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Impact of a care pathway for COPD on adherence to guidelines and hospital readmission: a cluster randomized trial
Kris Vanhaecht1, Cathy Lodewijckx2, Walter Sermeus2
1Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven; Department of Quality Management, University Hospitals Leuven.
Insights
Implementing a care pathway for patients with chronic obstructive pulmonary disease (COPD) exacerbations reduced 30-day readmissions but did not affect 6-month readmission rates. This COPD management strategy shows promise for short-term outcomes.
Area of Science:
- Pulmonary Medicine
- Healthcare Management
- Clinical Trials
Background:
- In-hospital management of chronic obstructive pulmonary disease (COPD) exacerbations often yields suboptimal patient outcomes.
- There is a need for improved strategies to manage COPD exacerbations effectively during hospitalization.
Purpose of the Study:
- To evaluate the impact of implementing a care pathway (CP) for COPD exacerbations on 6-month readmission rates.
- To assess secondary outcomes including 30-day readmission rates, mortality, length of stay, and adherence to clinical guidelines.
Main Methods:
- An international cluster randomized controlled trial was conducted across general hospitals in Belgium, Italy, and Portugal.
- Hospitals were randomized to either implement a CP or provide usual care for patients experiencing COPD exacerbations.
- A total of 22 hospitals (11 intervention, 11 control) involving 342 patients were included in the study.
Main Results:
- The care pathway (CP) did not significantly impact the 6-month readmission rate for COPD exacerbations.
- A significant reduction in the 30-day readmission rate was observed in the intervention group (9.7%) compared to the control group (15.3%) (OR=0.427, P=0.040).
- Adherence to process indicators showed a significant improvement in the intervention group for 2 out of 24 indicators.
Conclusions:
- The implemented in-hospital care pathway for COPD exacerbations effectively reduces 30-day readmission rates.
- The care pathway did not demonstrate a significant effect on 6-month readmission rates for COPD exacerbations.
Purpose:
Current in-hospital management of exacerbations of COPD is suboptimal, and patient outcomes are poor. The primary aim of this study was to evaluate whether implementation of a care pathway (CP) for COPD improves the 6 months readmission rate. Secondary outcomes were the 30 days readmission rate, mortality, length of stay and adherence to guidelines.
Patients And Methods:
An international cluster randomized controlled trial was performed in Belgium, Italy and Portugal. General hospitals were randomly assigned to an intervention group where a CP was implemented or a control group where usual care was provided. The targeted population included patients with COPD exacerbation.
Results:
Twenty-two hospitals were included, whereof 11 hospitals (n=174 patients) were randomized to the intervention group and 11 hospitals (n=168 patients) to the control group. The CP had no impact on the 6 months readmission rate. However, the 30 days readmission rate was significantly lower in the intervention group (9.7%; 15/155) compared to the control group (15.3%; 22/144) (odds ratio =0.427; 95% confidence interval 0.222-0.822; P=0.040). Performance on process indicators was significantly higher in the intervention group for 2 of 24 main indicators (8.3%).
Conclusion:
The implementation of this in-hospital CP for COPD exacerbation has no impact on the 6 months readmission rate, but it significantly reduces the 30 days readmission rate.
