 years of active program delivery compared to 1 year prior to program implementation. Results A total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3 years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all causes showed a significant decline, with hazard ratios (HRs) of 0.55 (year 1) and 0.51 (year 2) of intervention (P<0.001). In addition, patients’ mean LOS (days) for COPD-related admissions declined significantly from 10.8 to 6.8 (P<0.05). Conclusion A comprehensive disease management program for COPD patients, including education, case management, and follow-up, was associated with significant reduction in hospital admissions and LOS.
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Affiliation(s)
| | | | - Don D Sin
- Department of Medicine, Centre for Heart Lung Innovation, St Paul's Hospital; Division of Respirology, Department of Medicine
| | - Jeremy Road
- Division of Respirology, Department of Medicine; Department of Medicine, Faculty of Medicine, Institute for Heart and Lung Health, University of British Columbia
| | - Carmen Rempel
- Department of Medicine, Faculty of Medicine, Institute for Heart and Lung Health, University of British Columbia
| | - Jane Burns
- Department of Medicine, Faculty of Medicine, Institute for Heart and Lung Health, University of British Columbia
| | - Stephan F van Eeden
- Department of Medicine, Centre for Heart Lung Innovation, St Paul's Hospital; Division of Respirology, Department of Medicine
| | - J M FitzGerald
- Division of Respirology, Department of Medicine; Department of Medicine, Faculty of Medicine, Institute for Heart and Lung Health, University of British Columbia; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, BC, Canada
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14
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García-Rivero JL, Esquinas C, Barrecheguren M, Bonnin-Vilaplana M, García-Sidro P, Herrejón A, Martinez-Rivera C, Malo de Molina R, Marcos PJ, Mayoralas S, Naval E, Ros JA, Valle M, Miravitlles M. Risk Factors of Poor Outcomes after Admission for a COPD Exacerbation: Multivariate Logistic Predictive Models. COPD 2016; 14:164-169. [PMID: 27983876 DOI: 10.1080/15412555.2016.1260538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to identify a multivariate model to predict poor outcomes after admission for exacerbation of chronic obstructive pulmonary disease (COPD). We performed a multicenter, observational, prospective study. Patients admitted to hospital for COPD were followed up for 3 months. Relevant clinical variables at admission were selected. For each variable, the best cut-offs for the risk of poor outcome were identified using receiver operating characteristic (ROC) curves. Finally, a stepwise logistic regression model was performed. A total of 106 patients with a mean age of 71.1 (9.8) years were included. The mean maximum expiratory volume in the first second (FEV1)(%) was 45.2%, and the mean COPD assessment test (CAT) score at admission was 24.8 (7.1). At 3 months, 39 (36.8%) patients demonstrated poor outcomes: death (2.8%), readmission (20.8%) or new exacerbation (13.2%). Variables included in the logistic model were: previous hospital admission, FEV1 < 45%, Charlson ≥ 3, hemoglobin (Hb)<13 g/L, PCO2 ≥ 46 mmHg, fibrinogen ≥ 554 g/L, C-reactive protein (CRP)≥45 mg/L, leukocyte count < 9810 × 109/L, purulent sputum, long-term oxygen therapy (LTOT) and CAT ≥ 31 at admission. The final model showed that Hb < 13 g/L (OR = 2.46, 95%CI 1.09-6.36), CRP ≥ 45 mg/L (OR = 2.91, 95%CI: 1.11-7.49) and LTOT (3.07, 95%CI: 1.07-8.82) increased the probability of poor outcome up to 82.4%. Adding a CAT ≥ 31 at admission increased the probability to 91.6% (AUC = 0.75; p = 0.001). Up to 36.8% of COPD patients had a poor outcome within 3 months after hospital discharge, with low hemoglobin and high CRP levels being the risk factors for poor outcome. A high CAT at admission increased the predictive value of the model.
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Affiliation(s)
| | - Cristina Esquinas
- b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
| | - Miriam Barrecheguren
- b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
| | | | | | | | | | | | | | | | - Elsa Naval
- j Hospital de La Ribera , Alzira , Spain
| | | | - Manuel Valle
- g Hospital Puerta del Hierro , Majadahonda , Spain
| | - Marc Miravitlles
- b Pneumology Department , Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
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Hermiller JB, Yakubov SJ, Reardon MJ, Deeb GM, Adams DH, Afilalo J, Huang J, Popma JJ. Predicting Early and Late Mortality After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2016; 68:343-52. [DOI: 10.1016/j.jacc.2016.04.057] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/17/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
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Sahin H, Varol Y, Naz I, Aksel N, Tuksavul F, Ozsoz A. The effect of pulmonary rehabilitation on COPD exacerbation frequency per year. CLINICAL RESPIRATORY JOURNAL 2016; 12:165-174. [PMID: 27240018 DOI: 10.1111/crj.12507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/21/2016] [Accepted: 05/23/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to investigate the effect of pulmonary rehabilitation (PR) on the number of exacerbations in chronic obstructive pulmonary diseases (COPD) patients. METHODS The study included 82 patients referred to our hospital's PR Unit between June 2013 and June 2014. Patients were divided into two groups, including those with low exacerbation risk (low number of exacerbations) (Groups A + B) and those experiencing frequent exacerbations (Groups C+ D) according to the combined COPD assessment. RESULTS Patients were included in a PR program that consisted of 16 sessions in total, held twice a week over a period of 2 months. After one year, patients were called to find out about their COPD exacerbation frequency. Groups presented similar characteristics in terms of age, BMI and smoking duration prior to the PR program (P > .05). The frequent exacerbators had lower scores in exercise capacity, arterial oxygenation, health-related quality of life and anxiety (P < .05). However, both groups exhibited significantly improved scores in the perceived dyspnea, FEV1 percentage, arterial oxygenation, exercise capacity, quality of life and anxiety after pulmonary rehabilitation (P < .05). The number of post-PR emergency referrals and hospitalization (P < .0001, P = .04), and depression score decreased significantly among the frequent exacerbators. Group 1 presented insignificant changes in the number of emergency referrals and hospitalizations (P < .05). CONCLUSION Notwithstanding disease severity, PR treatment is reported to have positive effects on COPD patients in terms of perceived dyspnea, exercise capacity, arterial oxygenation, quality of life, anxiety and depression. This study found reduced number of emergency referrals and hospitalization among COPD patients with frequent exacerbations after PR.
