Home care in patients hospitalized for exacerbation of COPD

Abstract

INTRODUCTION: With the objective of reducing the rate of readmissions of discharged for COPD exacerbation, our chronic outpatient respiratory care unit (UCCRA) was created.

METHODS: Observational study in which we compared data of patient included in UCCRA from January to October 2015 with patients with not home care, and with the patients included in UCCRA in the same period in 2014 with only telephone follow-up. Patients were admitted in UCCRA if they fit our criteria, based on our Readmission Risk Scale (RRS) that incorporates these variables: age, exacerbations (hospitalization or not) in the last year, FEV1, bacterial colonization, chronic bronchitis, Karnofsky index and cardiovascular comorbidity. Patients were included in UCCRA if they had suffered > 2 hospitalizations in the last year or > 7 points in our RRS.

RESULTS: We included 399 patients, 234 patients were discharged after an exacerbation of COPD in 2015, with a mean age (MA) of 71.8 years, mean stay (MS) of 7.4 days and 13.3% of readmissions. 108 were included in UCCRA, who had significantly higher MS and previous exacerbations, reduced FEV1 and Karnofsky, and higher percentage of readmissions than not included (22.2 vs 6.3%). Patients with home care in 2015, compared with 2014 with telephone follow-up (165 patients, MA: 72.6, MS: 6.2), had more previous non-hospital exacerbations (p <0.05) and less readmissions (13.6 vs 19.3%, p 0.06). UCCRA patients in 2015 had significantly less previous hospitalizations and fewer readmissions than those of UCCRA in 2014 (22.2 vs 50%).

CONCLUSIONS: UCCRA with home care was valid to reduce readmissions in COPD patients, compared with telephone follow-up. Previous hospitalizations was the variable that better predict readmission.