Gaps in the care of patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease

Choi, Perry P.; Day, Anna; Etchells, Edward
April 2004
CMAJ: Canadian Medical Association Journal;4/27/2004, Vol. 170 Issue 9, p1409
Academic Journal
P atients admitted to hospital because of an exacer- bation of chronic obstructive pulmonary disease (COPD)account for about 10%of hospital admis- sions and represent a substantial portion of hospital costs. 1 These patients are at high risk of adverse events,including acute respiratory failure,cellulitis,delirium and theo- Background: Patients admitted to hospital because of an exacer-bation of chronic obstructive pulmonary disease (COPD) are at high risk of adverse events. We evaluated the association between gaps in care and adverse events during the hospital stay and after discharge. Methods: We retrospectively reviewed the charts of 105 consecu-tive patients discharged from hospial between Jan. 1 and Dec. 31, 2001, with a diagnosis of COPD exacerbation. On the ba-sis of published guidelines, prior studies and discussions with colleagues, we defined a care gap as having occurred if any of 9 important inpatient and 7 discharge-related processes of care did not take place correctly. Inpatient adverse events in-cluded worsening of condition after admission, transfer to a higher level of care, cardiac arrest and death. Discharge-related adverse events were defined as including readmission to the hospital, revisit to the emergency department or death within 30 days after discharge. Results: Of the 105 patients studied, 88 (84%) had at least 1 inpa-tient gap in care and 16 (15%) an inpatient adverse event; 2 of the 16 died. Patients who had an inpatient adverse event had more gaps in their care (2.0 v. 1.3 gaps, p = 0.004) and longer stays (16.4 v. 8.6 days, p = 0.007). There were 6 adverse events (frequency 38%) among the 16 patients with 3 or more gaps in their care, 6 adverse events (28%) among the 21 pa-tients with 2 gaps, 1 adverse event (2%) among the 51 patients with 1 gap and 3 adverse events (18%) among the 17 patients with no gaps in their care (p = 0.001 for trend). Of the 103 pa-tients discharged alive, 102 (99%) had...


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