Sánchez-Mellado Diana, Villar-Álvarez Felipe, Fernández Ormaechea Itziar, Naya Prieto Alba, Armenta Fernández Rebeca, Gómez Del Pulgar Murcia Teresa, Mahillo-Fernández Ignacio, Peces-Barba Romero Germán
Pulmonology Department, IIS Fundación Jiménez Díaz, Madrid, Spain.
CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
Open Respir Arch. 2022 Jun 19;4(3):100190. doi: 10.1016/j.opresp.2022.100190. eCollection 2022 Jul-Sep.
To decrease readmissions at 30 and 90 days post-discharge from a hospital admission for chronic obstructive pulmonary disease exacerbation (COPDE) through the home care model of the Ambulatory Chronic Respiratory Care Unit (ACRCU), increase patient survival at one year, and validate our readmission risk scale (RRS).
This was an observational study, with a prospective data collection and a retrospective data analysis. A total of 491 patients with a spirometry diagnosis of chronic obstructive pulmonary disease (COPD) requiring hospitalisation for an exacerbation were included in the study. Subjects recruited within the first year (204 cases) received conventional care (CC). In the following year a home care (HC) programme was implemented and of those recruited that year (287) 104 were included in the ACRCU, administered by a specialised nurse.
In the group of patients included in the home care model of the Ambulatory Chronic Respiratory Care Unit (ACRCU) a lower number of readmissions was observed at 30 and 90 days after discharge (30.5% vs. 50%, = 0.012 and 47.7% vs. 65.2%, = 0.031, respectively) and a greater one-year survival (85.3% vs. 59.1%, < 0.001). The validation of our RRS revealed that the tool's capacity to predict readmissions at both 30 and 90 days was not high (AUC = 0.69 and AUC = 0.66, respectively).
The inclusion of exacerbator or fragile COPD patients in the ACRCU could achieve a decrease in readmissions and an increase in survival. The number of episodes of exacerbation within the 12 months prior to the hospital admission is the variable that best predicts the risk of readmission.
通过门诊慢性呼吸护理单元（ACRCU）的家庭护理模式，降低慢性阻塞性肺疾病急性加重（COPDE）住院出院后30天和90天的再入院率，提高患者一年生存率，并验证我们的再入院风险量表（RRS）。
这是一项观察性研究，采用前瞻性数据收集和回顾性数据分析。共有491例经肺活量测定诊断为慢性阻塞性肺疾病（COPD）且因急性加重需要住院治疗的患者纳入研究。第一年招募的受试者（204例）接受常规护理（CC）。在接下来的一年中实施了家庭护理（HC）计划，当年招募的患者（287例）中有104例被纳入由专业护士管理的ACRCU。
在门诊慢性呼吸护理单元（ACRCU）家庭护理模式纳入的患者组中，出院后30天和90天的再入院人数较少（分别为30.5%对50%，P = 0.012；47.7%对65.2%，P = 0.031），一年生存率更高（85.3%对59.1%，P < 0.001）。我们的RRS验证显示，该工具预测30天和90天再入院的能力不高（AUC分别为0.69和0.66）。
将急性加重期或脆弱的COPD患者纳入ACRCU可降低再入院率并提高生存率。入院前12个月内的急性加重发作次数是预测再入院风险的最佳变量。
