Woodhouse Douglas C, Frolkis Alexandra D, Murray Brenna J, Solbak Nathan M, Samardzic Najla, Burak Kelly W
Family Medicine, University of Calgary, Calgary, CAN.
Internal Medicine, University of Calgary, Calgary, CAN.
Cureus. 2021 Aug 19;13(8):e17303. doi: 10.7759/cureus.17303. eCollection 2021 Aug.
Background Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are chronic conditions with high acute care utilization. Disease-specific order sets were developed for patients with COPD or HF in Calgary to reduce total days in hospital for this population of patients. However, many patients have comorbidities which may contribute to hospital utilization; thus, disease-specific order sets may not be an optimal solution to reduce overall acute care utilization. Methods Inpatient data on Calgary hospitalizations for COPD or HF between April 1, 2017 - March 31, 2019 and associated diagnoses were identified. Outcomes included total days in hospital and length of stay for COPD and HF patients stratified by number of comorbidities. Results Total days in hospital increased with the number of comorbidities for both conditions. During the study period, 131 patients with COPD and no comorbidities had a median length of stay of three days (IQR: 3) compared to 3,911 COPD patients with one to five comorbidities with a median length of stay of seven days (IQR: 9). There were 47 patients with HF and no comorbidities with a median length of stay of four days (IQR: 5) compared to 6,273 HF patients with one to five comorbidities with a median length of stay of nine days (IQR: 12). Common comorbidities included hypertension, type 2 diabetes, and acute renal failure. COPD and HF are frequently comorbid. Conclusions Total days in hospital for patients with COPD or HF is positively correlated with the number of comorbidities. COPD or HF patients with between one to five comorbidities (compared to those with no comorbidities, and those with more than five comorbidities) represent the majority of total days in hospital, and the majority of patients. This highlights the importance of focusing on patients with comorbidities in efforts to reduce hospital utilization, and suggests that concurrent management of commonly occurring comorbidities for HF and COPD patients may be necessary to achieve this goal.
慢性阻塞性肺疾病（COPD）和心力衰竭（HF）是急性护理利用率较高的慢性疾病。卡尔加里为慢性阻塞性肺疾病或心力衰竭患者制定了特定疾病医嘱集，以减少该类患者的住院总天数。然而，许多患者存在合并症，这可能导致住院率上升；因此，特定疾病医嘱集可能不是降低总体急性护理利用率的最佳解决方案。方法：确定2017年4月1日至2019年3月31日期间卡尔加里因慢性阻塞性肺疾病或心力衰竭住院的患者的住院数据及相关诊断。结果包括按合并症数量分层的慢性阻塞性肺疾病和心力衰竭患者的住院总天数和住院时长。结果：两种疾病的住院总天数均随合并症数量的增加而增加。在研究期间，131例无合并症的慢性阻塞性肺疾病患者的中位住院时长为3天（四分位间距：3），而3911例有1至5种合并症的慢性阻塞性肺疾病患者的中位住院时长为7天（四分位间距：9）。47例无合并症的心力衰竭患者的中位住院时长为4天（四分位间距：5），而6273例有1至5种合并症的心力衰竭患者的中位住院时长为9天（四分位间距：12）。常见合并症包括高血压、2型糖尿病和急性肾衰竭。慢性阻塞性肺疾病和心力衰竭常合并存在。结论：慢性阻塞性肺疾病或心力衰竭患者的住院总天数与合并症数量呈正相关。有1至5种合并症的慢性阻塞性肺疾病或心力衰竭患者（与无合并症患者及合并症超过5种的患者相比）占住院总天数的大部分，且占患者总数的大部分。这凸显了在努力降低住院率时关注合并症患者的重要性，并表明为实现这一目标，可能有必要同时管理心力衰竭和慢性阻塞性肺疾病患者常见的合并症。
