Division of Pulmonary, Critical Care, Allergy and Immunology, Department of Medicine, Northshore University Health System, Evanston, IL.
Chest. 2019 Oct;156(4):802-807. doi: 10.1016/j.chest.2019.06.005.
Hospitalizations for patients with acute exacerbations of COPD are associated with several adverse patient outcomes as well as with significant health-care costs. Despite many interventions targeted at reducing readmissions following an initial hospitalization, there are few strategies that have been consistently associated with reductions in this outcome. Despite the lack of consensus as to the best strategies to deploy to reduce readmissions related to acute exacerbations of COPD, efforts must continue to focus on determining the best approaches for this population. These tactics will need to be cost-effective for payers while not being cost-prohibitive for providers. In addition, these interventions will need to be relatively easy to institute while not being overbearing for patients or providers. Larger systems with their greater financial resources will likely find success with technology and data-driven comprehensive programs; independent hospitals and practices are more likely to succeed with less resource-intensive interventions such as early postdischarge follow-up, coaching, action plans, self-management education, and pulmonary rehabilitation. Choosing the right interventions that will utilize financial and human resources in a cost-effective manner, while tailoring the approaches to meet the needs of a specific patient group, will be of key importance.
COPD 急性加重患者的住院治疗与多种不良患者结局以及显著的医疗保健成本相关。尽管有许多针对减少首次住院后再入院的干预措施,但很少有策略能始终与降低这一结果相关联。尽管对于减少 COPD 急性加重相关再入院的最佳策略尚未达成共识,但必须继续努力确定针对这一人群的最佳方法。这些策略对于支付方而言必须具有成本效益,而对于服务提供方而言又不能过于昂贵。此外,这些干预措施需要相对容易实施,而不会给患者或服务提供方带来过重负担。拥有更多财务资源的大型系统可能会在技术和数据驱动的综合项目方面取得成功;独立的医院和诊所则更有可能通过资源密集度较低的干预措施取得成功,如出院后早期随访、辅导、行动计划、自我管理教育和肺康复。选择以具有成本效益的方式利用财务和人力资源的正确干预措施,并根据特定患者群体的需求调整方法,将是至关重要的。