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Affiliation(s)
- Hulya Sahin
- Department of Pulmonary Rehabilitation, Pulmonary Rehabilitation Unit, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Yelda Varol
- Department of Chest Diseases, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Ilknur Naz
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Katip Celebi University, Izmir, Turkey
| | - Nimet Aksel
- Department of Chest Diseases, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Fevziye Tuksavul
- Department of Pulmonary Rehabilitation, Pulmonary Rehabilitation Unit, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Ayse Ozsoz
- Department of Chest Diseases, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
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García-Sanz MT, Cánive-Gómez JC, García-Couceiro N, Senín-Rial L, Alonso-Acuña S, Barreiro-García A, López-Val E, Valdés L, González-Barcala FJ. Factors associated with the incidence of serious adverse events in patients admitted with COPD acute exacerbation. Ir J Med Sci 2016; 186:477-483. [PMID: 27083455 DOI: 10.1007/s11845-016-1431-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/21/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause of hospitalization. Patient outcome and prognosis following AECOPD are variable. The aim of this study is to identify the factors associated with the incidence of serious adverse events (SAE), defined as need for ICU admission, noninvasive ventilation, death during hospitalization or early readmission, in those patients admitted with AECOPD. METHODS We conducted a retrospective study by reviewing the medical records of all patients admitted with AECOPD in the University Hospital Complex of Santiago de Compostela in 2007 and 2008. To identify variables independently associated with SAE incidence, we conducted a logistic regression including those variables which proved to be significant in the univariate analysis. RESULTS 757 patients were assessed (mean age 74.8 years, SD 11.26), 77.2 % male, and 186 (24.6 %) of the patients assessed experienced an SAE. Factors associated with SAE in multivariate analysis were anticholinergic therapy (OR 3.19; CI 95 %: 1.16; 8.82), oxygen therapy at home (OR 3.72; CI 95 %: 1.62; 8.57), oxygen saturation at admission (OR 0.93; CI 95 %: 0.88; 0.99) and serum albumin (OR 0.26; CI 95 %: 0.1; 0.66). CONCLUSION Oxygen therapy at home, anticholinergic therapy as baseline treatment, lower oxygen saturation at admission and lower serum albumin level seem to be associated with higher incidence of SAE in patients with AECOPD.
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Affiliation(s)
- M-T García-Sanz
- Emergency Department, Salnés County Hospital, Vilagarcía de Arousa, Pontevedra, Spain.
| | - J-C Cánive-Gómez
- Family and Community Medicine, Hospital Complex of Pontevedra, Pontevedra, Spain
| | - N García-Couceiro
- Nursing Staff, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - L Senín-Rial
- Nursing Staff, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - S Alonso-Acuña
- Nursing Staff, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - A Barreiro-García
- Nursing Staff, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - E López-Val
- Nursing Staff, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - L Valdés
- Pneumology Service, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - F-J González-Barcala
- Pneumology Service, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
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Al Aqqad SM, Tangiisuran B, Hyder Ali IA, Md. Kassim RMN, Wong JL, Tengku Saifudin TI. Hospitalisation of multiethnic older patients with AECOPD: exploration of the occurrence of anxiety, depression and factors associated with short-term hospital readmission. CLINICAL RESPIRATORY JOURNAL 2016; 11:960-967. [DOI: 10.1111/crj.12448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 12/14/2015] [Accepted: 12/24/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Sana’ M.H. Al Aqqad
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia; 11800 Pulau Pinang Malaysia
| | - Balamurugan Tangiisuran
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia; 11800 Pulau Pinang Malaysia
| | | | - Razul Md. Nazri Md. Kassim
- Jabatan Perubatan Respiratori, Hospital Sultanah Bahiyah, Lebuh Raya Darul Aman; Alor Setar 05350 Kedah Malaysia
| | - Jyi Lin Wong
- Hospital Umum Sarawak, Jalan Tun Ahmad Zaidi Adruce; Kuching 93586 Sarawak Malaysia
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Hunter LC, Lee RJ, Butcher I, Weir CJ, Fischbacher CM, McAllister D, Wild SH, Hewitt N, Hardie RM. Patient characteristics associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records. BMJ Open 2016; 6:e009121. [PMID: 26801463 PMCID: PMC4735181 DOI: 10.1136/bmjopen-2015-009121] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To investigate patient characteristics of an unselected primary care population associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). DESIGN Retrospective open cohort using pseudonymised electronic primary care data linked to secondary care data. SETTING Primary care; Lothian (population approximately 800,000), Scotland. PARTICIPANTS Data from 7002 patients from 72 general practices with a COPD diagnosis date between 2000 and 2008 recorded in their primary care record. Patients were followed up until 2010, death or they left a participating practice. MAIN OUTCOME MEASURES First and subsequent admissions for AECOPD (International Classification of Diseases (ICD) 10 codes J44.0, J44.1 in any diagnostic position) after COPD diagnosis in primary care. RESULTS 1756 (25%) patients had at least 1 AECOPD admission; 794 (11%) had at least 1 readmission and the risk of readmission increased with each admission. Older age at diagnosis, more severe COPD, low body mass index (BMI), current smoking, increasing deprivation, COPD admissions and interventions for COPD prior to diagnosis in primary care, and comorbidities were associated with higher risk of first AECOPD admission in an adjusted Cox proportional hazards regression model. More severe COPD and COPD admission prior to primary care diagnosis were associated with increased risk of AECOPD readmission in an adjusted Prentice-Williams-Peterson model. High BMI was associated with a lower risk of first AECOPD admission and readmission. CONCLUSIONS Several patient characteristics were associated with first AECOPD admission in a primary care cohort of people with COPD but fewer were associated with readmission. Prompt diagnosis in primary care may reduce the risk of AECOPD admission and readmission. The study highlights the important role of primary care in preventing or delaying a first AECOPD admission.
