COPD 护理套餐对住院再入院率的影响。
Impact of a COPD care bundle on hospital readmission rates.
出版信息
J Am Pharm Assoc (2003). 2023 Jan-Feb;63(1):269-274. doi: 10.1016/j.japh.2022.10.002. Epub 2022 Oct 11.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality worldwide and contributes considerably to morbidity and health care costs. In October 2014, the Centers for Medicare and Medicaid Services introduced financial penalties followed by bundled payments for care improvement initiatives in patients hospitalized with COPD.
OBJECTIVES
This study seeks to evaluate whether an evidence-based interprofessional COPD care bundle focused on inpatient, transitional, and outpatient care would reduce hospital readmission rates.
METHODS
A pre- and postintervention analysis comparing readmission rates after a hospitalization for COPD in subjects who received standard of care versus an interprofessional team-led COPD care bundle was conducted. The primary outcome was 30-day all-cause readmissions; secondary outcomes included 60- and 90-day all-cause readmissions, escalation of pharmacotherapy, interprofessional interventions, and hospital length of stay.
RESULTS
A total of 189 subjects were included in the control arm and 127 subjects in the COPD care bundle arm. A reduction in 30-day all-cause readmissions between the control arm and COPD care bundle arm (21.7% vs. 11.8%, P = 0.017) was seen. Similar outcomes were seen in 60-day (18% vs. 8.7%, P = 0.013) and 90-day all-cause readmissions (19.6% vs. 4.7%, P < 0.001). Pharmacists consulted with 68.5% of subjects and assisted with access to outpatient medications in 45.7% of subjects in the COPD care bundle arm. An escalation in maintenance therapy occurred more often in the COPD care bundle arm (22.2% vs. 44.9%, P < 0.001) than the control arm.
CONCLUSIONS
An interprofessional team-led COPD care bundle resulted in significant reductions in all-cause hospital readmissions at 30, 60, and 90 days.
背景
慢性阻塞性肺疾病（COPD）是全球主要的死亡原因之一，极大地导致了发病率和医疗保健费用。2014 年 10 月，医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）针对 COPD 住院患者的护理改善计划引入了财务处罚和捆绑支付。
目的
本研究旨在评估以住院、过渡和门诊护理为重点的循证跨专业 COPD 护理套餐是否会降低医院再入院率。
方法
对接受标准护理的 COPD 住院患者与接受跨专业团队主导的 COPD 护理套餐的患者进行住院后 30 天全因再入院率的预干预和干预后分析。主要结局是 30 天全因再入院率；次要结局包括 60 天和 90 天全因再入院率、药物治疗升级、跨专业干预和住院时间。
结果
对照组共纳入 189 例患者，COPD 护理套餐组共纳入 127 例患者。与对照组相比，COPD 护理套餐组 30 天全因再入院率（21.7%对 11.8%，P=0.017）降低。60 天（18%对 8.7%，P=0.013）和 90 天全因再入院率（19.6%对 4.7%，P<0.001）也出现类似结果。COPD 护理套餐组有 68.5%的患者接受了药师咨询，45.7%的患者获得了门诊药物治疗。COPD 护理套餐组维持治疗升级的发生率高于对照组（22.2%对 44.9%，P<0.001）。
结论
以跨专业团队为主导的 COPD 护理套餐可显著降低 30、60 和 90 天全因医院再入院率。
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