Morsø Lars, Jensen Morten Sall, von Plessen Christian, Qvist Peter
Department for Regional Health Research, Centre for Quality, University of Southern Denmark, Odense, Denmark.
Health Serv Res Manag Epidemiol. 2017 Jan 12;4:2333392816687704. doi: 10.1177/2333392816687704. eCollection 2017 Jan-Dec.
Rehabilitation after hospital stay implies several benefits for patients with chronic obstructive pulmonary disease (COPD); still few patients are referred and participate in rehabilitation programs. We conducted a case study to investigate the effects of interventions targeting the referral, uptake, and completion for a program of early rehabilitation in the primary health-care sector.
We undertook targeted initiatives to make patients participate in an individualized rehabilitation program with gradual increased intensity. After discharge, primary care COPD nurses and physiotherapists guided patients through progressing exercises in small groups online. Patients proceeded to class-based exercises, patient education and/or leisure activities, or continued telerehabilitation. We evaluated the effects of the intervention by assessing referral rates, completion, and readmission.
Sixteen (23% of discharged patients) patients were referred to rehabilitation. In comparison, only 1 (0.8%) in 131 patients from Vejle hospital was referred to Vejle hospital. Twelve patients completed rehabilitation, all having severe COPD. All started the program within 2 weeks and proceeded to the online-guided exercises within 4 weeks. Study data showed that after 30 days, 1 (6.3%) of the 16 patients in the rehabilitation program had been readmitted compared to 8 (14.8%) of 55 patients who were not referred. After 90 days, 2 (12.5%) and 11 (20.0%) patients were readmitted, respectively. The readmission rate showed a nonsignificant decline in patients participating in rehabilitation.
This case study showed that the referral rate of patients with COPD to early municipal rehabilitation is extremely low without a targeted effort and still insufficient in spite of a focused intervention. We showed that completion of a municipal rehabilitation program shortly after discharge is possible even for patients with severe COPD. The findings from our pilot study can guide further investigations into the effect of implementation strategies for handovers between health-care sectors to secure early-onset rehabilitation of patients with COPD.
住院后的康复对慢性阻塞性肺疾病（COPD）患者有诸多益处；然而，很少有患者被转介并参与康复项目。我们进行了一项案例研究，以调查针对初级卫生保健部门早期康复项目的转介、参与和完成情况的干预措施的效果。
我们采取了针对性举措，使患者参与强度逐渐增加的个体化康复项目。出院后，初级保健COPD护士和物理治疗师通过在线小组形式指导患者逐步进行锻炼。患者进而参加基于课堂的锻炼、患者教育和/或休闲活动，或继续进行远程康复。我们通过评估转介率、完成情况和再入院情况来评估干预措施的效果。
16名（占出院患者的23%）患者被转介至康复项目。相比之下，在韦勒医院的131名患者中，只有1名（0.8%）被转介至韦勒医院。12名患者完成了康复，均患有重度COPD。所有患者均在2周内开始该项目，并在4周内开始在线指导锻炼。研究数据显示，30天后，康复项目中的16名患者中有1名（6.3%）再次入院，而未被转介的55名患者中有8名（14.8%）再次入院。90天后，分别有2名（12.5%）和11名（20.0%）患者再次入院。参与康复的患者再入院率呈非显著下降。
本案例研究表明，在没有针对性努力的情况下，COPD患者转介至早期市政康复的比例极低，尽管进行了有针对性的干预，这一比例仍然不足。我们表明，即使是重度COPD患者，出院后不久完成市政康复项目也是可行的。我们试点研究的结果可为进一步调查卫生保健部门之间交接的实施策略对确保COPD患者早期康复的效果提供指导。
