EHS-Based COPD Treatment Plans Can Reduce Length of Stay in the Hospital

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) management often involve systemic corticosteroids (SC). Researchers recently found that the use of a standardized electronic health system (EHS)—based order set to manage AECOPD was linked to a decreased reduction in steroid dose and length of stay (LOS) in the hospital.

The researchers of the study, published in the International Journal of Chronic Obstructive Pulmonary Disease, used data of Medicare recipients discharged with an AECOPD diagnosis from the University of Alabama at Birmingham’s University Hospital from 2014 to 2016. The standardized EHS-based order set the study used was referred to as the “COPD PowerPlan” and was initiated and activated by providers at the time of hospital admission and included admission, laboratory, pharmacy, and radiology orders for managing AECOPD.

The default SC option used in the study included intravenous methylprednisolone for 24 hours followed by oral prednisone for 4 days. The primary outcome of the evaluation was to determine the difference in cumulative SC dose between individuals treated with the COPD PowerPlan versus those treated without using the PowerPlan, known as the “usual care” group.

“Clinicians were educated and encouraged to use the PowerPlan at meetings, and using electronic reminders and through hospital administrative reminders in the 3 months prior to its implementation and quarterly in the first year of its launch. Use of the PowerPlan was encouraged but was optional,” explained the authors.

There was a total of 250 patients included in the analysis. The PowerPlan was used in 72 (29%) patients and cumulative steroid use was reduced by 31% in this group when compared with the usual care group. Also, the use of PowerPlan was independently associated with decreased LOS without affecting 30- and 90-day readmission rates.

“We have demonstrated the real-world applicability of using a standardized EHS-based intervention on reducing corticosteroid exposure and hospital LOS in managing patients hospitalized with AECOPD without adversely affecting hospital readmissions,” concluded the study. “These findings suggest health systems can safely adopt EHS-based COPD treatment plans using currently accepted standard treatment regimens.”

The researchers noted that the study was limited because it was a cohort study and causation could not be assigned to the intervention. Also, while only 29% of patients were treated with the PowerPlan, this is higher than prior reports that reveal only a 19% utilization rate of order sets, the authors added.

Reference

Gulati S, Zouk AN, Kalehoff JP, et al. The use of a standardized order set reduces systemic corticosteroid dose and length of stay for individuals hospitalized with acute exacerbations of COPD: a cohort study. Int J Chron Obstruct Pulmon Dis. 2018;13:2271-2278.