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Affiliation(s)
- L C Hunter
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, Midlothian, UK
| | - R J Lee
- Centre for Population Health Sciences, Medical School, University of Edinburgh, Edinburgh, Midlothian, UK
| | - I Butcher
- Centre for Population Health Sciences, Medical School, University of Edinburgh, Edinburgh, Midlothian, UK
| | - C J Weir
- Reader in Medical Statistics and Associate Director (Statistics) Health Services Research Unit, Centre for Population Health Sciences, Medical School, University of Edinburgh, Edinburgh, Midlothian, UK
| | - C M Fischbacher
- Clinical Director for Information Services, Information Services Division (ISD), NHS National Services Scotland, Edinburgh, Midlothian, UK
| | - D McAllister
- Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, Midlothian, UK
| | - S H Wild
- Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh, Midlothian, UK
| | - N Hewitt
- Clinical Lead, Lothian Respiratory Managed Clinical Network, NHS Lothian, Edinburgh, Midlothian, UK
| | - R M Hardie
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, Midlothian, UK
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Gaude GS, Rajesh BP, Chaudhury A, Hattiholi J. Outcomes associated with acute exacerbations of chronic obstructive pulmonary disorder requiring hospitalization. Lung India 2015; 32:465-72. [PMID: 26628761 PMCID: PMC4587001 DOI: 10.4103/0970-2113.164150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disorder (AECOPD) are known to be associated with increased morbidity and mortality and have a significant socioeconomic impact. The factors that determine frequent hospital readmissions for AECOPD are poorly understood. The present study was done to ascertain failures rates following AECOPD and to evaluate factors associated with frequent readmissions. MATERIALS AND METHODS We conducted a prospective study among 186 patients with COPD with one or more admissions for acute exacerbations in a tertiary care hospital. Frequency of previous re-admissions for AECOPD in the past year, and clinical characteristics, including spirometry were ascertained in the stable state both before discharge and at 6-month post-discharge. Failure rates following treatment were ascertained during the follow-up period. All the patients were followed up for a period of 2 years after discharge to evaluate re-admissions for the AECOPD. RESULTS Of 186 COPD patients admitted for AECOPD, 54% had one or more readmission, and another 45% had two or more readmissions over a period of 2 years. There was a high prevalence of current or ex-heavy smokers, associated co-morbidity, underweight patients, low vaccination prevalence and use of domiciliary oxygen therapy among COPD patients. A total of 12% mortality was observed in the present study. Immediate failure rates after first exacerbation was observed to be 34.8%. Multivariate analysis showed that duration >20 years (OR = 0.37; 95% CI: 0.10-0.86), use of Tiotropium (OR = 2.29; 95% CI: 1.12-4.69) and use of co-amoxiclav during first admission (OR = 2.41; 95% CI: 1.21-4.79) were significantly associated with higher immediate failure rates. The multivariate analysis for repeated admissions revealed that disease duration >10 years (OR = 0.50; 95% CI: 0.27-0.93), low usage of inhaled ICS + LABA (OR = 2.21; 95% CI: 1.08-4.54), and MRC dyspnea grade >3 (OR = 2.51; 95% CI: 1.08-5.82) were independently associated with frequent re-admissions for AECOPD. CONCLUSIONS The outcomes of patients admitted for an acute exacerbation of COPD were poor. The major factors influencing frequency of repeated COPD exacerbations were disease duration, low usage of inhaled ICS + LABA, and MRC dyspnea grade >3.
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Affiliation(s)
- Gajanan S Gaude
- Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - B P Rajesh
- Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Alisha Chaudhury
- Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Jyothi Hattiholi
- Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
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Cho KH, Kim YS, Nam CM, Kim TH, Kim SJ, Han KT, Park EC. Home oxygen therapy reduces risk of hospitalisation in patients with chronic obstructive pulmonary disease: a population-based retrospective cohort study, 2005-2012. BMJ Open 2015; 5:e009065. [PMID: 26621517 PMCID: PMC4679832 DOI: 10.1136/bmjopen-2015-009065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study evaluated the effect of home oxygen therapy (HOT) on hospital admissions in chronic obstructive pulmonary disease (COPD) patients. DESIGN AND SETTING Using nationwide health insurance claims from 2002-2012, we conducted a longitudinal population-based retrospective cohort study. PARTICIPANTS Individuals who were aged 40 years or above and newly diagnosed with COPD in 2005. OUTCOME MEASURES The primary outcome was total number of hospitalisations during the study period. Participants were matched using HOT propensity scores and were stratified by respiratory impairment (grade 1: FEV1 ≤25% or PaO2 ≤55 mm Hg; grade 2: FEV1 ≤30% or PaO2 56-60 mm Hg; grade 3: FEV1 ≤40% or PaO2 61-65 mm Hg; 'no grade': FEV1 or PaO2 unknown), then a negative binomial regression analysis was performed for each group. RESULTS Of the 36,761 COPD patients included in our study, 1330 (3.6%) received HOT. In a multivariate analysis of grade 1 patients performed before propensity score matching, the adjusted relative risk of hospitalisation for patients who did not receive HOT was 1.27 (95% CI 1.01 to 1.60). In a multivariate analysis of grade 1 patients performed after matching, the adjusted relative risk for patients who did not receive HOT was 1.65 (95% CI 1.25 to 2.18). In grade 2 or grade 3 patients, no statistical difference in hospital admission risk was detected. In the 'no grade' group of patients, HOT was associated with an increased risk of hospitalisation. CONCLUSIONS HOT reduces the risk of hospital admission in COPD patients with severe hypoxaemia. However, apart from these patients, HOT use is not associated with hospital admissions.
