Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Respir Med. 2011 Oct;105 Suppl 1:S26-30. doi: 10.1016/S0954-6111(11)70007-5.
Chronic obstructive pulmonary disease (COPD) follows a slowly progressive natural course that can be accelerated by acute exacerbations, which frequently trigger admissions to hospital. Specific healthcare professional profiles such as that of discharge coordinator have been successful in reducing numbers of hospitalizations and need for medical care in patients with various chronic diseases, but data for COPD are sparse and inconclusive. This study was conceived to test whether coordinated discharge and post-discharge care could reduce re-hospitalizations and use of resources in patients with COPD.
METHODS/DESIGN: This ongoing single-center randomized controlled clinical trial, which began in November 2009, is enrolling COPD patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages II IV, hospitalized because of acute exacerbation. Patients are randomized in a 1:1 fashion to the intervention group, which has care organized by a discharge coordinator, and a control group receiving the usual care. The primary endpoint of the study is the number of patients hospitalized because of worsening of COPD. Data are collected at baseline, at the time of hospital discharge, and at the following time-points after discharge: 48 hours, 7 10 days, 30 days, 90 days, and 180 days.
In COPD patients requiring hospital admission, coordinated discharge appears a feasible option for improving patient and healthcare system-related outcomes. This study will provide evidence on the effectiveness of a discharge coordinator in patients hospitalized because of acute exacerbation of COPD and may give relevant guidance for implementation in clinical practice.
NCT01225627.
慢性阻塞性肺疾病（COPD）呈缓慢进展的自然病程，可因急性加重而加速，急性加重常导致住院。特定的医疗专业人员，如出院协调员，在减少各种慢性病患者的住院次数和医疗需求方面取得了成功，但 COPD 的相关数据很少且尚无定论。本研究旨在检验协调出院和出院后护理是否能减少 COPD 患者的再住院率和资源使用。
方法/设计：这是一项正在进行的单中心随机对照临床试验，于 2009 年 11 月开始，招募 GOLD 分期 II-IV 期的因急性加重而住院的 COPD 患者。患者以 1:1 的比例随机分为干预组和对照组，干预组由出院协调员负责组织护理，对照组接受常规护理。研究的主要终点是因 COPD 恶化而住院的患者人数。数据在基线、出院时和出院后以下时间点收集：48 小时、7-10 天、30 天、90 天和 180 天。
对于需要住院的 COPD 患者，协调出院似乎是改善患者和医疗系统相关结局的可行选择。本研究将为急性加重期 COPD 住院患者中出院协调员的有效性提供证据，并可能为临床实践中的实施提供相关指导。
NCT01225627。
