Home Intervention and Predictor Variables for Rehospitalization in Chronic Obstructive Pulmonary Disease Exacerbations

• Published in: Archivos de bronconeumología (English ed.) Vol. 49; no. 1; pp. 10 - 14
• Main Authors: Jurado Gámez, Bernabé, Feu Collado, Nuria, Jurado García, José Carlos, García Gíl, Francisco, Muñoz Gomariz, Elisa, Jiménez Murillo, Luis, Muñoz Cabrera, Luis
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España 01-01-2013
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adrenergic beta-Agonists - therapeutic use; Age Factors; Aged; Agudización de la enfermedad pulmonar obstructiva crónica; Bronchodilator Agents - therapeutic use; Carbon Dioxide - blood; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease exacerbation; Disease Progression; Enfermedad pulmonar obstructiva crónica; Female; Forced Expiratory Volume; Hipercapnia; Home Care Services, Hospital-Based - statistics & numerical data; House Calls; Humans; Hypercapnia; Internal Medicine; Male; Middle Aged; Oxygen Inhalation Therapy; Partial Pressure; Patient Readmission - statistics & numerical data; Predictores de reingreso; Predictors of readmission; Prevalence; Prognosis; Prospective Studies; Pulmonary Disease, Chronic Obstructive - blood; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - nursing; Pulmonary Medicine; Pulmonary/Respiratory; Readmission risk; Riesgo de reingreso; Spain - epidemiology; Telephone; Spain; Predictores de reingreso; Hypercapnia; Readmission risk; Chronic obstructive pulmonary disease exacerbation; Predictors of readmission; Chronic obstructive pulmonary disease; Hipercapnia; Riesgo de reingreso; Agudización de la enfermedad pulmonar obstructiva crónica; Enfermedad pulmonar obstructiva crónica
• ISSN: 1579-2129; 1579-2129
• DOI: 10.1016/j.arbr.2012.11.002

Abstract Background Chronic obstructive pulmonary disease (COPD) exacerbation increases mortality and resources used associated with hospitalization. We studied whether early home monitoring reduces the rate of readmission and if there are any predictor variables. Patients and methods We performed a prospective, controlled, parallel-group study in patients who were hospitalized for COPD. Patients whose residence was within less than 15 km from the hospital were assigned to an interventional group (home visits by nurses about 48–72 h after discharge), the remaining patients were assigned to a conventional care group. The rate of rehospitalization within the first month was compared between the 2 groups, as well as those variables that showed a predictive capability. Results Seventy-one patients were included: 35 in the conventional care group and 36 in the interventional group. In the latter, the treatment was modified in 13 patients (36%). The hospital readmission rate was 17%, which was similar in both groups ( P =.50). For every 5-year increase in age, the risk for readmission was 2.54 (95%CI 1.06–5.07) and for each increase of 10 mmHg in PaCO2 , the risk of readmission was 8.34 (95%CI 2.43–18.55). Conclusions Early home monitoring did not decrease the readmission rate during the first month. Older age and high PaCO2 are factors that identify the group with a high risk for rehospitalization.