A Respiratory Therapist Disease Management Program for Subjects Hospitalized With COPD.
BACKGROUND: Patients with COPD often require repeated emergency department visits and hospitalizations for COPD exacerbations. Such readmissions increase health-care costs and expose COPD patients to the added risks of nosocomial infections and increased mortality. METHODS: To determine whether a re...
| Publicado en: | Respiratory Care Vol. 62; no. 1; pp. 1 - 10 |
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| Autores principales: | , , , , , , , , |
| Formato: | CEU research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Jan2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120544351&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 120544351 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Jan2017 vid: 62 iid: 1 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 120544351 120544351 120544351 10.4187/respcare.05030 120544351 ppf: 1 ppct: 9 formats: fmt: @attributes: type: P tig: atl: A Respiratory Therapist Disease Management Program for Subjects Hospitalized With COPD. aug: au: Silver, Patty C. Kollef, Marin H. Clinkscale, Darnetta Watts, Peggy Kidder, Robin Eads, Brittany Bennett, Debbie Lora, Carolyn Quartaro, Michael affil: Department of Respiratory Care Services, Bames-Jewish Hospital, St. Louis, Missouri sug: subj: Pulmonary Disease, Chronic Obstructive Disease Management Respiratory Therapists Utilization Disease Exacerbation Prevention and Control Program Evaluation Readmission Emergency Service Utilization Length of Stay Human Prospective Studies Randomized Controlled Trials Descriptive Statistics Funding Source Academic Medical Centers Random Assignment APACHE (Acute Physiology and Chronic Health Evaluation) Chi Square Test Fisher's Exact Test Mann-Whitney U Test Multivariate Analysis Data Analysis Software Multiple Logistic Regression Confidence Intervals Middle Age Female Male Comorbidity Drugs, Prescription Therapeutic Use Education, Continuing (Credit) Severity of Illness Indices Middle Aged: 45-64 years Female Male ab: BACKGROUND: Patients with COPD often require repeated emergency department visits and hospitalizations for COPD exacerbations. Such readmissions increase health-care costs and expose COPD patients to the added risks of nosocomial infections and increased mortality. METHODS: To determine whether a respiratory therapist (RT) disease management program could reduce re-hospitalization and emergency department visits, a prospective, single-center, unblinded, randomized trial was performed. RESULTS: We enrolled 428 subjects (214 intervention, 214 control). The primary outcome (combined non-hospitalized emergency department visits and hospital readmissions for a COPD exacerbation during the 6-month follow-up) was similar for the study groups (91 vs 159, P = .08). When the 2 components of the primary end point were analyzed individually, the percentage of subjects with non-hospitalized emergency department visits for COPD exacerbations was similar between groups (15.0% vs 15.9%, P = .79). Readmission for a COPD exacerbation was significantly lower in the intervention group (20.1% vs 28.5%, P = .042). The median (interquartile range) duration of hospitalization for a COPD exacerbation was less for the intervention group (5 [3-11] d vs 8 [4-18.5] d, P = .045). In-patient hospital days (306 d vs 523 d, P = .02) and ICU days (17 d vs 53 d, P = .02) due to COPD exacerbations were significantly less for the intervention group. Mortality was similar for both groups (1.4% vs 0.9%, P > .99). CONCLUSIONS: Our RT disease management program was associated with less readmission, fewer ICU days, and shorter hospital stays due to COPD exacerbations. Further studies are needed to determine the optimal utilization of RT disease management teams for patients with COPD to optimize outcomes and prevent return hospital visits. pubtype: Academic Journal doctype: CEU research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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