Social and clinical predictors of short- and long-term readmission after a severe exacerbation of copd

Abstract

Introduction and objectives The aim of this study was to evaluate the predictive ability of multiple social, and clinical factors for readmission after a severe acute exacerbation of COPD (AECOPD) during various time periods. Methods We performed a prospective cohort study in which recruited patients with AECOPD. We systematically collected numerous clinical (symptoms, pulmonary function, comorbidities, and treatment) and social (financial situation, housing situation, family support, caregiver overload, ability to perform activities, and risk of social exclusion) variables using several questionnaires and indices. The patients were followed closely for one year and readmissions at 30, 60, and 365 days were analysed. Results 253 patients were included, aged 68.9±9.8years, FEV 1 = 42.1%±14.2%, and a Charlson's index = 1.8±0.9. Of these patients, 20.2%, 39.6%, and 63.7% were readmitted within the first 30, 90, and 365 days after discharge, respectively. In the multivariate model applied, the variables that were independently associated with readmission over all three periods of the analysis were dependence to perform basic activities of daily living (BADLs) (odds ratio [OR] = 2.10-4.10) and a history of two or more admissions within the previous year (OR = 2.78-3.78). At 90 days, a history of bacterial isolates in a previous sputum culture (OR = 2.39) and at 365 days, a high grade of dyspnoea (OR = 2.51) and obesity (OR = 2.38) were also identified as predictors of hospital readmission.

Sociodemographic and Clinical Variables Related to the Overburden of the Informal Caregivers of Patients Hospitalized for Chronic Obstructive Pulmonary Disease Exacerbations

“…In our study, dependence to carry out activities may not have been related to caregiver overburden, because the discriminative capacity of these variables was likely much lower in our hands than in previous studies in the same cohort 4,21 or in other studies with larger samples of patients with different profiles. 33 This was because of the specific profile of the COPD patients with a regular informal caregiver that were examined in our work-almost all of which had some degree of dependence, a high frequency of hospitalizations, and a significant need for care.…”

“…The SocioEPOC Cohort comprised 253 patients; a detailed description and analysis of all the variables collected for these patients has already been published. 6,21 Briefly, 63 (24.9%) of the patients lived alone, 71 patients lived with others, but those household members did not have a caregiver role, and 119 (47%) had a primary caregiver, of which 20 (16.8%) were paid and 99 (83.2%) were informal caregivers. These data are shown in the study flowchart presented in Figure 1.…”

“…The methodology used for this study was previously published elsewhere in a greater detail. 4,21 After the third or fourth day of hospital admission, we interviewed the patient and their informal caregiver, and completed the information by reviewing the electronic medical records of the COPD patient, including social, demographic, and clinical data. This study included patients who had informal caregivers at the time of inclusion.…”

Four Decades of COPD Mortality Trends: Analysis of Trends and Multiple Causes of Death

“…In this study, just over 40% of death certificates included COPD as part of the dying process, implying that the real burden of the disease in the mortality statistics is considerably higher. In clinical hospital cohort studies published in Spain, the most frequent causes of mortality reported in patients with COPD are neoplasms and cardiovascular diseases [ 22 , 23 ]. This is in line with our study in that when COPD is not considered to be the underlying cause of death, most of the patients die due to neoplasms (essentially bronchopulmonary), different cardiovascular diseases, or dementias.…”

Social disparities in unplanned 30-day readmission rates after hospital discharge in patients with chronic health conditions: A retrospective cohort study using patient level hospital administrative data linked to the population census in Switzerland

“…On the other hand, in a study in two urban hospitals, which included also non-chronically ill patients, living alone showed no effect on the potentially preventable hospital readmission rate (42). Neither showed living alone and care giver availability as having an effect on the 30-day readmission rate in severe COPD patients when controlling for health status and further social factors (29).…”