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Affiliation(s)
- Kyoung Hee Cho
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
- Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea
| | - Young Sam Kim
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Chung Mo Nam
- Department of Biostatistics, College of Medicine, Yonsei University, Seoul, Korea
| | - Tae Hyun Kim
- Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea
- Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Sun Jung Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
- Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea
| | - Kyu-Tae Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
- Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea
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Kerkhof M, Freeman D, Jones R, Chisholm A, Price DB. Predicting frequent COPD exacerbations using primary care data. Int J Chron Obstruct Pulmon Dis 2015; 10:2439-50. [PMID: 26609229 PMCID: PMC4644169 DOI: 10.2147/copd.s94259] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Acute COPD exacerbations account for much of the rising disability and costs associated with COPD, but data on predictive risk factors are limited. The goal of the current study was to develop a robust, clinically based model to predict frequent exacerbation risk. PATIENTS AND METHODS Patients identified from the Optimum Patient Care Research Database (OPCRD) with a diagnostic code for COPD and a forced expiratory volume in 1 second/forced vital capacity ratio <0.7 were included in this historical follow-up study if they were ≥40 years old and had data encompassing the year before (predictor year) and year after (outcome year) study index date. The data set contained potential risk factors including demographic, clinical, and comorbid variables. Following univariable analysis, predictors of two or more exacerbations were fed into a stepwise multivariable logistic regression. Sensitivity analyses were conducted for subpopulations of patients without any asthma diagnosis ever and those with questionnaire data on symptoms and smoking pack-years. The full predictive model was validated against 1 year of prospective OPCRD data. RESULTS The full data set contained 16,565 patients (53% male, median age 70 years), including 9,393 patients without any recorded asthma and 3,713 patients with questionnaire data. The full model retained eleven variables that significantly predicted two or more exacerbations, of which the number of exacerbations in the preceding year had the strongest association; others included height, age, forced expiratory volume in 1 second, and several comorbid conditions. Significant predictors not previously identified included eosinophilia and COPD Assessment Test score. The predictive ability of the full model (C statistic 0.751) changed little when applied to the validation data set (n=2,713; C statistic 0.735). Results of the sensitivity analyses supported the main findings. CONCLUSION Patients at risk of exacerbation can be identified from routinely available, computerized primary care data. Further study is needed to validate the model in other patient populations.
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Affiliation(s)
| | | | - Rupert Jones
- Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK
| | | | - David B Price
- Research in Real-Life, Cambridge, UK ; Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Srivastava K, Thakur D, Sharma S, Punekar YS. Systematic review of humanistic and economic burden of symptomatic chronic obstructive pulmonary disease. PHARMACOECONOMICS 2015; 33:467-488. [PMID: 25663178 DOI: 10.1007/s40273-015-0252-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND An understanding of the humanistic and economic burden of individuals with symptomatic chronic obstructive pulmonary disease (COPD) is required to inform payers and healthcare professionals about the disease burden. OBJECTIVES The aim of this systematic review was to identify and present humanistic [health-related quality of life (HRQoL)] and economic burdens of symptomatic COPD. METHODS A comprehensive search of online databases (reimbursement or claims databases/other databases), abstracts from conference proceedings, published literature, clinical trials, medical records, health ministries, financial reports, registries, and other sources was conducted. Adult patients of any race or gender with symptomatic COPD were included. Humanistic and economic burdens included studies evaluating HRQoL and cost and resource use, respectively, associated with symptomatic COPD. RESULTS Thirty-two studies reporting humanistic burden and 74 economic studies were identified. Symptomatic COPD led to impairment in the health state of patients, as assessed by HRQoL instruments. It was also associated with high economic burden across all countries. The overall, direct, and indirect costs per patient increased with an increase in symptoms, dyspnoea severity, and duration of disease. Across countries, the annual societal costs associated with symptomatic COPD were higher among patients with comorbidities. CONCLUSIONS Symptomatic COPD is associated with a substantial economic burden. The HRQoL of patients with symptomatic COPD is, in general, low and influenced by dyspnoea.
