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Original Study
Discharge Coordinator Intervention Prevents Hospitalizations in Patients With COPD: A Randomized Controlled Trial

https://doi.org/10.1016/j.jamda.2013.03.003Get rights and content

Abstract

Objectives

To test whether coordination of discharge from hospital reduces hospitalizations in patients with chronic obstructive pulmonary disease (COPD).

Design

Randomized controlled clinical trial.

Setting

Specialized pulmonary hospital.

Participants

Patients hospitalized for an acute exacerbation of COPD.

Intervention

Care as usual included routine patient education, supervised inhaler use, respiratory physiotherapy, and disease-related communication. The discharge coordinator intervention added assessment of patient situation and homecare needs. Patients and caregivers were actively involved and empowered in the discharge planning process, which was communicated with community medical professionals to provide continuity of care at home.

Measurements

The primary end-point of the study was the number of patients hospitalized because of worsening COPD. Key secondary end-points were time-to-COPD hospitalization, all-cause mortality, all-cause hospitalization, days alive and out of hospital, and health-related quality of life.

Results

Of 253 eligible patients (71 ± 9 years, 72% men, 87% GOLD III/IV), 118 were assigned to intervention and 135 to usual care. During a follow-up of 180 days, fewer patients receiving intervention were hospitalized for COPD (14% versus 31%, P = .002) or for any cause (31% versus 44%, P = .033). In time-to-event analysis, intervention was associated with lower rates of COPD hospitalizations (P = .001). A Cox model of proportional hazards, adjusted for sex, age, GOLD stage, heart failure, malignant disease, and long-term oxygen treatment, demonstrated that intervention reduced the risk of COPD hospitalization (hazard ratio 0.43, 95% confidence interval 0.24–0.77, P = .002).

Conclusion

Among patients hospitalized for acute COPD exacerbation, discharge coordinator intervention reduced both COPD hospitalizations and all-cause hospitalizations.

Section snippets

Study Design

For this randomized controlled clinical trial we enrolled 253 eligible patients between November 2, 2009, and December 6, 2011, from a specialized pulmonary hospital. The study design and protocol have been published previously.15 In brief, patients with acute exacerbation of COPD were randomized within 48 hours after admission to discharge coordinator intervention or care as usual. During 180 days after discharge, patients were regularly followed by phone or through direct contact. The

Study Patients

A total of 253 patients were enrolled during the recruitment period (Figure 1) and were followed for at least 180 days after discharge from hospital or until death. The clinical and sociodemographic characteristics of the patients are shown in Table 1. Enrolled patients were mostly elderly men (72%) with an average age of 71 ± 9 years, with significant smoking exposure and mostly with severe pulmonary obstruction. The 2 groups of patients were similar with respect to baseline characteristics,

Discussion

Among our hospitalized patients with COPD, discharge coordinator intervention significantly reduced both COPD hospitalizations and all-cause hospitalizations during the 180 days after discharge. The reduction in all-cause hospitalizations in the intervention group was apparently driven by reduction of COPD hospitalizations. We observed no benefits in health-related quality of life and no reduction of all-cause mortality.

Over the past decade there has been growing interest in the use

Acknowledgments

This trial was made possible through the dedication and effort of the trial personnel: Marusa Ahacic, Barbara Bukovnik, Dragica Cof, Ana Delimar, Dejan Dobersek, Natasa Grahovec, Ivanka Krzisnik, Maja Mali, Pika Mesko Brguljan, Breda Papler, Urska Papler, Katja Pilar, Irena Pocvavsek, Lojzka Prestor, Sasa Primozic, Majda Pusavec, Mojca Sarlija, Tina Starman, Alain Sumer, Katja Vrankar, Barbara Zadnik, Natasa Zizmond, and Katja Zupanc.

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    Clinical trials registration: ClinicalTrials.gov - NCT0122562, No financial support was received for this trial.

    The authors declare no conflicts of interest.

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