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Randomized Controlled Trial
. 2016 Nov 23:11:2897-2908.
doi: 10.2147/COPD.S119849. eCollection 2016.

Impact of a care pathway for COPD on adherence to guidelines and hospital readmission: a cluster randomized trial

Kris Vanhaecht  1 , Cathy Lodewijckx  2 , Walter Sermeus  2 , Marc Decramer  3 , Svin Deneckere  4 , Fabrizio Leigheb  5 , Paulo Boto  6 , Seval Kul  7 , Deborah Seys  2 , Massimiliano Panella  8
Affiliations
Randomized Controlled Trial

Impact of a care pathway for COPD on adherence to guidelines and hospital readmission: a cluster randomized trial

Kris Vanhaecht et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: 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.

Patients and 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%).

Conclusion: 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.

Keywords: COPD; care pathway; cluster randomized controlled trial; quality improvement; readmission.

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Conflict of interest statement

DisclosureEuropean Pathway Association obtained an unrestricted education grant from Pfizer SA, and this study was partially funded by Clinical Research Fund of University Hospitals Leuven. The funders had no role in the design, data collection, analysis, interpretation of data, writing of the report or decision to submit the report for publication. The autonomy of E-P-A and all involved academic institutions with regard to scientific independence and intellectual property on the methodology was guaranteed. MD has been part of Advisory Board for AstraZeneca, Boehringer-Pfizer, GSK, Nycomed, Novartis, Altana and Dompé. He has performed consulting work for Boehringer-Pfizer, GSK and Novartis. He also received lecture fees from these companies. All of the above amounted to <10,000 euro per annum. He received a research grant of 45,000 euro/year from AstraZeneca and 25,000 euro/year from GSK. KV, WS and MP are board members of European Pathway Association. KV, CL, WS, SD, FL, PB, SK, DS and MP report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study overview. Abbreviation: CP, care pathway.
Figure 2
Figure 2
Participant flow at hospital and patient level.
See this image and copyright information in PMC

References

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