Euceda Glenda, Kong Wing-Tai, Kapoor Amber, Hokanson John E, Dilauro Patricia, Ogunnaike Rahila, Chronakos John
Department of Internal Medicine, Danbury Hospital, Western Connecticut Health Network, Danbury.
Department of Research and Innovation, Danbury Hospital, Western Connecticut Health Network, Danbury.
Chronic Obstr Pulm Dis. 2018 May 17;5(3):185-192. doi: 10.15326/jcopdf.5.3.2017.0177.
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is one of the leading causes of hospitalization in the United States. Prior investigations suggest clinical and physiological parameters are important determinants for AECOPD readmissions. Strategies aimed at addressing these factors have not resulted in a major reduction of readmissions. We compared patients readmitted after an index AECOPD admission with non-readmitted patients. Patients' age, gender, body mass index, comorbidities (obstructive sleep apnea, chronic hypercapnia, congestive heart failure, lung cancer, pulmonary arterial hypertension, pneumonia, interstitial lung disease, atrial fibrillation, musculoskeletal disorders, cognitive disorders, and anxiety disorders), substance abuse and smoking status were assessed. Some 272 patients were included: 20 patients were readmitted within 30 days of their index hospitalization; 252 patients were not readmitted within 30 days of their index admission. Readmitted patients were significantly more likely to have pneumonia than non-readmitted patients (30.0% versus 13.1%, <0.05). No statistically significant difference was seen with respect to other clinical comorbidities. Patients readmitted within 30 days were significantly more likely than non-readmitted patients to have safety issues at home (80.0% versus. 39.3%, <0.001), anxiety (60.0% versus 29.8%, <0.01), and lack of transportation (35.0% versus 15.5%, <0.05). Implementation of a comprehensive care management program (CCMP) was associated with a reduction in readmissions from 21.5% to 13.6% (<0.01, 95% confidence interval [CI] 2.08-12.45). A CCMP can reduce readmissions through attention to social variables, optimization of in-hospital care, improved coordination of pre- and post-discharge, a system to better identify problems after discharge, and an office setup that accommodates same-day visits.
慢性阻塞性肺疾病急性加重（AECOPD）是美国住院治疗的主要原因之一。先前的调查表明，临床和生理参数是AECOPD再入院的重要决定因素。针对这些因素的策略并未导致再入院率大幅降低。我们比较了首次AECOPD入院后再次入院的患者与未再次入院的患者。评估了患者的年龄、性别、体重指数、合并症（阻塞性睡眠呼吸暂停、慢性高碳酸血症、充血性心力衰竭、肺癌、肺动脉高压、肺炎、间质性肺疾病、心房颤动、肌肉骨骼疾病、认知障碍和焦虑症）、药物滥用和吸烟状况。共纳入约272例患者：20例患者在首次住院后30天内再次入院；252例患者在首次入院后30天内未再次入院。再次入院的患者患肺炎的可能性显著高于未再次入院的患者（30.0%对13.1%，<0.05）。在其他临床合并症方面未观察到统计学上的显著差异。30天内再次入院的患者比未再次入院的患者在家中出现安全问题的可能性显著更高（80.0%对39.3%，<0.001）、焦虑症（60.0%对29.8%，<0.01）和缺乏交通工具（35.0%对15.5%，<0.05）。实施综合护理管理计划（CCMP）与再入院率从21.5%降至13.6%相关（<0.01，95%置信区间[CI]2.08 - 12.45）。CCMP可以通过关注社会变量、优化住院治疗、改善出院前后的协调、建立一个能更好地识别出院后问题的系统以及一个能安排当日就诊的办公室设置来降低再入院率。
