Audit of acute admissions of chronic obstructive pulmonary disease: inpatient management and outcome

Chang, Catherina L.; Sullivan, Glenda; Karalus, Noel; Hancox, Robert J.; McLachlan, J. D.; Mills, Graham

doi:10.1111/j.1445-5994.2006.01283.x

Cited by 29 publications

(76 citation statements)

References 16 publications

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“…Other unidentified factors, such as hospital-level variables, might play an important role. The high mortality after acute COPD exacerbation is in keeping with results from previous studies where short-term mortality ranged from 2 to 14% [9,16].…”

Section: Discussionsupporting

confidence: 77%

Profiling hospital performance to monitor the quality of care: the case of COPD

Agabiti¹,

Belleudi²,

Davoli³

et al. 2009

Eur Respir J

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Comparative outcomes data are widely used to monitor quality of care in the cardiovascular area; little is available in the respiratory field. We applied validated methods to compare hospital outcomes for chronic obstructive pulmonary disease (COPD) exacerbation.From the hospital information system, we selected all hospital admissions for COPD exacerbation in Rome (for 2001Rome (for -2005. Vital status within 30 days was obtained from the municipality mortality register. Each hospital was compared to a pool of hospitals with the lowest adjusted mortality rate (the benchmark). Age, sex and several potential clinical predictors were covariates in logistic regression analysis.12,756 exacerbated COPD patients were analysed (mean age 74 yrs, 71% males). Diabetes, hypertension, ischaemic heart disease, heart failure and arrhythmia were the most common coexisting conditions. The average crude mortality in the benchmark group was 3.8%; in the remaining population it was 7.5% (range 5.2-17.2%). In comparison with the benchmark, the relative risk of 30-day mortality varied widely across the hospitals (range 1.5-5.9%).A large variability in 30-day mortality after COPD exacerbation exists even considering patients' characteristics. Although these results do not detect mechanisms related to worse outcomes, they may be useful to stimulate providers to revision and improvement of COPD care management.

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Section: Discussionsupporting

confidence: 77%

Profiling hospital performance to monitor the quality of care: the case of COPD

Agabiti¹,

Belleudi²,

Davoli³

et al. 2009

Eur Respir J

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“…This is illustrated by the wide range of reported LOS (3–16 days) 9,10. In the absence of a published definition for prolonged LOS, we defined a LOS longer than the 75th percentile as prolonged LOS in this article, which is in line with other studies 11–13…”

Section: Introductionsupporting

confidence: 54%

Factors associated with a prolonged length of stay after acute exacerbation of chronic obstructive pulmonary disease (AECOPD)

Wang¹,

Stavem²,

Dahl³

et al. 2014

COPD

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BackgroundEarly identification of patients with a prolonged stay due to acute exacerbation of chronic obstructive pulmonary disease (COPD) may reduce risk of adverse event and treatment costs. This study aimed to identify predictors of prolonged stay after acute exacerbation of COPD based on variables on admission; the study also looked to establish a prediction model for length of stay (LOS).MethodsWe extracted demographic and clinical data from the medical records of 599 patients discharged after an acute exacerbation of COPD between March 2006 and December 2008 at Oslo University Hospital, Aker. We used logistic regression analyses to assess predictors of a length of stay above the 75th percentile and assessed the area under the receiving operating characteristic curve to evaluate the model’s performance.ResultsWe included 590 patients (54% women) aged 73.2±10.8 years (mean ± standard deviation) in the analyses. Median LOS was 6.0 days (interquartile range [IQR] 3.5–11.0). In multivariate analysis, admission between Thursday and Saturday (odds ratio [OR] 2.24 [95% CI 1.60–3.51], P<0.001), heart failure (OR 2.26, 95% CI 1.34–3.80), diabetes (OR 1.90, 95% CI 1.07–3.37), stroke (OR 1.83, 95% CI 1.04–3.21), high arterial PCO2 (OR 1.26 [95% CI 1.13–1.41], P<0.001), and low serum albumin level (OR 0.92 [95% CI 0.87–0.97], P=0.001) were associated with a LOS >11 days. The statistical model had an area under the receiver operating characteristic curve of 0.73.ConclusionAdmission between Thursday and Saturday, heart failure, diabetes, stroke, high arterial PCO2, and low serum albumin level were associated with a prolonged LOS. These findings may help physicians to identify patients that will need a prolonged LOS in the early stages of admission. However, the predictive model exhibited suboptimal performance and hence is not ready for clinical use.

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“…The US and New Zealand studies describing in-hospital management of AECOPD reported similar percentages of patients with prescriptions for systemic corticosteroid: 84.9% and 83%, respectively. 4,7 However, the rates of antibiotic use were higher (84.6% and 80%) than in the current study, which could be explained by the inclusion of all types of antibiotics in the previous analyses. In the current analysis, only respiratory antibiotics were considered, with exclusion of other antibiotics that might be prescribed in the context of AECOPD, such as ciprofloxacin.…”

Section: Discussioncontrasting

confidence: 49%

Management of Chronic Obstructive Pulmonary Disease in Patients Admitted to a Tertiary Care Centre for Exacerbation of Their Disease

Dault

Dubé

Blais

et al. 2012

CJHP

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Audit of acute admissions of chronic obstructive pulmonary disease: inpatient management and outcome

Abstract: This audit documented the general characteristics, assessment, management and outcome of the COPD admissions to a secondary New Zealand hospital. Further investigations into factors contributing to shorter length of stay and predictors of mortality are needed.

Cited by 29 publications

References 16 publications

Profiling hospital performance to monitor the quality of care: the case of COPD

Profiling hospital performance to monitor the quality of care: the case of COPD

Factors associated with a prolonged length of stay after acute exacerbation of chronic obstructive pulmonary disease (AECOPD)

Management of Chronic Obstructive Pulmonary Disease in Patients Admitted to a Tertiary Care Centre for Exacerbation of Their Disease

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