COPD Transition Bundle May Lower Risk of Hospital Readmission

Real-world findings indicate that a transition bundle for hospitalized patients with chronic obstructive pulmonary disease (COPD) lowers their chance of being readmitted to the hospital within a month of discharge, and that connecting the patient with a care coordinator has a limited impact on outcomes, according to the study published in Chest.

Findings from the multicenter randomized controlled trial of 4000 patients show that compared with patients not receiving the intervention, patients who received the transition bundle were 83% (relative risk [RR], 0.17; 95% CI, 0.07-0.35) less likely to be readmitted to the hospital within 7 days of discharge and were 26% (RR, 0.74; 95% CI, 0.60-0.91) less likely to be readmitted to the hospital within 30 days of discharge. Readmissions within 90 days were not different between the groups.

The transition bundle included:

• The patient demonstrating adequate inhaler technique
• A discharge summary sent to the patient’s family physician and a scheduled follow-up visit
• Treatments optimized and reconciled prior to discharge
• A discharge management plan
• Referral to pulmonary rehabilitation
• Screening for frailty and comorbidities
• Assessment of smoking status and counseling/referral for smoking cessation

“Individuals living with COPD experience disproportionately high hospital (re)admission rates and longer hospital length of stay (LOS), resulting in increased costs and significant variability in the care provided,” explained the researchers. “Variability in care contributes to suboptimal care transitions, increased (re)admissions and (re)visits, and poor health outcomes. Minimizing care variability and improving coordination across the care continuum may lower the frequency of COPD hospital readmissions and ED [emergency department] revisits while improving quality and continuity of care.”

One proposed solution to these challenges has been care bundles, explained the researchers, noting that the variable results of the approach have been documented. However, in the current study, the researchers found that uptake of the transition bundle was low, 19.2%, across sites.

Compared with patients who did not receive the intervention, patients who received the transition bundle had a 7.3% (RR, 1.07; 95% CI, 1.0-1.15) relative increase in median LOS and a 76% (RR, 1.76; 95% CI, 1.53-2.02) increased risk of a 30-day hospital revisit. They were also more likely to follow up with their family physician within 14 days of hospital discharge.

“The transition bundle group visited the ED on average 2.4 times per patient within 30 days of discharge compared with 1.3 times per patient in the usual care group. The same group who made increased ED visits within 30 days also showed a significantly lower rate of 30-day hospital readmissions,” noted the researchers. “Aboumatar et al attribute an increased frequency of ED visits among patients with COPD to greater symptom awareness, which may explain the current findings, given that our transition bundle contained COPD education components including symptom awareness.”

The researchers assessed the impact of adding a care coordinator to the transition bundle, finding that it had no impact on hospital readmissions at any point, median LOS, or 30-day hospital revisits. However, the care coordinator was associated with a 7.6% increase in follow up with the family physician within 14 days and this occurred 2.4 days sooner compared with patients not connected with a care coordinator. This finding, said the researchers, indicate that the transition bundle promoted interaction with primary care, which could have contributed to the lower readmissions seen among patients receiving the intervention.

Reference

Atwood C, Bhutani M, Ospina M, et al. Optimizing COPD acute care patient outcomes using a standardized transition bundle and care coordinator: a randomized controlled trial. Chest. 2022;162(2):321-330. doi:10.1016/j.chest.2022.03.047