Randomised controlled trial of home based care of patients with chronic obstructive pulmonary disease

Hermiz, Oshana; Comino, Elizabeth; Marks, Guy B.; Daffurn, Katharine; Wilson, Sandy J.; Harris, Monica J.

doi:10.1136/bmj.325.7370.938

Cited by 165 publications

(208 citation statements)

References 17 publications

Supporting

Mentioning

192

Contrasting

Unclassified

Order By: Relevance

“…42 One trial reported significantly reduced adverse drug events as a consequence of pharmacist counselling of patients following discharge but no change in readmissions. 43 Two trials involving 334 patients with chronic lung disease failed to show any impact of nurse home visits on readmissions, 44,45 in contrast to two trials involving 878 patients with cardiac disease that demonstrated a significant (P < 0.05) one-third decrease in readmissions. 46,47 In a Cochrane review of 33 studies involving 5110 patients, telephone calls initiated by hospital staff to patients shortly after discharge failed to reduce readmissions.…”

Section: Post-discharge Home Visits or Telephonic Follow-upmentioning

confidence: 95%

Preventing the rebound: improving care transition in hospital discharge processes

Scott

2010

Aust. Health Review

View full text Add to dashboard Cite

Background. Unplanned readmissions of recently discharged patients impose a significant burden on hospitals with limited bed capacity. Deficiencies in discharge processes contribute to such readmissions, which have prompted experimentation with multiple types of peridischarge interventions.Objective. To determine the relative efficacy of peridischarge interventions categorised into two groups: (1) single component interventions (sole or predominant) implemented either before or after discharge; and (2) integrated multicomponent interventions which have pre-and postdischarge elements.Design. Systematic metareview of controlled trials. Data collection. Search of four electronic databases for controlled trials or systematic reviews of trials published between January 1990 and April 2009 that reported effects on readmissions.Data synthesis. Among single-component interventions, only four (intense self-management and transition coaching of high-risk patients and nurse home visits and telephone support of patients with heart failure) were effective in reducing readmissions. Multicomponent interventions that featured early assessment of discharge needs, enhanced patient (and caregiver) education and counselling, and early postdischarge follow-up of high-risk patients were associated with evidence of benefit, especially in populations of older patients and those with heart failure.Conclusion. Peridischarge interventions are highly heterogenous and reported outcomes show considerable variation. However, multicomponent interventions targeted at high-risk populations that include pre-and postdischarge elements seem to be more effective in reducing readmissions than most single-component interventions, which do not span the hospitalcommunity interface.What is known about this topic? Unplanned readmissions within 30 days of hospital discharge are common and may reflect deficiencies in discharge processes. Various peridischarge interventions have been evaluated, mostly single-component interventions that occur either before or after discharge, but failing to yield consistent evidence of benefit in reducing readmissions. More recent trials have assessed multicomponent interventions which involve pre-and postdischarge periods, but no formal review of such studies has been undertaken. What does this paper add? With the exception of intense self-management and transition coaching of high-risk patients, and nurse home visits and telephonic support for patients with heart failure, single-component interventions were ineffective in reducing readmissions. Multicomponent interventions demonstrated evidence of benefit in reducing readmissions by as much as 28%, with best results achieved in populations of older patients and those with heart failure. What are the implications for practitioners and managers? Hospital clinicians and managers should critically review and, where appropriate, modify their current discharge processes in accordance with these findings and negotiate the extra funding and personnel required to allow succ...

show abstract

Section: Post-discharge Home Visits or Telephonic Follow-upmentioning

confidence: 95%

Preventing the rebound: improving care transition in hospital discharge processes

Scott

2010

Aust. Health Review

View full text Add to dashboard Cite

show abstract

“…Our findings, however, are consistent with this previous report, and we were unable to identify intervention to reduce 30-day rehospitalizations in patients with COPD exacerbations; our findings also indicate that there do not appear to be interventions that consistently reduce rehospitalizations at subsequent time points (e.g., 6 or 12 months post discharge). Other randomized controlled trials that enrolled ambulatory patients or patients presenting to the emergency department with COPD exacerbations (but not hospitalized) also found inconsistent benefits of interventions designed to reduce hospitalizations (37)(38)(39)(40). Although there appear to be a large number of studies examining strategies to reduce rehospitalizations, the lack of a standard approach to defining patient populations, study interventions and comparators, outcomes, timeframe for assessing outcomes, and settings in which the study was conducted are barriers to cross-study syntheses of evidence.…”

