Early Supported Discharge/ Hospital At Home For Acute Exacerbation Of Chronic Obstructive Pulmonary Disease: A Review and Meta-Analysis.

  1. Lookup NU author(s)
  2. Dr Carlos Echevarria
  3. Andrew Bryant
  4. Dr Sally Corbett
  5. Dr John Steer
  6. Dr Stephen Bourke
Author(s)Echevarria C, Brewin K, Horobin H, Bryant A, Corbett S, Steer J, Bourke SC
Publication type Article
JournalCOPD: Journal of Chronic Obstructive Pulmonary Disease
Year2016
Volume13
Issue4
Pages523-533
ISSN (print)1541-2555
ISSN (electronic)1541-2563
Full text for this publication is not currently held within this repository. Alternative links are provided below where available.
A systematic review and meta-analysis was performed to assess the safety, efficacy and cost of Early Supported Discharge (ESD) and Hospital at Home (HAH) compared to Usual Care (UC) for patients with acute exacerbation of COPD (AECOPD). The structure of ESD/HAH schemes was reviewed, and analyses performed assuming return to hospital during the acute period (prior to discharge from home treatment) was, and was not, considered a readmission. The pre-defined search strategy completed in November 2014 included electronic databases (Medline, Embase, Amed, BNI, Cinahl and HMIC), libraries, current trials registers, national organisations, key respiratory journals, key author contact and grey literature. Randomised controlled trials (RCTs) comparing ESD/HAH to UC in patients admitted with AECOPD, or attending the emergency department and triaged for admission, were included. Outcome measures were mortality, all-cause readmissions to 6 months and cost. Eight RCTs were identified; seven reported mortality and readmissions. The structure of ESD/HAH schemes, particularly selection criteria applied and level of support provided, varied considerably. Compared to UC, ESD/HAH showed a trend towards lower mortality (RRMH = 0.66; 95% CI 0.40–1.09, p = 0.10). If return to hospital during the acute period was not considered a readmission, ESD/HAH was associated with fewer readmissions (RRMH = 0.74, 95% CI: 0.60–0.90, p = 0.003), but if considered a readmission, the benefit was lost (RRMH = 0.84; 95% CI 0.69–1.01, p = 0.07). Costs were lower for ESD/HAH than UC. ESD/HAH is safe in selected patients with an AECOPD. Further research is required to define optimal criteria to guide patient selection and models of care.
PublisherTaylor and Francis
URLhttp://dx.doi.org/10.3109/15412555.2015.1067885
DOI10.3109/15412555.2015.1067885
Actions    Link to this publication

Altmetrics provided by Altmetric

Share