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Effectiveness of a chronic obstructive pulmonary disease integrated care pathway in a regional health system: a propensity score matched cohort study.

ABSTRACT: OBJECTIVE:The chronic obstructive pulmonary disease (COPD) integrated care pathway (ICP) programme was designed and implemented to ensure that the care for patients with COPD is comprehensive and integrated across different care settings from primary care to acute hospital and home. We evaluated the effectiveness of the ICP programme for patients with COPD. DESIGN, SETTING AND PARTICIPANTS:A retrospective propensity score matched cohort study was conducted comparing differences between programme enrolees and propensity-matched non-enrolees in a Regional Health System in Singapore. Data on patients diagnosed with COPD who enrolled in the programme (n=95) and patients who did not enrol (n=6330) were extracted from the COPD registry and hospital administrative databases. Enrolees and non-enrolees were propensity score matched. OUTCOME MEASURES:The risk of COPD hospitalisations and COPD hospital bed days savings were compared between the groups using a difference-in-difference strategy and generalised estimating equation approach. Adherence with recommended care elements for the COPD-ICP group was measured quarterly at baseline and during a 2-year follow-up period. RESULTS:Compared with non-enrolees, COPD hospitalisation risk for ICP programme enrolees was significantly lower in year 2 (incidence rate ratio (IRR): 0.73; 95%?CI 0.54 to 1.00). Similarly, COPD hospital bed days was significantly lower for enrolees in year 2 (IRR: 0.78; 95%?CI 0.64 to 0.95). ICP programme patients had sustained improvements in compliance with all recommended care elements for patients with COPD. The overall all-or-none care bundle compliance rate had improved from 28% to 54%. CONCLUSION:The study concluded that the COPD-ICP programme was associated with reductions in COPD hospitalisation risk and COPD health utilisation in a 2-year follow-up period.

SUBMITTER: Wu CX

PROVIDER: S-EPMC5875646 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Effectiveness of a chronic obstructive pulmonary disease integrated care pathway in a regional health system: a propensity score matched cohort study.

Wu Christine Xia CX Hwang Chi Hong CH Tan Woan Shin WS Tai Kai Pik KP Kwek Lynette Siang Lim LSL Chee Thong Gan TG Choo Yee Mun YM Phng Francis Wei Loong FWL Chua Gerald Seng Wee GSW

BMJ open 20180322 3

<h4>Objective</h4>The chronic obstructive pulmonary disease (COPD) integrated care pathway (ICP) programme was designed and implemented to ensure that the care for patients with COPD is comprehensive and integrated across different care settings from primary care to acute hospital and home. We evaluated the effectiveness of the ICP programme for patients with COPD.<h4>Design, setting and participants</h4>A retrospective propensity score matched cohort study was conducted comparing differences be ...[more]

PMID: 29572394

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Project description:BackgroundPrevious studies showed bacterial lysates were effective for pediatric asthma. However, evidence of polyvalent bacterial lysate Qipian is lacking.MethodsIn this real-world retrospective cohort study, data of children with asthma, aged six months to 14 years old, attending to Jiangxi Provincial Children's Hospital from January 2021 to April 2022, prescribed routine treatment for asthma plus Qipian (Qipian group) or not (control group) were extracted. To minimize the impact of confounders on the outcomes, baseline characteristics were utilized to perform propensity score matching through a multivariable logistic regression model. After matching, asthma control, exacerbation, etc. were compared.ResultsTotally, 795 patients were included (337 in the Qipian group and 458 in the control group), with 278 pairs (556 patients) matched. Most baseline characteristics were well-balanced. The proportion of males were 68.3% and 70.1% in the two groups. The Qipian group favored better asthma control, with more "controlled" [3-month: 257 (92.4%) vs. 240 (86.3%); 6-month: 246 (88.5%) vs. 235 (84.5%)], and fewer "poorly/very poorly controlled" patients, compared with the control group (P=0.004 and 0.025, respectively). Patients in the Qipian group had lower risks of exacerbation. Incidence rate ratios (IRR) for any exacerbation were 0.56 [95% confidence interval (CI): 0.33 to 0.93] in the 3-month period and 0.83 (95% CI: 0.55 to 1.26) in the 6-month period. IRR for severe exacerbations were 0.09 (95% CI: 0.01 to 0.71) in the 3-month period and 0.20 (95% CI: 0.06 to 0.70) in the 6-month period (compared to the control group). Qipian significantly reduced the cumulative dose of short-acting beta-agonist (3-month: 3.22±10.37 vs. 8.08±16.71 mg; P<0.001; 6-month: 6.56±16.23 vs. 11.81±24.41 mg; P=0.002). There was no difference in incidences of respiratory tract infection or fever due to respiratory tract infection between the two groups. Numbers of antibacterial agent prescription were fewer in the Qipian group compared to the control group (3-month: 0.67±1.16 vs. 1.04±1.45; P=0.001; 6-month: 1.14±1.69 vs. 1.51±2.12; P=0.023).ConclusionsAccording to this retrospective study, Qipian may be effective for improved pediatric asthma control. Safety profile and mechanisms of action of Qipian need further investigation. Further randomized controlled trials are warranted to confirm our results.

Project description:BackgroundRegional citrate anticoagulation (RCA) is the gold standard of anticoagulation for continuous renal replacement therapy but is rarely used for intermittent hemodialysis (IHD) in ICU. Few studies assessed the safety and efficacy of RCA during IHD in ICU; however, no data are available comparing RCA to heparin anticoagulation, which are commonly used for IHD. The aim of this study was to assess the efficacy and safety of RCA compared to heparin anticoagulation during IHD.MethodsThis retrospective single-center cohort study included consecutive ICU patients treated with either heparin anticoagulation (unfractionated or low-molecular-weight heparin) or RCA for IHD from July to September in 2015 and 2017. RCA was performed with citrate infusion according to blood flow and calcium infusion by diffusive influx from dialysate. Using a propensity score analysis, as the primary endpoint we assessed whether RCA improved efficacy, quantified with Kt/V from the ionic dialysance, compared to heparin anticoagulation. The secondary endpoint was safety. Exploratory analyses were performed on the changes in efficacy and safety between the implementation period (2015) and at long term (2017).ResultsIn total, 208 IHD sessions were performed in 56 patients and were compared (124 RCA and 84 heparin coagulation). There was no difference in Kt/V between RCA and heparin (0.95 ± 0.38 vs. 0.89 ± 0.32; p = 0.98). A higher number of circuit clotting (12.9% vs. 2.4%; p = 0.02) and premature interruption resulting from acute high transmembrane pressure (21% vs. 7%; p = 0.02) occurred in the RCA sessions compared to the heparin sessions. In the propensity score-matching analysis, RCA was associated with an increased risk of circuit clotting (absolute differences = 0.10, 95% CI [0.03-0.18]; p = 0.008). There was no difference in efficacy and safety between the two time periods (2015 and 2017).ConclusionRCA with calcium infusion by diffusive influx from dialysate for IHD was easy to implement with stable long-term efficacy and safety but did not improve efficacy and could be associated with an increased risk of circuit clotting compared to heparin anticoagulation in non-selected ICU patients. Randomized trials to determine the best anticoagulation for IHD in ICU patients should be conducted in a variety of settings.

Dataset Information

Effectiveness of a chronic obstructive pulmonary disease integrated care pathway in a regional health system: a propensity score matched cohort study.

Publications

Effectiveness of a chronic obstructive pulmonary disease integrated care pathway in a regional health system: a propensity score matched cohort study.

Similar Datasets

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