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Clinician Article

A systematic review of the effectiveness of discharge care bundles for patients with COPD.



  • Ospina MB
  • Mrklas K
  • Deuchar L
  • Rowe BH
  • Leigh R
  • Bhutani M, et al.
Thorax. 2017 Jan;72(1):31-39. doi: 10.1136/thoraxjnl-2016-208820. Epub 2016 Sep 9. (Review)
PMID: 27613539
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Disciplines
  • Hospital Doctor/Hospitalists
    Relevance - 6/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 6/7
    Newsworthiness - 5/7
  • Respirology/Pulmonology
    Relevance - 5/7
    Newsworthiness - 4/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 3/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 3/7

Abstract

BACKGROUND: A COPD discharge bundle is a set of evidence-based practices aimed at improving patient outcomes after discharge from acute care settings following an exacerbation. We conducted a systematic review on the effectiveness of COPD discharge bundles and summarised their individual care elements.

METHODS: Biomedical electronic databases and clinical trial registries were searched from database inception through April 2016 to identify experimental studies evaluating care bundles offered to patients with COPD at discharge. Random-effects meta-analyses of clinical trials data were conducted for hospital readmissions, mortality, and quality of life (QoL).

RESULTS: The review included 14 studies (5 clinical trials, 7 uncontrolled trials, and 2 interrupted time series). A total of 26 distinct elements of care were included in the bundles of individual studies. Evidence from four clinical trials with moderate-to-high risk of bias showed that COPD discharge bundles reduced hospital readmissions (pooled risk ratio (RR): 0.80; 95% CI 0.65 to 0.99). There was insufficient evidence that care bundles influence long-term mortality (RR: 0.74; 95% CI 0.43 to 1.28; four trials) or QoL (mean difference in St. George's Respiratory Questionnaire: 1.84; 95% CI -2.13 to 5.8).

CONCLUSIONS: Discharge bundles for patients with COPD led to fewer readmissions but did not significantly improve mortality or QoL. Future studies should employ higher quality research methods, fully report care bundle elements, implementation strategies and intervention fidelity to better evaluate the effectiveness of packaging evidence-based interventions together to improve outcomes of patients with COPD discharged from acute care settings.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

A systematic review and meta-analysis of a heterogeneous collection of studies showing a modest effect of discharge bundles for reducing re-admissions.

General Internal Medicine-Primary Care(US)

This is a nice summary of the literature since it's difficult to conduct (and then aggregate) quality of care studies like this. The discharge bundles, however, are worth a look at 'face value'.

Hospital Doctor/Hospitalists

The study presents weak evidence on a relatively minor outcome.

Hospital Doctor/Hospitalists

The discharge bundle is very relevant for inpatient providers who care for patients with COPD. Seeing an association with decreased readmissions is important on several levels, including a financial one with the CMS Hospital Readmission Reduction Program now active.

Internal Medicine

This is the evidence we have until now. However, the power is low (a total of 60 patients for the mortality outcome), and the bundles are heterogenous.

Internal Medicine

COPD is a common cause of morbidity and mortality. A bundle care approach at the time of discharge is likely to have an impact. As the authors point out, too many elements in the bundle may not be practical. They have suggested a set of core elements: demonstration of adequate inhaler technique, educational programmes on disease management, individually tailored care plans, assessment and referral for pulmonary rehabilitation, outpatient follow-up and referral to smoking cessation programmes. Some or all of them would help COPD patients.

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