Decrease in Readmissions after Hospitalisation for COPD Exacerbation through a Home Care Model.

Area of Science:

• Pulmonary Medicine
• Healthcare Management
• Clinical Research

Background:

• Hospital readmissions for chronic obstructive pulmonary disease exacerbation (COPDE) represent a significant burden on healthcare systems.
• Effective management strategies are needed to reduce readmission rates and improve long-term survival for COPD patients.

Purpose of the Study:

• To evaluate the effectiveness of the Ambulatory Chronic Respiratory Care Unit (ACRCU) home care model in reducing 30- and 90-day hospital readmissions for COPDE.
• To assess the impact of the ACRCU model on one-year patient survival.
• To validate a readmission risk scale (RRS) for predicting COPD readmissions.

Main Methods:

• An observational study with prospective data collection and retrospective analysis.
• Inclusion of 491 patients diagnosed with COPD requiring hospitalization for exacerbation.
• Comparison between conventional care (CC) and the ACRCU home care (HC) program managed by a specialized nurse.

Main Results:

• The ACRCU home care model resulted in significantly lower readmission rates at 30 days (30.5% vs. 50%) and 90 days (47.7% vs. 65.2%) compared to conventional care.
• One-year survival was substantially higher in the ACRCU group (85.3% vs. 59.1%).
• The readmission risk scale (RRS) showed limited predictive capacity for 30- and 90-day readmissions (AUC = 0.69 and 0.66, respectively).

Conclusions:

• Integrating exacerbator or fragile COPD patients into the ACRCU home care model can decrease readmissions and improve survival.
• The number of exacerbation episodes in the 12 months preceding hospital admission is the strongest predictor of readmission risk.