title: Discharge coordinator intervention prevents hospitalizations in patients with COPD: a randomized controlled trial.
abstract: OBJECTIVE
  To test whether coordination of discharge from hospital reduces hospitalizations in patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Randomized controlled clinical trial.
  
  
  METHODS
  Specialized pulmonary hospital.
  
  
  METHODS
  Patients hospitalized for an acute exacerbation of COPD.
  
  
  METHODS
  Care as usual included routine patient education, supervised inhaler use, respiratory physiotherapy, and disease-related communication. The discharge coordinator intervention added assessment of patient situation and homecare needs. Patients and caregivers were actively involved and empowered in the discharge planning process, which was communicated with community medical professionals to provide continuity of care at home.
  
  
  METHODS
  The primary end-point of the study was the number of patients hospitalized because of worsening COPD. Key secondary end-points were time-to-COPD hospitalization, all-cause mortality, all-cause hospitalization, days alive and out of hospital, and health-related quality of life.
  
  
  RESULTS
  Of 253 eligible patients (71 ± 9 years, 72% men, 87% GOLD III/IV), 118 were assigned to intervention and 135 to usual care. During a follow-up of 180 days, fewer patients receiving intervention were hospitalized for COPD (14% versus 31%, P = .002) or for any cause (31% versus 44%, P = .033). In time-to-event analysis, intervention was associated with lower rates of COPD hospitalizations (P = .001). A Cox model of proportional hazards, adjusted for sex, age, GOLD stage, heart failure, malignant disease, and long-term oxygen treatment, demonstrated that intervention reduced the risk of COPD hospitalization (hazard ratio 0.43, 95% confidence interval 0.24-0.77, P = .002).
  
  
  CONCLUSIONS
  Among patients hospitalized for acute COPD exacerbation, discharge coordinator intervention reduced both COPD hospitalizations and all-cause hospitalizations.
authors.affiliation: Division of Cardiology, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia. mitja.lainscak@guest.arnes.si
authors.forename: Mitja
authors.initials: M
authors.lastname: Lainscak
authors.forename: Sasa
authors.initials: S
authors.lastname: Kadivec
authors.forename: Mitja
authors.initials: M
authors.lastname: Kosnik
authors.forename: Barbara
authors.initials: B
authors.lastname: Benedik
authors.forename: Marjana
authors.initials: M
authors.lastname: Bratkovic
authors.forename: Tatjana
authors.initials: T
authors.lastname: Jakhel
authors.forename: Robert
authors.initials: R
authors.lastname: Marcun
authors.forename: Petra
authors.initials: P
authors.lastname: Miklosa
authors.forename: Barbara
authors.initials: B
authors.lastname: Stalc
authors.forename: Jerneja
authors.initials: J
authors.lastname: Farkas
mesh_terms: D000368:Aged; D019090:Case Management; D005260:Female; D018575:Home Care Services, Hospital-Based; D006760:Hospitalization / Q000706:statistics & numerical data*; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D020380:Needs Assessment; D010351:Patient Discharge; D010353:Patient Education as Topic; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy*