Spece Laura J, Donovan Lucas M, Griffith Matthew F, Collins Margaret P, Feemster Laura C, Au David H
a Division of Pulmonary, Critical Care and Sleep Medicine , University of Washington , Seattle , Washington , USA.
b Health Services Research and Development , VA Puget Sound Health Care System , Seattle , Washington , USA.
COPD. 2018 Oct;15(5):489-495. doi: 10.1080/15412555.2018.1543390.
Quality of chronic obstructive pulmonary disease (COPD) care is thought to be an important intermediate process to improve the well-being of patients admitted to hospital for exacerbation. We sought to examine the quality of inpatient COPD care and the associations with readmission and mortality. We performed a cohort study of 2,364 veterans aged over 40 and hospitalized for COPD between 2005 and 2011 at five Department of Veterans Affairs hospitals. We examined whether patients received six guideline recommended care items including short-acting bronchodilators, corticosteroids, antibiotics, positive-pressure ventilation (in cases of acute hypercarbic respiratory failure), chest imaging, and arterial blood gas measurement. Our primary outcome was all-cause hospital readmission or death within 30 days. Overall quality of care was not significantly associated with readmission or death (acute care aOR 0.98; 95% CI 0.87-1.11; ICU aOR 0.89; 95% CI 0.71-1.13). Delivery of corticosteroids and antibiotics was associated with reduced odds of readmission and death (aOR 0.77; 95% CI 0.61-0.92). Few patients received all of the recommended care items (18% of acute care, 38% of ICU patients). Quality of care did not vary by race or sex but did vary significantly across sites and did not improve over time. Our composite measure of COPD care quality was not associated with readmission or death. Further efforts are needed to improve care delivery to patients hospitalized with COPD.
慢性阻塞性肺疾病（COPD）的护理质量被认为是改善因病情加重而住院患者健康状况的一个重要中间过程。我们试图研究住院COPD患者的护理质量以及与再入院和死亡率的关联。我们对2364名40岁以上、于2005年至2011年期间在五家退伍军人事务部医院因COPD住院的退伍军人进行了一项队列研究。我们检查了患者是否接受了六项指南推荐的护理项目，包括短效支气管扩张剂、皮质类固醇、抗生素、正压通气（急性高碳酸血症呼吸衰竭时）、胸部成像和动脉血气测量。我们的主要结局是30天内的全因再入院或死亡。总体护理质量与再入院或死亡无显著关联（急性护理调整后比值比为0.98；95%置信区间为0.87 - 1.11；重症监护病房调整后比值比为0.89；95%置信区间为0.71 - 1.13）。皮质类固醇和抗生素的使用与再入院和死亡几率降低相关（调整后比值比为0.77；95%置信区间为0.61 - 0.92）。很少有患者接受了所有推荐的护理项目（急性护理患者中有18%，重症监护病房患者中有38%）。护理质量不因种族或性别而异，但在不同地点有显著差异，且未随时间改善。我们对COPD护理质量的综合衡量指标与再入院或死亡无关。需要进一步努力改善对因COPD住院患者的护理。
