Effectiveness of discharge-coordinator intervention in patients with chronic obstructive pulmonary disease: study protocol of a randomized controlled clinical trial.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) follows a slowly progressive natural course that can be accelerated by acute exacerbations, which frequently trigger admissions to hospital. Specific healthcare professional profiles such as that of discharge coordinator have been successful in reducing numbers of hospitalizations and need for medical care in patients with various chronic diseases, but data for COPD are sparse and inconclusive. This study was conceived to test whether coordinated discharge and post-discharge care could reduce re-hospitalizations and use of resources in patients with COPD.


METHODS
This ongoing single-center randomized controlled clinical trial, which began in November 2009, is enrolling COPD patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages II IV, hospitalized because of acute exacerbation. Patients are randomized in a 1:1 fashion to the intervention group, which has care organized by a discharge coordinator, and a control group receiving the usual care. The primary endpoint of the study is the number of patients hospitalized because of worsening of COPD. Data are collected at baseline, at the time of hospital discharge, and at the following time-points after discharge: 48 hours, 7 10 days, 30 days, 90 days, and 180 days.


CONCLUSIONS
In COPD patients requiring hospital admission, coordinated discharge appears a feasible option for improving patient and healthcare system-related outcomes. This study will provide evidence on the effectiveness of a discharge coordinator in patients hospitalized because of acute exacerbation of COPD and may give relevant guidance for implementation in clinical practice.


BACKGROUND
NCT01225627.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. jerneja.farkas@mf.uni-lj.si
Jerneja
J
Farkas
Sasa
S
Kadivec
Mitja
M
Kosnik
Mitja
M
Lainscak
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005541:Forced Expiratory Volume; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011788:Quality of Life; D012720:Severity of Illness Index