Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
Intern Med J. 2012 Apr;42(4):380-7. doi: 10.1111/j.1445-5994.2011.02475.x.
Chronic obstructive pulmonary disease (COPD) exacerbations are a major cause of hospital admission and clinical guidelines for optimised management are available. However, few data assessing concordance with these guidelines are available. We aimed to identify gaps and document variability in clinical practices for COPD admissions.
Medical records of all admissions over a 3-month period as COPD with non-catastrophic or severe comorbidities or complications at eight acute-care hospitals within the Hunter New England region were retrospectively audited.
Mean (SD) length of stay was 6.3 (6.1) days for 221 admissions with mean age of 71 (10), 53% female and 34% current smokers. Spirometry was performed in 34% of admissions with a wide inter-hospital range (4-58%, P < 0.0001): mean FEV1 was 36% (18) predicted. Arterial blood gases were performed on admission in 54% of cases (range 0-85%, P < 0.0001). Parenteral steroids were used in 82% of admissions, antibiotics in 87% and oxygen therapy during admission in 79% (with oxygen prescription in only 3% of these). Bronchodilator therapy was converted from nebuliser to an inhaler device in 51% of cases early in admission at 1.6 (1.7) days. Only 22% of patients were referred to pulmonary rehabilitation (inter-hospital range of 0-50%, P = 0.002). Re-admission within 28 days was higher in rural hospitals compared with metropolitan (27% vs 7%, P < 0.0001).
We identified gaps in best practice service provision associated with wide inter-hospital variations, indicating disparity in access to services throughout the region.
慢性阻塞性肺疾病（COPD）加重是住院的主要原因，已有优化管理的临床指南。然而，可用的评估与这些指南相符程度的数据很少。我们旨在确定 COPD 入院治疗的临床实践中的差距和变异性。
对 Hunter New England 地区 8 家急性护理医院在 3 个月期间因非灾难性或严重合并症或并发症而入院的所有 COPD 患者的病历进行回顾性审核。
221 例住院患者的平均（SD）住院时间为 6.3（6.1）天，平均年龄为 71（10）岁，53%为女性，34%为当前吸烟者。34%的入院患者进行了肺量测定，各医院间的范围很广（4-58%，P < 0.0001）：平均 FEV1 为预测值的 36%（18）。54%的病例在入院时进行了动脉血气检查（范围为 0-85%，P < 0.0001）。82%的入院患者使用了静脉内皮质类固醇，87%使用了抗生素，79%在入院期间使用了氧气治疗（其中只有 3%在这些患者中开具了氧气处方）。在入院后 1.6（1.7）天，51%的患者将支气管扩张剂治疗从雾化器转换为吸入装置。仅有 22%的患者被转诊至肺康复（各医院间的范围为 0-50%，P = 0.002）。与城市相比，农村医院的 28 天内再入院率更高（27% vs 7%，P < 0.0001）。
我们发现了最佳实践服务提供方面的差距，这与各医院间的广泛差异有关，表明该地区在服务获取方面存在差异。
