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Fuoco MJ, Mularski RA, Wu B, Moretz C, McBurnie MA, Stanford RH, Crawford P, Gratie D, Salas B. Continuity of Care Assessment Within a Vertically Integrated Care Management Organization Before and After COPD-Related Exacerbations. Int J Chron Obstruct Pulmon Dis 2021; 16:2755-2767. [PMID: 34675501 PMCID: PMC8504477 DOI: 10.2147/copd.s290714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 08/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background There is currently little research describing patient experience and continuity of care immediately prior, during, and following an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This analysis examined clinical characteristics, chronic obstructive pulmonary disease (COPD)‑related medication patterns and outpatient visits before and after an AECOPD. Methods This retrospective analysis used electronic health records, medical claims, and pharmacy dispensing data for patients within the Kaiser Permanente Northwest Health System. Patients with ≥1 AECOPD between January 1, 2015 and December 31, 2017 were identified. The most recent AECOPD was considered the index date. An AECOPD was defined as an inpatient hospitalization with a primary diagnosis of COPD, or respiratory failure with a secondary diagnosis of COPD, or an outpatient visit with a primary diagnosis of COPD and dispensing of respiratory-related antibiotics and/or oral corticosteroids ±5 days of the visit. Eligible patients were: ≥40 years old; ≥2 encounters within 12 months of each other or ≥1 hospitalization with primary or secondary COPD diagnosis, chronic bronchitis, or emphysema prior to index; and continuously enrolled ±90 days relative to index. COPD-related inhaled maintenance medication, rescue inhalers, oral corticosteroid use, and ambulatory visits were assessed 90-days pre- and post-index. Results There were 2829 patients included (mean [standard deviation] age: 69.0 [10.5] years) who had an AECOPD (7% severe; 93% moderate). The percentage of patients on inhaled maintenance therapy increased from 60.6% pre-AECOPD to 68.8% post-AECOPD and increased from 60.0% to 87.4% among patients who experienced a severe AECOPD. COPD-related ambulatory visits increased more than four-fold for primary care and more than doubled for pulmonologist visits in the post-AECOPD period. Conclusion The low proportion of patients observed with changes to controller and rescue medication (particularly following a moderate AECOPD), yet higher utilization of COPD-related ambulatory visits before and after an AECOPD suggests that there is opportunity to improve pharmacotherapy management.
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Affiliation(s)
- Morgan Justice Fuoco
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Richard A Mularski
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Benjamin Wu
- GlaxoSmithKline, US Value Evidence and Outcomes, Research Triangle Park, Durham, NC, USA
| | - Chad Moretz
- GlaxoSmithKline, US Value Evidence and Outcomes, Research Triangle Park, Durham, NC, USA
| | - Mary Ann McBurnie
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Richard H Stanford
- GlaxoSmithKline, US Value Evidence and Outcomes, Research Triangle Park, Durham, NC, USA
| | - Phillip Crawford
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Daniel Gratie
- GlaxoSmithKline, US Value Evidence and Outcomes, Research Triangle Park, Durham, NC, USA
| | - Bianca Salas
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
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2
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Tendedez H, Ferrario MA, McNaney R, Gradinar A. Respire: A Scenario-Based Tool to Explore Human-Data Interaction in Clinical Decision-Making (Preprint). JMIR Hum Factors 2021; 9:e32456. [PMID: 35522463 PMCID: PMC9123541 DOI: 10.2196/32456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/07/2022] [Accepted: 03/21/2022] [Indexed: 01/20/2023] Open
Affiliation(s)
- Helena Tendedez
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Maria-Angela Ferrario
- School of Electronics, Electrical Engineering and Computer Science, Queen's University Belfast, Belfast, United Kingdom
| | - Roisin McNaney
- Department of Human Centred Computing, Monash University, Melbourne, Australia
| | - Adrian Gradinar
- Lancaster Institute for the Contemporary Arts, Lancaster University, Lancaster, United Kingdom
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3
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Njoku CM, Alqahtani JS, Wimmer BC, Peterson GM, Kinsman L, Hurst JR, Bereznicki BJ. Risk factors and associated outcomes of hospital readmission in COPD: A systematic review. Respir Med 2020; 173:105988. [PMID: 33190738 DOI: 10.1016/j.rmed.2020.105988] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of unplanned readmission. There is need to identify risk factors for, and strategies to prevent readmission in patients with COPD. AIM To systematically review and summarise the prevalence, risk factors and outcomes associated with rehospitalisation due to COPD exacerbation. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Five databases were searched for relevant studies. RESULTS Fifty-seven studies from 30 countries met the inclusion criteria. The prevalence of COPD-related readmission varied from 2.6 to 82.2% at 30 days, 11.8-44.8% at 31-90 days, 17.9-63.0% at 6 months, and 25.0-87.0% at 12 months post-discharge. There were differences in the reported factors associated with readmissions, which may reflect variations in the local context, such as the availability of community-based services to care for exacerbations of COPD. Hospitalisation in the previous year prior to index admission was the key predictor of COPD-related readmission. Comorbidities (in particular asthma), living in a deprived area and living in or discharge to a nursing home were also associated with readmission. Relative to those without readmissions, readmitted patients had higher in-hospital mortality rates, shorter long-term survival, poorer quality of life, longer hospital stay, increased recurrence of subsequent readmissions, and accounted for greater healthcare costs. CONCLUSIONS Hospitalisation in the previous year was the principal risk factor for COPD-related readmissions. Variation in the prevalence and the reported factors associated with COPD-related readmission indicate that risk factors cannot be generalised, and interventions should be tailored to the local healthcare environment.