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Affiliation(s)
- Kunal Srivastava
- HERON Health PVT (Now Parexel), 3rd Floor, DLF Tower E, Rajiv Gandhi IT Park, Chandigarh, India
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Chang C, Zhu H, Shen N, Han X, Chen Y, He B. Utility of the combination of serum highly-sensitive C-reactive protein level at discharge and a risk index in predicting readmission for acute exacerbation of COPD. J Bras Pneumol 2014; 40:495-503. [PMID: 25410837 PMCID: PMC4263330 DOI: 10.1590/s1806-37132014000500005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 02/22/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Frequent readmissions for acute exacerbations of COPD (AECOPD) are an independent risk factor for increased mortality and use of health-care resources. Disease severity and C-reactive protein (CRP) level are validated predictors of long-term prognosis in such patients. This study investigated the utility of combining serum CRP level with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) exacerbation risk classification for predicting readmission for AECOPD. METHODS This was a prospective observational study of consecutive patients hospitalized for AECOPD at Peking University Third Hospital, in Beijing, China. We assessed patient age; gender; smoking status and history (pack-years); lung function; AECOPD frequency during the last year; quality of life; GOLD risk category (A-D; D indicating the greatest risk); and serum level of high-sensitivity CRP at discharge (hsCRP-D). RESULTS The final sample comprised 135 patients. Of those, 71 (52.6%) were readmitted at least once during the 12-month follow-up period. The median (interquartile) time to readmission was 78 days (42-178 days). Multivariate analysis revealed that serum hsCRP-D ≥ 3 mg/L and GOLD category D were independent predictors of readmission (hazard ratio = 3.486; 95% CI: 1.968-6.175; p < 0.001 and hazard ratio = 2.201; 95% CI: 1.342-3.610; p = 0.002, respectively). The ordering of the factor combinations by cumulative readmission risk, from highest to lowest, was as follows: hsCRP-D ≥ 3 mg/L and GOLD category D; hsCRP-D ≥ 3 mg/L and GOLD categories A-C; hsCRP-D < 3 mg/L and GOLD category D; hsCRP-D < 3 mg/L and GOLD categories A-C. CONCLUSIONS Serum hsCRP-D and GOLD classification are independent predictors of readmission for AECOPD, and their predictive value increases when they are used in combination.
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Affiliation(s)
- Chun Chang
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Hong Zhu
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Ning Shen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Xiang Han
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Yahong Chen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Bei He
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
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Turner AM, Sen S, Steeley C, Khan Y, Sweeney P, Richards Y, Mukherjee R. Evaluation of oxygen prescription in relation to hospital admission rate in patients with chronic obstructive pulmonary disease. BMC Pulm Med 2014; 14:127. [PMID: 25096821 PMCID: PMC4129429 DOI: 10.1186/1471-2466-14-127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 07/24/2014] [Indexed: 11/18/2022] Open
Abstract
Background Long term oxygen therapy (LTOT) has a strong evidence base in COPD patients with respiratory failure, but prescribing practices are recognized to need reform to ensure appropriate use and minimize costs. In the UK, since February 2006, all Home Oxygen prescription is issued by hospitals, making respiratory specialists totally in charge of home oxygen prescription. It has been widely noted that inappropriate home oxygen, often for intermittent use (“short burst”), is frequently prescribed in patients with COPD and related conditions with the intention to prevent hospital admissions outside of evidence based LTOT guidelines. We participated in a national Lung Improvement Project aimed at making LTOT use more evidence based. We utilised this unique opportunity of studying the effect of removal of oxygen from COPD patients (who did not meet LTOT criteria) on hospital admission rates. Methods Primary and secondary care data sources were used to identify patients with COPD in a single primary care trust who were admitted to hospital at least once due to COPD between April 2007 and November 2010. Admission rates were compared between LTOT users and non-users, adjusted for age and COPD severity. LTOT users were further studied for predictors of admission in those appropriately or inappropriately given oxygen according to NICE guidance, and for admissions before and after oxygen receipt, adjusting further for co-morbidity. Mortality and economic analyses were also conducted. Results Readmission was more likely in LTOT users (3.18 v 1.67 per patient, p < 0.001) after adjustment for FEV1 and age by multiple regression. When stratifying by appropriateness of LTOT prescription, adjusting also for Charlson index and other covariates, FEV1 predicted admission in appropriate users but there were no predictors in inappropriate users. In longitudinal analyses admission rates did not differ either side of oxygen prescription in appropriate or inappropriate LTOT users. Specialist assessment resulted in cost savings due to reduced use of oxygen. Conclusions Admission to hospital is more likely in LTOT users, independent of COPD severity. Oxygen use outside NICE guidance does not appear to prevent admissions.
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Affiliation(s)
| | | | | | | | | | | | - Rahul Mukherjee
- Department of Respiratory Medicine & Physiology, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley Green, Birmingham B9 5SS, UK.
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Gaurav K, Vaid U, Sexauer W, Kavuru MS. Readmissions after hospital discharge with acute exacerbation of COPD: are we missing something? Hosp Pract (1995) 2014; 42:58-69. [PMID: 24769785 DOI: 10.3810/hp.2014.04.1104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an important part of the disease's morbidity, mortality, and progression, and is associated with increasing utilization of health care resources. The concept of integrated care based on a chronic care model is relatively new to chronic obstructive pulmonary disease, but has proved successful in improving clinical outcomes and probably in decreasing health care utilization in other chronic conditions. A comprehensive approach is needed to target a change in behavioral patterns in patients, increase physician's awareness and adherence to evidence-based recommendations, and address system related issues. This article discusses the evidence for various facets of nonpharmacological management of AECOPD and proposes a model of care that might be the missing link for reducing hospital readmissions for AECOPD. This model may decrease the morbidity, slow disease progression, and curb the increasing health care resource utilization without compromising patient care.
