Gavish Rachel, Levy Amalia, Dekel Or Kalchiem, Karp Erez, Maimon Nimrod
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel.
Chest. 2015 Aug;148(2):375-381. doi: 10.1378/chest.14-1453.
The high frequency of readmissions in patients with COPD remains a significant problem. The impact of a pulmonologist follow-up visit during the month after discharge from hospital because of COPD exacerbation on reducing readmissions was examined. A profile of patients who did not attend the follow-up visits was built.
Our population-based retrospective cohort study analyzed the data of all patients with COPD who were treated at a lung institute in an Israeli hospital and were hospitalized between January 1, 2004, and December 31, 2010. Multivariate logistic regression was used to characterize the patient who did not attend the follow-up visit and to examine the effect of lack of visit on rehospitalization within 90 days of discharge. Cox proportional hazards analysis was used to model the effect of lacking visit on additional hospitalization or death during the study period.
Of the 195 patients enrolled in the study, 44.1% had follow-up visits with pulmonologists within 30 days of discharge. Not attending the follow-up visit was associated with distant residence, a higher number of hospitalizations in the previous year, a lack of a recommendation in the discharge letter for a follow-up visit, and a lower frequency of follow-up visits with pulmonologists in the previous year. Moreover, not attending the follow-up visit was associated with a significant increased risk of rehospitalization within 90 days of discharge (OR, 2.91; 95% CI, 1.06-8.01).
Early follow-up visits with pulmonologists seem to reduce the exacerbation-related rehospitalization rates of patients with COPD. We recommend that patients have early postdischarge follow-up visits with pulmonologists.
慢性阻塞性肺疾病（COPD）患者再入院率居高不下仍是一个重大问题。本研究探讨了因COPD急性加重而住院出院后一个月内肺科医生随访对降低再入院率的影响。同时构建了未参加随访患者的概况。
我们基于人群的回顾性队列研究分析了2004年1月1日至2010年12月31日期间在以色列一家医院的肺部疾病研究所接受治疗并住院的所有COPD患者的数据。采用多因素逻辑回归来描述未参加随访的患者特征，并检验未随访对出院后90天内再次住院的影响。使用Cox比例风险分析来模拟未随访对研究期间再次住院或死亡的影响。
在纳入研究的195例患者中，44.1%在出院后30天内接受了肺科医生的随访。未参加随访与居住距离远、上一年住院次数较多、出院小结中未建议随访以及上一年肺科医生随访频率较低有关。此外，未参加随访与出院后90天内再次住院的风险显著增加相关（比值比，2.91；95%可信区间，1.06 - 8.01）。
早期接受肺科医生随访似乎可降低COPD患者因急性加重导致的再入院率。我们建议患者出院后尽早接受肺科医生的随访。