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Affiliation(s)
- Chidiamara M Njoku
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
| | - Jaber S Alqahtani
- UCL Respiratory, University College London, London, UK; Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Barbara C Wimmer
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Port Macquarie, New South Wales, Australia
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Bonnie J Bereznicki
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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García Sanz MT, González Barcala FJ. Establecer el pronóstico de la agudización de EPOC mediante el uso de escalas de riesgo: punto de vista del servicio de urgencias. Arch Bronconeumol 2020; 56:63-64. [DOI: 10.1016/j.arbres.2019.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/14/2019] [Accepted: 04/23/2019] [Indexed: 11/16/2022]
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5
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Lin WY, Verma VK, Lee MY, Lin HC, Lai CS. Prediction of 30-Day Readmission for COPD Patients Using Accelerometer-Based Activity Monitoring. SENSORS 2019; 20:s20010217. [PMID: 31905995 PMCID: PMC6982816 DOI: 10.3390/s20010217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/27/2019] [Accepted: 12/27/2019] [Indexed: 01/03/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) claimed 3.0 million lives in 2016 and ranked 3rd among the top 10 global causes of death. Moreover, once diagnosed and discharged from the hospital, the 30-day readmission risk in COPD patients is found to be the highest among all chronic diseases. The existing diagnosis methods, such as Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019, Body-mass index, airflow Obstruction, Dyspnea, and Exercise (BODE) index, modified Medical Research Council (mMRC), COPD assessment test (CAT), 6-minute walking distance, which are adopted currently by physicians cannot predict the potential readmission of COPD patients, especially within the 30 days after discharge from the hospital. In this paper, a statistical model was proposed to predict the readmission risk of COPD patients within 30-days by monitoring their physical activity (PA) in daily living with accelerometer-based wrist-worn wearable devices. This proposed model was based on our previously reported PA models for activity index (AI) and regularity index (RI) and it introduced a new parameter, quality of activity (QoA), which incorporates previously proposed parameters, such as AI and RI, with other activity-based indices to predict the readmission risk. Data were collected from continuous PA monitoring of 16 COPD patients after hospital discharge as test subjects and readmission prediction criteria were proposed, with a 63% sensitivity and a 37.78% positive prediction rate. Compared to other clinical assessment, diagnosis, and prevention methods, the proposed model showed significant improvement in predicting the 30-day readmission risk.
