Optimizing COPD Acute Care Patient Outcomes Using a Standardized Transition Bundle and Care Coordinator

BackgroundAcute exacerbations of COPD (AECOPD) are associated with high morbidity and mortality and frequent readmissions.Research QuestionWhat is the effectiveness of a COPD transition bundle, with and without a care coordinator, on rehospitalizations and ED revisits?Study Design and MethodsTwo patient cohorts were selected: (1) the group exposed to the transition bundle and (2) the group not exposed to the transition bundle (usual care group). Patients exposed subsequently were randomized to a care coordinator. An AECOPD transition bundle was implemented in the hospital; patients randomized to the care coordinator were contacted ≤ 72 h after discharge. Six hundred four patients (320 to the care coordinator and 284 to routine care) who met eligibility criteria from five hospitals across three cities in Alberta, Canada, were exposed to the transition bundle, whereas 3,106 patients discharged from the same hospitals received the usual care. Primary outcomes were 7-day, 30-day, and 90-day readmissions, median length of stay (LOS), and 30-day ED revisits.ResultsThe transition bundle cohort were 83% (relative risk RR, 0.17; 95% CI, 0.07-0.35) less likely to be readmitted within 7 days and 26% (RR, 0.74; 95% CI, 0.60-0.91) less likely to be readmitted within 30 days of discharge. Ninety-day readmissions were unchanged (RR, 1.05; 95% CI, 0.93-1.18). The transition bundle was associated with a 7.3% (RR, 1.07; 95% CI, 1.0-1.15) relative increase in LOS and a 76% (RR, 1.76; 95% CI, 1.53-2.02) greater risk of a 30-day ED revisit. The care coordinator did not influence readmission or ED revisits.InterpretationThe COPD transition bundle reduced 7- and 30-day hospital readmissions while increasing LOS and ED revisits. The care coordinator did not improve outcomes.Trial RegistryClinicalTrials.gov; No.: NCT03358771; URL: www.clinicaltrials.gov Acute exacerbations of COPD (AECOPD) are associated with high morbidity and mortality and frequent readmissions. What is the effectiveness of a COPD transition bundle, with and without a care coordinator, on rehospitalizations and ED revisits? Two patient cohorts were selected: (1) the group exposed to the transition bundle and (2) the group not exposed to the transition bundle (usual care group). Patients exposed subsequently were randomized to a care coordinator. An AECOPD transition bundle was implemented in the hospital; patients randomized to the care coordinator were contacted ≤ 72 h after discharge. Six hundred four patients (320 to the care coordinator and 284 to routine care) who met eligibility criteria from five hospitals across three cities in Alberta, Canada, were exposed to the transition bundle, whereas 3,106 patients discharged from the same hospitals received the usual care. Primary outcomes were 7-day, 30-day, and 90-day readmissions, median length of stay (LOS), and 30-day ED revisits. The transition bundle cohort were 83% (relative risk RR, 0.17; 95% CI, 0.07-0.35) less likely to be readmitted within 7 days and 26% (RR, 0.74; 95% CI, 0.60-0.91) less likely to be readmitted within 30 days of discharge. Ninety-day readmissions were unchanged (RR, 1.05; 95% CI, 0.93-1.18). The transition bundle was associated with a 7.3% (RR, 1.07; 95% CI, 1.0-1.15) relative increase in LOS and a 76% (RR, 1.76; 95% CI, 1.53-2.02) greater risk of a 30-day ED revisit. The care coordinator did not influence readmission or ED revisits. The COPD transition bundle reduced 7- and 30-day hospital readmissions while increasing LOS and ED revisits. The care coordinator did not improve outcomes. ClinicalTrials.gov; No.: NCT03358771; URL: www.clinicaltrials.gov Take-home PointsStudy Question: What is the effectiveness of a COPD transition bundle, with and without a care coordinator, on rehospitalizations and ED revisits?Results: Patients in the transition bundle group were less likely to be readmitted to hospital within 7 and 30 days, but were more likely to have longer length of stay and more visits to the ED. A care coordinator did not influence readmission or ED revisit rates.Interpretation: Overall, the use of a COPD transition bundle in a real-world setting was effective at reducing 7-day and 30-day hospital readmissions, likely through facilitating care continuity with primary care. Study Question: What is the effectiveness of a COPD transition bundle, with and without a care coordinator, on rehospitalizations and ED revisits? Results: Patients in the transition bundle group were less likely to be readmitted to hospital within 7 and 30 days, but were more likely to have longer length of stay and more visits to the ED. A care coordinator did not influence readmission or ED revisit rates. Interpretation: Overall, the use of a COPD transition bundle in a real-world setting was effective at reducing 7-day and 30-day hospital readmissions, likely through facilitating care continuity with primary care. COPD is the third leading cause of death worldwide.1World Health OrganizationWorld Health Statistics 2008. WHO Press, World Library Cataloguing-in-Publication Data, Geneva, Switzerland2008: 1-112Google Scholar,2Lozano R. Naghavi M. 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