Targeted Individualized Care for Hospitalized COPD Patients

An individualized comprehensive care package for acute exacerbation of chronic obstructive pulmonary disease patients reduces 90-day mortality.

Although a “need-based” individualized comprehensive care package for people admitted to hospitals for acute exacerbation of chronic obstructive pulmonary disease (COPD) did not reduce 30- and 90-day readmission rates in all patients, it did reduce 90-day total mortality and also reduced 90-day readmission rates in women. The study, by Simon L. Adamson, and colleagues, was published in the International Journal of COPD.

Acute exacerbation of COPD, characterized by a sudden worsening of patients’ respiratory symptoms, such as shortness of breath, cough, and sputum production, is associated with increased COPD morbidity and mortality. Acute exacerbation of COPD also decreases quality of life, accelerates lung function decline, and is associated with significant healthcare costs. Since patients with COPD experience the greatest number of readmissions to acute hospital care and the emergency department of any patient group, reducing acute exacerbation of COPD and reducing hospital readmissions are primary goals of COPD management.

The authors retrospectively reviewed data of patients admitted for acute exacerbation of COPD to 2 inner-city teaching hospitals to determine the impact of a comprehensive and individualized care management strategy on readmissions for acute exacerbation of COPD. The experimental group (191 patients) received comprehensive care targeted to the sensitive time period (2-4 weeks) immediately following a hospitalization due to acute exacerbation of COPD; 271 patients were controls. The total number of readmissions in 30 and 90 days after index hospitalization were measured, and the length of time between index admission and first readmission and all-cause mortality were secondary outcomes.

The 2 groups were similar in terms of age, sex, forced expiratory volume in 1 second, body mass index, pack-years smoked, and number and types of comorbidities. Comprehensive care significantly reduced 90-day readmission rates in females (P = .0205) but not in males or in the whole group. Average times between index admission and first readmission were not different between the 2 groups. The 90-day all-cause in-hospital mortality rates were significantly less in the care package group (2.67% vs 7.97%, P = .0268).

A larger randomized trial is needed to tease out which aspects of the comprehensive plan are more effective in improving patient outcomes, the authors note.

“We suspect that better and earlier recognition of exacerbations, improved self-management techniques, and availability of an outreach team in the community could have contributed to the beneficial effects of the intervention after [acute exacerbation of] COPD,” they concluded.