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Affiliation(s)
- Wen-Yen Lin
- Department of Electrical Engineering, Center for Biomedical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan;
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan;
- Correspondence: ; Tel.: +886-3-2118-800 (ext. 3675)
| | - Vijay Kumar Verma
- Department of Electrical Engineering, Center for Biomedical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan;
| | - Ming-Yih Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan;
- Graduate Institute of Biomedical Engineering, Center for Biomedical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan;
| | - Chao-Sung Lai
- Department of Electronic Engineering, Center for Biomedical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan;
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Tao-Yuan 33305, Taiwan
- Department of Materials Engineering, Ming Chi University of Technology, New Taipei 24301, Taiwan
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Ding H, Fatehi F, Maiorana A, Bashi N, Hu W, Edwards I. Digital health for COPD care: the current state of play. J Thorac Dis 2019; 11:S2210-S2220. [PMID: 31737348 DOI: 10.21037/jtd.2019.10.17] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) imposes a huge burden to our healthcare systems and societies. To alleviate the burden, digital health-"the use of digital technologies for health"-has been recognized as a potential solution for improving COPD care at scale. The aim of this review is to provide an overview of digital health interventions in COPD care. We accordingly reviewed recent and emerging evidence on digital transformation approaches for COPD care focusing on (I) self-management, (II) in-hospital care, (III) post-discharge care, (IV) hospital-at-home, (V) ambient environment, and (VI) public health surveillance. The emerging approaches included digital-technology-enabled homecare programs, electronic records, big data analytics, and environment-monitoring applications. The digital health approaches of telemonitoring, telehealth and mHealth support the self-management, post-discharge care, and hospital-at-home strategy, with prospective effects on reducing acute COPD exacerbations and hospitalizations. Electronic records and classification tools have been implemented; and their effectiveness needs to be further evaluated in future studies. Air pollution concentrations in the ambient environment are associated with declined lung functions and increased risks for hospitalization and mortality. In all the digital transformation approaches, clinical evidence on reducing mortality, the ultimate goal of digital health intervention, is often inconsistent or insufficient. Digital health transformation provides great opportunities for clinical innovations and discovery of new intervention strategies. Further research remains needed for achieving reliable improvements in clinical outcomes and cost-benefits in future studies.
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Affiliation(s)
- Hang Ding
- The Australian e-Health Research Centre, CSIRO Health & Biosecurity, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Farhad Fatehi
- The Australian e-Health Research Centre, CSIRO Health & Biosecurity, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Andrew Maiorana
- Allied Health Department and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Nazli Bashi
- The Australian e-Health Research Centre, CSIRO Health & Biosecurity, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Wenbiao Hu
- School of Public Health and Social Work, Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Iain Edwards
- Department of Community Health, Peninsula Health, Melbourne, Australia
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7
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Bartels W, Adamson S, Leung L, Sin DD, van Eeden SF. Emergency department management of acute exacerbations of chronic obstructive pulmonary disease: factors predicting readmission. Int J Chron Obstruct Pulmon Dis 2018; 13:1647-1654. [PMID: 29872284 PMCID: PMC5973381 DOI: 10.2147/copd.s163250] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale Readmissions are common following acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and are partially responsible for increased morbidity and mortality in COPD. Numerous factors have been shown to predict readmission of patients previously admitted to hospital for AECOPD; however, factors related to readmission in patients who are triaged in emergency departments (EDs) and sent directly home are poorly understood. We postulate that patients seen in the ED for AECOPD and directly sent home have a high readmission rate, and we suspect that inadequate management and follow-up contribute to this high readmission rate. Methods We conducted a 1-year retrospective study of all patients seen in the ED for AECOPD at an inner-city tertiary care hospital; 30- and 90-day readmission rates for COPD and all-cause admissions to the ED and hospital were determined. Patients discharged directly home from the ED were compared with those admitted to hospital for management. Patient, treatment, and system variables that could potentially impact readmission were documented. Multivariate Poisson regression models were used to determine which factors predicted readmissions. Results The readmission rates in the ED group (n=240) were significantly higher than that in the hospitalized group (n=271): 1) the 90-day ED readmissions (1.29 vs 0.51, p<0.0001) and 30-day ED readmissions (0.54 vs 0.20, p<0.0001) (ED vs hospitalized groups) were significantly higher in the ED group; 2) the time to first readmission was significantly shorter in the ED group than in the hospitalized group (24.1±22 vs 31.8±27.8 days; p<0.05). Cardiovascular comorbidities (p<0.00001), substance abuse disorder (p<0.001), and mental illness (p<0.001) were the strongest predictors of readmission in the ED group. Age (p<0.01), forced expiratory volume in 1 second (p<0.001), and cardiovascular comorbidities (p<0.05) were the best predictors for both 30- and 90-day COPD readmission rates in the ED group. Only 50% of the ED group patients received bronchodilators, oral steroids, and antibiotics inclusively, and only 68% were referred for community follow-up. The need for oral steroids to treat AECOPD predicted future 90-day COPD readmissions in the ED group (p<0.003). Conclusion Patients discharged directly home from EDs have a significantly higher risk of readmission to EDs than those who are hospitalized. One possible reason for this is that COPD management is variable in EDs with <50% receiving appropriate therapy.
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Affiliation(s)
- Wiebke Bartels
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Simon Adamson
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lisa Leung
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stephan F van Eeden
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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