Efficacy of a home discharge care bundle after acute exacerbation of COPD

Abstract

Purpose

Acute exacerbations of COPD (AECOPD) are frequent and associated with a poor prognosis. A home discharge care bundle, the PRADO-BPCO program, has been set up by the French National Health System in order to reduce readmission rate after hospitalization for AECOPD. This program includes early consultations by the general practitioner, a nurse, and a physiotherapist after discharge. The aim of our study was to evaluate the effect of the PRADO-BPCO program on the 28-days readmission rate of COPD patients after hospitalization for AECOPD.

Patients and methods

This was a retrospective cohort study including all patients admitted for AECOPD in our center between November 2015 and January 2017. The readmission or death rate at 28 days after hospitalization for AECOPD was compared between patients included in the PRADO-BPCO program and patients with standard care after discharge. Inclusion in the program was decided by the physician in charge of the patient.

Results

A total of 62 patients were included in the PRADO-BPCO group and 202 in the control group. At baseline, patients in the PRADO group had a more severe COPD disease and more severe exacerbations than the control group and mean inpatient stay was shorter in the PRADO group: 8.6±4.3 vs 10.4±7.4 days (P=0.034). Readmission or death rate at 28 days was similar between groups: 10 (16.1%) in the PRADO group vs 30 (14.9%) in the control group (P=0.81). Ninety-days readmission or death rate and overall survival were similar in the two groups.

Conclusion

In our center, despite more severe COPD and a shorter hospitalization time, the PRADO-BPCO program failed to prove a benefit on the 28 days readmission or death rate when compared with standard care.

Keywords:

• COPD
• exacerbation
• patient readmission
• patient care bundles
• continuity of patient care

Acknowledgments

The authors thank Dr Valérie Buvat (Service médical de l’Assurance Maladie Normandie) and Virginie Illien (Caisse primaire d’Assurance Maladie de Rouen-Elbeuf-Dieppe) for their help in the management of PRADO procedure and patients.

Author contributions

SC: conception, acquisition, analysis, interpretation, drafting the work; MS, LT: interpretation and revising critically; AC: conception, interpretation, revising critically; MP: conception, acquisition, analysis, drafting the work, revising critically. All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.