Predischarge bundle for patients with acute exacerbations of COPD to reduce readmissions and ED visits: a randomized controlled trial.
BACKGROUND
Hospital readmissions for acute exacerbations of COPD (AECOPDs) pose burdens to the health-care system and patients. A current gap in knowledge is whether a predischarge screening and educational tool administered to patients with COPD reduces readmissions and ED visits.


METHODS
A single-center, randomized trial of admitted patients with AECOPDs was conducted at Henry Ford Hospital between February 2010 and April 2013. One hundred seventy-two patients were randomized to either the control (standard care) or the bundle group in which patients received smoking cessation counseling, screening for gastroesophageal reflux disease and depression or anxiety, standardized inhaler education, and a 48-h postdischarge telephone call. The primary end point was the difference in the composite risk of hospitalizations or ED visits for AECOPD between the two groups in the 30 days following discharge. A secondary end point was 90-day readmission rate.


RESULTS
Of the 172 patients, 18 of 79 in the control group (22.78%) and 18 of 93 in the bundle group (19.35%) were readmitted within 30 days. The risk of ED visits or hospitalizations within 30 days was not different between the groups (risk difference, -3.43%; 95% CI, -15.68% to 8.82%; P = .58). Overall, the time to readmission in 30 and 90 days was similar between groups (log-rank test P = .71 and .88, respectively).


CONCLUSIONS
A predischarge bundle intervention in AECOPD is not sufficient to reduce the 30-day risk of hospitalizations or ED visits. More resources may be needed to generate a measurable effect on readmission rates.


BACKGROUND
ClinicalTrials.gov; No.: NCT02135744; URL: www.clinicaltrials.gov.
Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI. Electronic address: jjennin2@hfhs.org.
Jeffrey H
JH
Jennings
Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI.
Krishna
K
Thavarajah
Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI.
Michael P
MP
Mendez
Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI.
Michael
M
Eichenhorn
Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI.
Paul
P
Kvale
Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI.
Lenar
L
Yessayan
D000208:Acute Disease; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles; D010351:Patient Discharge / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*