title: Impact of a care pathway for COPD on adherence to guidelines and hospital readmission: a cluster randomized trial.
abstract: OBJECTIVE
  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.
  
  
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven; Department of Quality Management, University Hospitals Leuven.
authors.forename: Kris
authors.initials: K
authors.lastname: Vanhaecht
authors.affiliation: Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven.
authors.forename: Cathy
authors.initials: C
authors.lastname: Lodewijckx
authors.affiliation: Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven.
authors.forename: Walter
authors.initials: W
authors.lastname: Sermeus
authors.affiliation: Department of Clinical and Experimental Medicine, KU Leuven - University of Leuven; University Hospitals Leuven, Leuven.
authors.forename: Marc
authors.initials: M
authors.lastname: Decramer
authors.affiliation: Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven; Medical Department, Delta Hospitals Roeselare, Roeselare, Belgium.
authors.forename: Svin
authors.initials: S
authors.lastname: Deneckere
authors.affiliation: Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Leigheb
authors.affiliation: Department of Health Services Policy and Management, Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Boto
authors.affiliation: Department of Biostatistics, School of Medicine, University of Gaziantep, Gaziantep, Turkey.
authors.forename: Seval
authors.initials: S
authors.lastname: Kul
authors.affiliation: Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven.
authors.forename: Deborah
authors.initials: D
authors.lastname: Seys
authors.affiliation: Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven; Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Panella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016000:Cluster Analysis; D019091:Critical Pathways / Q000592:standards*; D005060:Europe; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome
keywords: COPD; care pathway; cluster randomized controlled trial; quality improvement; readmission