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Affiliation(s)
- Kumar Gaurav
- Fellow, Division of Pulmonary and Critical Care, Thomas Jefferson University, Philadelphia, PA
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Lin J, Xu Y, Wu X, Chen M, Lin L, Gong L, Feng J. Risk factors associated with chronic obstructive pulmonary disease early readmission. Curr Med Res Opin 2014; 30:315-20. [PMID: 24156615 DOI: 10.1185/03007995.2013.858623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The 31 day readmission rate is deemed to be an important indicator of the quality of medical care in China. The objectives of this study were to identify the readmission rate of acute exacerbation for chronic obstructive pulmonary disease (COPD) and to evaluate associated risk factors. METHODS We retrospectively reviewed charts for patients with acute exacerbation of COPD (AECOPD) admitted to our hospital between January 2011 and November 2012. The early-readmission group and non-early-readmission group were determined by whether patients were readmitted within 31 days after discharge. Logistic regression analysis was performed to identify risk factors for early readmission following an AECOPD. RESULTS There were 692 patients with 925 admissions during the 23 month period; 63 (6.8%) admissions met our criteria for early readmission. Multivariate analysis showed that chronic cor pulmonale (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.26-3.64, p = 0.005), hypoproteinemia (OR 2.02, 95% CI 1.03-3.95, p = 0.040) and an elevated PaCO2 (OR 1.03, 95% CI 1.00-1.06, p = 0.027) were identified as risk factors for early readmission of AECOPD. CONCLUSION The readmission rate for AECOPD was 6.8%. AECOPD patients with chronic cor pulmonale, hypoproteinemia, and a high PaCO2 are at higher risk for readmission with 31 days of hospital discharge, and medical care of these patients warrants greater attention.
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Affiliation(s)
- Jian Lin
- Department of Respiratory Medicine, Taizhou Hospital of Wenzhou Medical University , Linhai, Zhejiang , P.R. China
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Bertens LCM, Reitsma JB, Moons KGM, van Mourik Y, Lammers JWJ, Broekhuizen BDL, Hoes AW, Rutten FH. Development and validation of a model to predict the risk of exacerbations in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2013; 8:493-9. [PMID: 24143086 PMCID: PMC3797610 DOI: 10.2147/copd.s49609] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Prediction models for exacerbations in patients with chronic obstructive pulmonary disease (COPD) are scarce. Our aim was to develop and validate a new model to predict exacerbations in patients with COPD. PATIENTS AND METHODS The derivation cohort consisted of patients aged 65 years or over, with a COPD diagnosis, who were followed up over 24 months. The external validation cohort consisted of another cohort of COPD patients, aged 50 years or over. Exacerbations of COPD were defined as symptomatic deterioration requiring pulsed oral steroid use or hospitalization. Logistic regression analysis including backward selection and shrinkage were used to develop the final model and to adjust for overfitting. The adjusted regression coefficients were applied in the validation cohort to assess calibration of the predictions and calculate changes in discrimination applying C-statistics. RESULTS The derivation and validation cohort consisted of 240 and 793 patients with COPD, of whom 29% and 28%, respectively, experienced an exacerbation during follow-up. The final model included four easily assessable variables: exacerbations in the previous year, pack years of smoking, level of obstruction, and history of vascular disease, with a C-statistic of 0.75 (95% confidence interval [CI]: 0.69-0.82). Predictions were well calibrated in the validation cohort, with a small loss in discrimination potential (C-statistic 0.66 [95% CI 0.61-0.71]). CONCLUSION Our newly developed prediction model can help clinicians to predict the risk of future exacerbations in individual patients with COPD, including those with mild disease.
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Affiliation(s)
- Loes C M Bertens
- Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
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Esquinas AM. COPD exacerbations admitted to intensive care unit. Organization, mortality, and noninvasive or invasive mechanical ventilation strategies: are they sufficiently well known? Int J Chron Obstruct Pulmon Dis 2013; 8:365-7. [PMID: 24015058 PMCID: PMC3760470 DOI: 10.2147/copd.s44602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ozyilmaz E, Kokturk N, Teksut G, Tatlicioglu T. Unsuspected risk factors of frequent exacerbations requiring hospital admission in chronic obstructive pulmonary disease. Int J Clin Pract 2013; 67:691-7. [PMID: 23758448 DOI: 10.1111/ijcp.12150] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 02/06/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Severe exacerbations are the leading cause of fatal events in chronic obstructive pulmonary disease (COPD). The new Global Initiative for Chronic Obstructive Lung Disease strategy included the number of exacerbations in the grading of the disease. The primary aim of this study was to evaluate the potentially modifiable precipitating factors of frequent severe exacerbations requiring hospital admission in COPD. The secondary aim was to investigate the risk factors of readmission within 2 months following an exacerbation requiring hospitalisation. METHODS Data regarding the number of exacerbations in the previous year, current comorbidities, medications, and clinical and functional status of COPD patients were evaluated. RESULTS We included 107 COPD patients (85% men). The mean number of severe exacerbations was 1.3 ± 1.7 (per patient/per year), and 37.4% of the patients had frequent severe exacerbations (≥ 2/year). Multivariate analysis indicated that haematocrit < 41%, angiotensin converting enzyme inhibitor or angiotensin receptor blocker use, positive gastro-oesophageal reflux disease symptoms, poor adherence to inhaled therapy/regular outpatient follow-up visits and FEV1 < 50% were independent predictors of frequent severe exacerbations. Readmission rate within 2 months after hospital discharge was 39.3%. The independent risk factors of readmission were poor adherence to inhaled therapy/regular outpatient follow-up visits, serum haematocrit < 41%, and FEV1 < 50%. CONCLUSION Chronic obstructive pulmonary disease patients with frequent exacerbations should be carefully assessed for modifiable confounding risk factors regardless of poor lung function to decrease exacerbation frequency and related poor prognosis.
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Affiliation(s)
- E Ozyilmaz
- Department of Pulmonary Disease, Cukurova University Faculty of Medicine, Adana, Turkey.
