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A systematic review of the effectiveness of discharge care bundles for patients with COPD
  1. Maria B Ospina1,
  2. Kelly Mrklas1,2,
  3. Lesly Deuchar1,
  4. Brian H Rowe1,3,4,
  5. Richard Leigh5,
  6. Mohit Bhutani6,
  7. Michael K Stickland1,6,7
  1. 1Alberta Health Services, Edmonton, Alberta, Canada
  2. 2Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
  4. 4School of Public Health, University of Alberta, Edmonton, Alberta, Canada
  5. 5Division of Respirology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  6. 6Division of Pulmonary Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
  7. 7G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, Alberta, Canada
  1. Correspondence to Dr Michael K. Stickland, Associate Professor, Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 3-135 Clinical Sciences Building, Edmonton, Alberta, Canada T6G 2J3; michael.stickland{at}ualberta.ca

Abstract

Background A COPD discharge bundle is a set of evidence-based practices aimed at improving patient outcomes after discharge from acute care settings following an exacerbation. We conducted a systematic review on the effectiveness of COPD discharge bundles and summarised their individual care elements.

Methods Biomedical electronic databases and clinical trial registries were searched from database inception through April 2016 to identify experimental studies evaluating care bundles offered to patients with COPD at discharge. Random-effects meta-analyses of clinical trials data were conducted for hospital readmissions, mortality, and quality of life (QoL).

Results The review included 14 studies (5 clinical trials, 7 uncontrolled trials, and 2 interrupted time series). A total of 26 distinct elements of care were included in the bundles of individual studies. Evidence from four clinical trials with moderate-to-high risk of bias showed that COPD discharge bundles reduced hospital readmissions (pooled risk ratio (RR): 0.80; 95% CI 0.65 to 0.99). There was insufficient evidence that care bundles influence long-term mortality (RR: 0.74; 95% CI 0.43 to 1.28; four trials) or QoL (mean difference in St. George's Respiratory Questionnaire: 1.84; 95% CI −2.13 to 5.8).

Conclusions Discharge bundles for patients with COPD led to fewer readmissions but did not significantly improve mortality or QoL. Future studies should employ higher quality research methods, fully report care bundle elements, implementation strategies and intervention fidelity to better evaluate the effectiveness of packaging evidence-based interventions together to improve outcomes of patients with COPD discharged from acute care settings.

  • COPD Exacerbations
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Footnotes

  • Contributors MBO, LD, RL, MB, BHR and MKS contributed to study conception and protocol of the review. MBO, KM and LD performed the systematic review. MBO performed the statistical analysis. All authors contributed to the interpretation of data. MBO drafted the paper and all authors provided critical revisions and contributed to the editing of the paper.

  • Funding This research was supported by Alberta Innovates Health Solutions (AIHS) through the Partnership for Research and Innovation in the Health System (PRIHS-2) programme. MKS is supported by a Heart and Stroke Foundation New Investigator Award. Dr. Rowe is supported by the Canadian Institutes of Health Research as a Tier I Canada Research Chair in Evidence-Based Emergency Medicine through the Government of Canada. K. Mrklas is supported by an Alberta Health Services Post Secondary Education Tuition Award.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement List of excluded studies available from corresponding author.

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