Reducing the Number of Hospitalization Days for COPD: Setting up a Transmural-Care Pathway

Figures & data

Table 1 Baseline Characteristics (n=752)

Age, years (mean ± SD)		69.6±10.0
Female (%)		58.2
BMI, median (range)		24.0 (11.4–52.6)
Current smoker (%)		38.2
Number of comorbidities, median (range)		1.0 (0–7)
Congestive heart failure (%)		7.3
Respiratory medication (%)	Only LABA	2.8
	Only LAMA	5.7
	LABA + ICS	21.8
	LAMA + ICS	2.1
	LABA + LAMA	11
	LABA + LAMA + ICS	44.0
	Other	12.6
Prednisolone maintenance treatment (%)		13.0
Antibiotic maintenance treatment (%)		10.6
Prednisolone in last 4 weeks (%)		46.0
Oxygen supplementation at home (%)		16.8
FEV1 % predicted (mean ± SD)		47.0±18.7
GOLD (%)	I	5.5
	II	33.0
	III	43.5
	IV	18.0
Hospital admissions due to COPD exacerbation in prior year (%)	0	66.5
	1	22.2
	2	6.9
	>3	4.4
COPD exacerbations in prior year (%)	0	51.0
	1	25.2
	2	13.9
	>3	9.9

Abbreviations: BMI, body-mass index; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; ICS, inhaled corticosteroid; FEV_1, forced expiratory volume in 1 second; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Table 2 Main Follow-Up Data

		n
Died		120 (16%)
Other reasons for incomplete follow-up	Moving away	1
	Stopped participation	3
	Other	8
		Mean ± SD	Median	Range
Number of hospital admissions (including index)		1.8±1.2	1	1–8
Patients with at least one readmission (%)		43
Follow-up (days)		307.2±107.6	365	2–365
Percentage of period hospitalized		6.2±11.5	2.7	0.3–90.9
Length of stay of index hospitalization		6.9±5.5	5	0–55

Table 3 Correlations of Baseline Characteristics with Percentage of Period Hospitalized

		β	95% CI		P–Value
			Lower	Upper
Sex		−0.095	−0.219	0.030	0.14
Age, years		0.003	−0.003	0.009	0.33
FEV1 % predicted		−0.007	−0.01	−0.003	0.00*
Smoking status	Ex-smoker	0.021	−0.274	0.316	0.89
	Current smoker	−0.092	−0.394	0.209	0.55
	Unknown	−0.266	−0.624	0.093	0.15
Inhaled corticosteroids		−0.038	−0.170	0.095	0.58
Oxygen supplementation at home		0.315	0.153	0.477	0.00*
Prednisolone maintenance treatment		0.246	0.067	0.426	0.01*
Antibiotic maintenance treatment		0.241	0.045	0.438	0.02*
Number of COPD exacerbations in prior year		0.084	0.039	0.129	0.00*
Number of hospital admissions due to COPD exacerbation in prior year		0.191	0.128	0.253	0.00*

Notes: *P<0.05. β is the standardized regression coefficient

Figure 1 Number of days hospitalized in 1 year (including index hospitalization).

Figure 2 Number of hospitalizations in 1 year (including index hospitalization).

Table 4 Correlation of Interventions with Percentage of Period Hospitalized

	Count		Percentage period hospitalized		95% CI		P-value (corrected)^#
	No^&	Yes	No^&	Yes	Lower	Upper
Contact in first week after discharge	336	416	3.29	2.43	−0.293	−0.008	0.04*
Home visit as contact in first week	189	227	2.42	2.43	−0.119	0.244	0.50
Home visit later during the year	576	176	2.51	3.01	−0.043	0.276	0.15
Starting nonpharmacological smoking-cessation guidance during hospitalization for smokers	216	49	2.51	2.07	−0.233	0.337	0.72
Starting nonpharmacological smoking-cessation guidance later during year for smokers	243	22	2.53	1.37	−0.825	−0.075	0.02*
Starting pharmacological smoking-cessation guidance during hospitalization for smokers	219	46	2.19	2.74	−0.182	0.367	0.51
Starting pharmacological smoking-cessation guidance later during year for smokers	253	12	2.49	1.40	−1.074	−0.050	0.03*
Lung-attack action plan reviewed during hospitalization	316	436	2.27	3.28	−0.110	0.175	0.66
Lung-attack action plan reviewed later during year	473	279	3.29	2.19	−0.293	−0.010	0.04*
Inhalation technique checked during hospitalization	222	530	2.19	3.01	0.042	0.351	0.01*
Inhalation technique checked later during year	433	319	3.56	2.19	−0.328	−0.043	0.01*
Expectations of patient/family discussed during hospitalization	558	194	2.74	2.47	−0.121	0.194	0.65
Palliative care, care plans discussed during hospitalization	576	176	2.56	3.01	−0.029	0.303	0.11
Palliative care, care plans discussed later during year	689	63	2.74	2.73	−0.225	0.226	1.00
Day 2 meeting conducted	293	459	3.29	2.43	−0.276	0.008	0.06

Notes: ^&No or unknown; *P<0.05; ^#P-values from linear regression model corrected for significant baseline variables (Table 3) and length of follow-up.

Figure 3 Variability in patient contact per region in the first week after discharge. Dark blue bars represent percentage of patients contacted in the first week after discharge, light blue percentage of patients for whom this contact was a home visit.

Figure 4 Overall change in COPD-admission days and COPD=readmission numbers between 2013 and 2018 per region and total. Dark blue bars represent percentage change in admission days; light blue percentage change in readmissions.