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Roger N, Burgos F, Giner J, Rosas A, Tresserras R, Escarrabill J. Survey about the use of lung function testing in public hospitals in Catalonia in 2009. Arch Bronconeumol 2013; 49:371-7. [PMID: 23414603 DOI: 10.1016/j.arbres.2012.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/12/2012] [Accepted: 12/19/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Underdiagnosis is one of the problems with the greatest impact on respiratory disease management and requires specific interventions. Access to quality spirometry is especially important and is an objective of the Master Plan for Respiratory Diseases of the Department of Health of the Generalitat de Catalunya. OBJECTIVE To determine the current use of spirometry at public hospitals in Catalonia, possible deficiencies and options for improvement. METHODS A cross-sectional survey of 65 public hospitals in Catalonia in 2009. Descriptive analyses were developed for each public health-care region. RESULTS A lack of uniformity was observed in the use of spirometry at the regional level (between 0,98 and 1.50 spirometries per 100 inhabitants). We identified two factors associated with a higher rate of spirometry: i) the existence of a Respiratory Medicine Department at the hospital, and ii) the existence of a set location to carry out spirometries. Several areas for improvement also were identified: quality control of the test itself, the inclusion of spirometry in electronic health-care records and continuing education programs. CONCLUSIONS The results of this study have identified areas for improvement in spirometry programs.
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Affiliation(s)
- Nuria Roger
- Direcció d'Especialitats Mèdiques, Consorci Hospitalari de Vic, Vic, Barcelona, España.
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Lum HD, Studenski SA, Degenholtz HB, Hardy SE. Early hospital readmission is a predictor of one-year mortality in community-dwelling older Medicare beneficiaries. J Gen Intern Med 2012; 27:1467-74. [PMID: 22692634 PMCID: PMC3475824 DOI: 10.1007/s11606-012-2116-3] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 04/18/2012] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Hospital readmission within thirty days is common among Medicare beneficiaries, but the relationship between rehospitalization and subsequent mortality in older adults is not known. OBJECTIVE To compare one-year mortality rates among community-dwelling elderly hospitalized Medicare beneficiaries who did and did not experience early hospital readmission (within 30 days), and to estimate the odds of one-year mortality associated with early hospital readmission and with other patient characteristics. DESIGN AND PARTICIPANTS A cohort study of 2133 hospitalized community-dwelling Medicare beneficiaries older than 64 years, who participated in the nationally representative Cost and Use Medicare Current Beneficiary Survey between 2001 and 2004, with follow-up through 2006. MAIN MEASURE One-year mortality after index hospitalization discharge. KEY RESULTS Three hundred and four (13.7 %) hospitalized beneficiaries had an early hospital readmission. Those with early readmission had higher one-year mortality (38.7 %) than patients who were not readmitted (12.1 %; p<0.001). Early readmission remained independently associated with mortality after adjustment for sociodemographic factors, health and functional status, medical comorbidity, and index hospitalization-related characteristics [HR (95 % CI) 2.97 (2.24-3.92)]. Other patient characteristics independently associated with mortality included age [1.03 (1.02-1.05) per year], low income [1.39 (1.04-1.86)], limited self-rated health [1.60 (1.20-2.14)], two or more recent hospitalizations [1.47 (1.01-2.15)], mobility difficulty [1.51 (1.03-2.20)], being underweight [1.62 (1.14-2.31)], and several comorbid conditions, including chronic lung disease, cancer, renal failure, and weight loss. Hospitalization-related factors independently associated with mortality included longer length of stay, discharge to a skilled nursing facility for post-acute care, and primary diagnoses of infections, cancer, acute myocardial infarction, and heart failure. CONCLUSIONS Among community-dwelling older adults, early hospital readmission is a marker for notably increased risk of one-year mortality. Providers, patients, and families all might respond profitably to an early readmission by reviewing treatment plans and goals of care.
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Affiliation(s)
- Hillary D Lum
- Division of Geriatric Medicine, University of Colorado School of Medicine, Denver, CO, USA
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Dalal AA, Shah M, D’Souza AO, Crater GD. Rehospitalization risks and outcomes in COPD patients receiving maintenance pharmacotherapy. Respir Med 2012; 106:829-37. [DOI: 10.1016/j.rmed.2011.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 11/11/2011] [Accepted: 11/16/2011] [Indexed: 12/27/2022]
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Nantsupawat T, Limsuwat C, Nugent K. Factors affecting chronic obstructive pulmonary disease early rehospitalization. Chron Respir Dis 2012; 9:93-8. [DOI: 10.1177/1479972312438703] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Centers for Medicare and Medicaid Services has identified early rehospitalization of patients with chronic obstructive pulmonary disease (COPD) exacerbations as a performance measure for hospital care. We retrospectively reviewed patients with COPD who were admitted to University Medical Center, Lubbock, Texas, USA, between October 2010 and March 2011. There were 81 COPD patients with 103 hospitalizations. The mean age was 73.9 years. Pulmonary function tests using the Global initiative for chronic Obstructive Lung Disease criteria had been done in 36 patients (44.4%) and revealed 1 mild (2.8%), 7 moderate (19.4%), 20 severe (55.6%), and 8 very severe (22.2%) cases. Only 38.4% of the patients had prior influenza vaccine. Most patients were treated with antibiotics (81.8%) and corticosteroids (87.9%). The mean length of stay was 4.9 days, and 4 patients died. Most of the patients were discharged home (63.6%) with a median follow-up interval of 14 days. Thirty-two percent did not have long-acting bronchodilators and/or inhaled corticosteroids prescribed on discharge. There were 14 early rehospitalizations within 30 days. Logistic regression analysis indicated that a history of coronary artery disease (odds ratio (OR) 6.4, 95% confidence interval (CI) 1.1–37.4) and unilateral pulmonary infiltrates (OR 12.8, 95% CI 1.9–86.4) significantly increased the early rehospitalization rates. Acute exacerbations of COPD in patients with a history of ischemic heart disease or unilateral pulmonary infiltrates are at increased risk for early readmission. These risk factors should be identified during hospitalization; early follow-up or other interventions may reduce readmissions. Influenza vaccine, maintenance bronchodilators and/or inhaled corticosteroids, and pulmonary function tests were underused, and these standards of care should be provided to improve care.