Section: Systematic Reviewmentioning

confidence: 99%

Interventions to Reduce Rehospitalizations after Chronic Obstructive Pulmonary Disease Exacerbations. A Systematic Review

Prieto-Centurion¹,

Markos

Ramey³

et al. 2014

Annals ATS

View full text Add to dashboard Cite

Rationale: Approximately 20% of patients hospitalized for COPD exacerbations in the United States will be readmitted within 30 days. The Centers for Medicare and Medicaid Services has recently proposed to revise the Hospital Readmissions Reduction Program to financially penalize hospitals with high all-cause 30-day rehospitalization rates after a hospitalization for COPD exacerbation on or after October 1, 2014.Objectives: To report the results of a systematic review of randomized clinical trials evaluating interventions to reduce the rehospitalizations after COPD exacerbations.Methods: Multiple electronic databases were systematically searched to identify relevant studies published between January 1966 and June 2013. Titles, abstracts, and, subsequently, full-text articles were assessed for eligibility. Each study was appraised using predefined criteria.Measurements and Main Results: Among 913 titles and abstracts screened, 5 studies (1,393 participants) met eligibility criteria. All studies had a primary outcome of rehospitalization at 6 or 12 months. No study examined 30-day rehospitalization as the primary outcome. Each study tested a different set of interventions. Two studies (one conducted in Canada and one conducted in Spain and Belgium) showed a decrease in all-cause rehospitalization over 12 months in the intervention group versus comparator group (mean number of hospitalizations per patient, 1.0 vs. 1.8; P = 0.01; percent hospitalized, 45 vs. 67%; P = 0.028; respectively). The only study conducted in the United States found a greater than twofold higher risk of mortality in the intervention group (17 vs. 7%, P = 0.003) but no significant difference in rehospitalizations. It was unclear which set of interventions was effective or harmful. Conclusions:The evidence base is inadequate to recommend specific interventions to reduce rehospitalizations in this population and does not justify penalizing hospitals for high 30-day rehospitalization rates after COPD exacerbations.

show abstract

“…Alcuni trials clinici randomizzati hanno mostrato che, in pazienti selezionati, l'assistenza domiciliare integrata rappresenta una valida alternativa all'ospedalizzazione per la gestione di una riacutizzazione in assenza di acidosi respiratoria (210)(211)(212)(213).…”

Section: Stabilire Un Piano DI Gestione Della Bpco E Delle Sue Comorbunclassified

Monografia Giovani FADOI: dalle evidenze alla pratica clinica

et al. 2018

View full text Add to dashboard Cite

La gestione della cardiopatia ischemica stabile: dalle evidenze alla pratica clinicaR. Gerloni, L. Mucci, T. Ciarambino, M. Ventura, V. Baglio, M. Chiuch, F. Saladini, S. Dorigoni, P. GnerreApproccio clinico al paziente pancitopenicoM.C. Pasquini, E. Barbagelata, P. Cavallo, T. Ciarambino, S. Ciarla, S. Deregibus, I. Mascherona, L. Mucci, L. ZanlariManagement dell’ipertiroidismo: dall’evidenza alla pratica clinicaM.R. Poggiano, E. Barbagelata, C. UsaiManagement del paziente con insufficienza cortico-surrenalica: dall’evidenza alla pratica clinicaI. Ambrosino, E. Cristaldi, M.R. Poggiano, P. Gnerre, R. Muscariello, M. VacanteLa gestione del paziente con broncopneumopatia cronica ostruttiva: dalle evidenze alla pratica clinicaI Parte - EvidenzeII ParteC. Cenci, C. Rinollo, T. Ciarambino, O. Para, G. Belmonte, S. Moretti, S. Ciarla, M. Gino, F. Pasin, N. Battino

show abstract

Randomised controlled trial of home based care of patients with chronic obstructive pulmonary disease

Abstract: Objectives To evaluate usefulness of limited community based care for patients with chronic obstructive pulmonary disease after discharge from hospital. Design Randomised controlled trial.

Cited by 165 publications

References 17 publications

Preventing the rebound: improving care transition in hospital discharge processes

Preventing the rebound: improving care transition in hospital discharge processes

Interventions to Reduce Rehospitalizations after Chronic Obstructive Pulmonary Disease Exacerbations. A Systematic Review

Monografia Giovani FADOI: dalle evidenze alla pratica clinica

Contact Info

Product

Resources

About