Mulpuru Sunita, Chin Melanie, Hasimja Delvina, Sandoz Jacqueline, Voduc Nha, Pakhale Smita, Inoue Jiro, Cassidy Joanne, Tessier Caroline, d'Entremont Barbara, Lawson Julie, Shaw Julia, Laframboise Wendy, Benson Tim, Forster Alan J
Division of Respirology, The Ottawa Hospital, Ottawa, Ontario, Canada
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
BMJ Open Qual. 2025 Aug 7;14(3):e003366. doi: 10.1136/bmjoq-2025-003366.
Frailty is associated with morbidity and mortality among people with chronic obstructive pulmonary disease (COPD), yet there are no established care pathways to manage frail patients with COPD. To address this gap, we developed, implemented and assessed the feasibility of a new frailty-focused care model for patients hospitalised with exacerbations of COPD.
We conducted a prospective cohort study among hospitalised patients with acute exacerbations of COPD in an academic hospital in Canada over 18 months. We developed and implemented a frailty-focused care model using the degree of frailty to guide personalised assessments, education, and care interventions during and after hospital discharge. We assessed the feasibility of using frailty-focused care in a real-world setting with prespecified targets for recruitment rate, care model completion and collection of patient-reported outcomes including symptom burden, health confidence, health status and self-management scores. Patients were followed up at 3 months after hospitalisation to reassess patient-reported outcomes.
87 patients used the frailty-focused care model during hospitalisation, 58 consented to participate in this study and 45 (78%) completed 3-month postdischarge follow-up. 47% (n=21) were at least mildly frail at baseline, with 35% (n=20) at risk of frailty. Target recruitment of 50 patients was achieved, and all participants completed core elements of frailty-focused care, including frailty assessment, personalised education and discharge planning. Patient-reported outcomes were measured in all participants in hospital, and in 78% (n=45) patients at 3-month follow-up. 23% (n=13) of patients initially reported feeling confident to manage their health condition. This improved to 62% (n=28) at 3-month follow-up.
This study provides a foundation to build innovative care models for frail individuals with COPD and shows it is feasible to use frailty-focused care in a real-world hospital setting. Future work requires strong patient engagement to better align frailty-focused care with patient-centred goals.
衰弱与慢性阻塞性肺疾病（COPD）患者的发病率和死亡率相关，但目前尚无既定的护理路径来管理COPD衰弱患者。为填补这一空白，我们开发、实施并评估了一种针对因COPD急性加重住院患者的新型以衰弱为重点的护理模式的可行性。
我们在加拿大一家学术医院对COPD急性加重的住院患者进行了为期18个月的前瞻性队列研究。我们开发并实施了一种以衰弱为重点的护理模式，利用衰弱程度来指导住院期间及出院后针对个体的评估、教育和护理干预。我们评估了在现实环境中使用以衰弱为重点的护理的可行性，设定了招募率、护理模式完成率以及收集患者报告结局（包括症状负担、健康信心、健康状况和自我管理评分）的预定目标。患者在出院后3个月接受随访，以重新评估患者报告结局。
87例患者在住院期间使用了以衰弱为重点的护理模式，58例同意参与本研究，45例（78%）完成了出院后3个月的随访。47%（n = 21）的患者在基线时至少有轻度衰弱，35%（n = 20）有衰弱风险。实现了招募50例患者的目标，所有参与者均完成了以衰弱为重点的护理的核心要素，包括衰弱评估、个性化教育和出院计划。所有住院参与者均进行了患者报告结局的测量，78%（n = 45）的患者在3个月随访时进行了测量。23%（n = 13）的患者最初报告对管理自身健康状况有信心。这一比例在3个月随访时提高到了62%（n = 28）。
本研究为为COPD衰弱个体构建创新护理模式奠定了基础，并表明在现实医院环境中使用以衰弱为重点的护理是可行的。未来的工作需要患者的积极参与，以使以衰弱为重点的护理更好地与以患者为中心的目标保持一致。