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Affiliation(s)
| | | | - K Nugent
- Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA
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Llauger Roselló MA, Pou MA, Domínguez L, Freixas M, Valverde P, Valero C. [Treating COPD in chronic patients in a primary-care setting]. Arch Bronconeumol 2011; 47:561-70. [PMID: 22036593 DOI: 10.1016/j.arbres.2011.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 10/05/2011] [Indexed: 10/15/2022]
Abstract
The aging of the populations in Western countries entails an increase in chronic diseases, which becomes evident with the triad of age, comorbidities and polymedication. chronic obstructive pulmonary disease represents one of the most important causes of morbidity and mortality, with a prevalence in Spain of 10.2% in the population aged 40 to 80. In recent years, it has come to be defined not only as an obstructive pulmonary disease, but also as a systemic disease. Some aspects stand out in its management: smoking, the main risk factor, even though avoidable, is an important health problem; very important levels of underdiagnosis and little diagnostic accuracy, with inadequate use of spirometry; chronic patient profile; exacerbations that affect survival and cause repeated hospitalizations; mobilization of numerous health-care resources; need to propose integral care (health-care education, rehabilitation, promotion of self-care and patient involvement in decision-making).
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Liu Z, Zhang W, Zhang J, Zhou X, Zhang L, Song Y, Wang Z. Oral hygiene, periodontal health and chronic obstructive pulmonary disease exacerbations. J Clin Periodontol 2011; 39:45-52. [PMID: 22092913 DOI: 10.1111/j.1600-051x.2011.01808.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2011] [Indexed: 01/24/2023]
Abstract
AIM To assess the associations of oral hygiene and periodontal health with chronic obstructive pulmonary disease (COPD) exacerbations. MATERIAL AND METHODS In total, 392 COPD patients were divided into frequent and infrequent exacerbation (≥2 times and <2 times in last 12 months) groups. Their lung function and periodontal status were examined. Information on oral hygiene behaviours was obtained by interview. RESULTS In the univariate analysis, fewer remaining teeth, high plaque index (PLI) scores, low tooth brushing times, and low regular supra-gingival scaling were significantly associated with COPD exacerbations (all p-values <0.05). After adjustment for age, gender, body mass index, COPD severity and dyspnoea severity, the associations with fewer remaining teeth (p = 0.02), high PLI scores (p = 0.02) and low tooth brushing times (p = 0.008) remained statistically significant. When stratified by smoking, fewer remaining teeth (OR = 2.05, 95% CI: 1.04-4.02) and low tooth brushing times (OR = 4.90, 95% CI: 1.26-19.1) among past smokers and high PLI scores (OR = 3.43, 95% CI: 1.19-9.94) among never smokers were significantly associated with COPD exacerbations. CONCLUSIONS Fewer remaining teeth, high PLI scores, and low tooth brushing times are significant correlates of COPD exacerbations, indicating that improving periodontal health and oral hygiene may be a potentially preventive strategy against COPD exacerbations.
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Affiliation(s)
- Zhiqiang Liu
- Department of Stomatology, Beijing ChaoYang Hospital affiliated to Capital Medical University, China
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Dalal AA, Shah M, D’Souza AO, Rane P. Costs of COPD exacerbations in the emergency department and inpatient setting. Respir Med 2011; 105:454-60. [DOI: 10.1016/j.rmed.2010.09.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 08/30/2010] [Accepted: 09/04/2010] [Indexed: 11/26/2022]
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Yawn BP, Raphiou I, Hurley JS, Dalal AA. The role of fluticasone propionate/salmeterol combination therapy in preventing exacerbations of COPD. Int J Chron Obstruct Pulmon Dis 2010; 5:165-78. [PMID: 20631816 PMCID: PMC2898089 DOI: 10.2147/copd.s4159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Indexed: 11/23/2022] Open
Abstract
Exacerbations contribute significantly to the morbidity of COPD, leading to an accelerated decline in lung function, reduced functional status, reduced health status and quality of life, poorer prognosis and increased mortality. Prevention of exacerbations is thus an important goal of COPD management. In patients with COPD, treatment with a combination of the inhaled corticosteroid fluticasone propionate (250 microg) and the long-acting beta(2)-agonist salmeterol (50 microg) in a single inhaler (250/50 microg) is an effective therapy option that has been shown to reduce the frequency of exacerbations, to improve lung function, dyspnea and health status, and to be relatively cost-effective as a COPD maintenance therapy. Importantly, results of various studies suggest that fluticasone propionate and salmeterol have synergistic effects when administered together that improve their efficacy in controlling symptoms and reducing exacerbations. The present non-systematic review summarizes the role of fluticasone propionate/salmeterol combination therapy in the prevention of exacerbations of COPD and its related effects on lung function, survival, health status, and healthcare costs.
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Affiliation(s)
- Barbara P Yawn
- Olmsted Medical Center, University of Minnesota, Rochester, Minnesota, USA
| | - Ibrahim Raphiou
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | | | - Anand A Dalal
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
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