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

Kris Vanhaecht, Cathy Lodewijckx, Walter Sermeus, Marc Decramer, Svin Deneckere, Fabrizio Leigheb, Paulo Boto, Seval Kul, Deborah Seys, Massimiliano Panella

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17 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)2897-2908
Number of pages12
JournalInternational Journal of COPD
Volume11
Issue number1
DOIs
Publication statusPublished - 23 Nov 2016

Keywords

  • Care pathway
  • Cluster randomized controlled trial
  • COPD
  • Quality improvement
  • Readmission

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