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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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Kearney L, Wiener RS, Dahodwala M, Fix GM, Hicks J, Little F, Howard J, Foreman AG, Wakeman C, O'Donnell C, Bulekova K, Drainoni ML, Kathuria H. A mixed methods study to inform and evaluate a longitudinal nurse practitioner/community health worker intervention to address social determinants of health and chronic obstructive pulmonary disease self-management. BMC Pulm Med 2022; 22:74. [PMID: 35232414 PMCID: PMC8889692 DOI: 10.1186/s12890-022-01863-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with low socioeconomic status experience higher prevalence and worse outcomes of chronic obstructive pulmonary disease (COPD). We undertook a quality improvement initiative at our safety net hospital in which a nurse practitioner (NP)/community health worker (CHW) team followed patients with COPD, frequent admissions, and unmet SDOH needs from hospitalization through one month post-discharge. We report our mixed methods approach to inform development and preliminary evaluation of this intervention. METHODS We first assessed characteristics of patients admitted with COPD in 2018 (n = 1811), performing multivariable logistic regression to identify factors associated with ≥ 2 admissions per year. We then tested a standardized tool to screen for unmet SDOH needs in a convenience sample of 51 frequently hospitalized patients with COPD. From January-July 2019, we pilot tested the NP/CHW intervention with 57 patients, reviewed NP/CHW logs, and conducted qualitative interviews with 16 patient participants to explore impressions of the intervention. RESULTS Patients with Medicaid insurance, mental health disorders, cardiac disease, and substance use disorder had increased odds of having ≥ 2 admissions. COPD severity, comorbidities, and unmet SDOH needs made COPD self-management challenging. Seventy-four percent of frequently admitted patients with COPD completing SDOH screening had unmet SDOH needs. Patients perceived that the NP/CHW intervention addressed these barriers by connecting them to resources and providing emotional support. CONCLUSIONS Many patients with COPD admitted at our safety-net hospital experience unmet SDOH needs that impede COPD self-management. A longitudinal NP/CHW intervention to address unmet SDOH needs following discharge appears feasible and acceptable.
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Affiliation(s)
- Lauren Kearney
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Renda Soylemez Wiener
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA.,Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Mohsin Dahodwala
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Gemmae M Fix
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.,Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Health Law Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Jacqueline Hicks
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Frederic Little
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Jinesa Howard
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Alexis Gallardo Foreman
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Cornelia Wakeman
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Charles O'Donnell
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA
| | - Katia Bulekova
- Research Computing Services (RCS) Group, Information Services & Technology, Boston University, Boston, MA, USA
| | - Mari-Lynn Drainoni
- Department of Health Law Policy & Management, Boston University School of Public Health, Boston, MA, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Evans Center for Implementation and Improvement Sciences, Boston University, Boston, MA, USA
| | - Hasmeena Kathuria
- The Pulmonary Center, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, R304, Boston, MA, 02118, USA.
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Tomar A, Ganesh SS, Richards JR. Transportation Preferences of Patients Discharged from the Emergency Department in the Era of Ridesharing Apps. West J Emerg Med 2019; 20:672-680. [PMID: 31316709 PMCID: PMC6625690 DOI: 10.5811/westjem.2019.5.42762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/07/2019] [Accepted: 05/12/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients discharged from the emergency department (ED) may encounter difficulty finding transportation home, increasing length of stay and ED crowding. We sought to determine the preferences of patients discharged from the ED with regard to their transportation home, and their awareness and past use of ridesharing services such as Lyft and Uber. Methods We performed a prospective, survey-based study during a five-month period at a university-associated ED and Level I trauma center serving an urban area. Subjects were adult patients who were about to be discharged from the ED. We excluded patients requiring ambulance transport home. Results Of 500 surveys distributed, 480 (96%) were completed. Average age was 47 ± 19 years, and 61% were female. There were 33,871 ED visits during the study period, and 67% were discharged home. The highest number of subjects arrived by ambulance (27%) followed by being dropped off (25%). Of the 408 (85%) subjects aware of ridesharing services, only eight (2%) came to the ED by this manner; however, 22 (5%) planned to use these services post-discharge. The survey also indicated that 377 (79%) owned smartphones, and 220 (46%) used ridesharing services. The most common plan to get home was with family/friend (35%), which was also the most preferred (29%). Regarding awareness and past use of ridesharing services, we were unable to detect any gender and/or racial differences from univariate analysis. However, we did detect age, education and income differences regarding awareness, but only age and education differences for past use. Logistic regression showed awareness and past use decreased with increasing patient age, but correlated positively with increasing education and income. Half the subjects felt their medical insurance should pay for their transportation, whereas roughly one-third felt ED staff should pay for it. Conclusion Patients most commonly prefer to be driven home by a family member or friend after discharge from the ED. There is awareness of ridesharing services, but only 5% of patients planned to use these services post-discharge from the ED. Patients who are older, have limited income, and are less educated are less likely to be aware of or have previously used ridesharing services. ED staff may assist these patients by hailing ridesharing services for them at time of discharge.
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Affiliation(s)
- Amar Tomar
- University of California, Davis Medical Center, Department of Emergency Medicine, Sacramento, California
| | - Siddhi S Ganesh
- University of California, Davis Medical Center, Department of Emergency Medicine, Sacramento, California
| | - John R Richards
- University of California, Davis Medical Center, Department of Emergency Medicine, Sacramento, California
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Epstein D, Barak-Corren Y, Isenberg Y, Berger G. Clinical Decision Support System: A Pragmatic Tool to Improve Acute Exacerbation of COPD Discharge Recommendations. COPD 2019; 16:18-24. [DOI: 10.1080/15412555.2019.1593342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Danny Epstein
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
| | - Yuval Barak-Corren
- Predictive Medicine Group, Boston Children’s Hospital, Boston, MA, USA
- Shaare Tzedek Medical Center, Jerusalem, Israel
| | - Yoni Isenberg
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
| | - Gidon Berger
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
- Division of Pulmonary Medicine, Rambam Health Care Campus, Haifa, Israel
- The Rappaport's Faculty of Medicine, The Technion Institute, Haifa, Israel
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