Article

Risk factors of hospitalization and readmission of patients with COPD exacerbation – systematic review

Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
International Journal of COPD (Impact Factor: 2.73). 02/2007; 2(3):241-51.
Source: PubMed

ABSTRACT Chronic obstructive lung disease (COPD) exacerbations are a significant cause of morbidity and mortality. Data regarding factors which causes or prevents exacerbations is very limited. The aim of this systematic review is to summarize the results from available studies to identify potential risk factors for hospital admission and/or re-admission among patients experiencing COPD exacerbations.
We undertook a systematic review of the literature. Potential studies were identified by searching the electronic databases: PubMed, EMBASE, BIOSIS, CINAHL, PsycINFO, Cochrane library, reference lists in trial reports, and other relevant articles.
Seventeen articles that met the predefined inclusioncriteria were identified. Heterogeneity of study designs, risk factors and outcomes restrict the result to only a systematic review and precluded a formal meta-analysis. In this review, three predictive factors: previous hospital admission, dyspnea and oral corticosteroids were all found to be significant risk factors of readmissions and variables including using long term oxygen therapy, having low health status or poor health related quality of life and not having routine physical activity were all associated with an increased risk of both admission and readmission to hospital.
There are a number of potential modifiable factors that are independently associated with a higher risk of COPD exacerbation requiring admission/readmission to the hospital. Identifying these factors and the development of targeted interventions could potentially reduce the number and severity of such exacerbations.

1 Follower
 · 
260 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine the effect of a follow-up visit with a primary care physician and/or pulmonologist within the first 30 days of hospital discharge on readmissions, emergency department (ED) visits, and mortality.
    Risk Management and Healthcare Policy 01/2014; 7:105-12. DOI:10.2147/RMHP.S62815
  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Treatment of stable chronic obstructive pulmonary disease (COPD) with long-acting bronchodilator (LABD) medications is recommended by the 2014 Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines. The primary objective of this study was to examine LABD prescription fills after a COPD-related hospitalization. This retrospective observational study used claims from Truven Health MarketScan(®) Commercial and Medicare Supplemental databases. Patients (age ≥40, commercial; age ≥65, Medicare supplemental) had a first hospitalization with a primary COPD diagnosis between April 1, 2009 and June 30, 2011 (index hospitalization) and were continuously enrolled for 1 year before and 9 months after hospitalization. Patients were categorized according to pre-index and/or post-index pharmacy claims. A total of 27,738 patients had an index hospitalization and met inclusion/exclusion criteria. Of those, 19,783 patients had COPD as a primary or secondary diagnosis during the year before index hospitalization and were included in the analysis. Approximately one quarter of the patients (26.32%) did not fill a prescription for an LABD or short-acting bronchodilator both 90 days before and 90 days after hospitalization. During the 90-day pre-index period, 40.57% of patients filled an LABD (with or without a short-acting bronchodilator) prescription. Over half of the patients (56.88%) filled an LABD prescription at some point during the 180-day post-index period, but, of those, a significantly greater proportion of patients filled an LABD prescription in the 1- to 90-day post-index period than in the 91- to 180-day post-index period (51.27% versus 43.66%; P<0.0001). A significant proportion of COPD patients in this study did not fill an LABD prescription before hospitalization for COPD. Moreover, hospitalization did not appear to greatly impact LABD initiation. Lastly, patients who did not fill an LABD prescription within the first 90 days posthospitalization were not likely to fill an LABD prescription later. Taken together, the results of this study suggest that many patients with COPD are undertreated.
    International Journal of COPD 01/2014; 9:431-9. DOI:10.2147/COPD.S59322

Preview

Download
6 Downloads
Available from