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

Lookup NU author(s): Dr Carlos Echevarria, Andrew Bryant, Dr Sally Corbett, Dr John Steer, Professor Stephen BourkeORCiD

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Abstract

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 (RR_MH = 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 (RR_MH = 0.74, 95% CI: 0.60–0.90, p = 0.003), but if considered a readmission, the benefit was lost (RR_MH = 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.

Publication metadata

Author(s): Echevarria C, Brewin K, Horobin H, Bryant A, Corbett S, Steer J, Bourke SC

Publication type: Article

Publication status: Published

Journal: COPD: Journal of Chronic Obstructive Pulmonary Disease

Year: 2016

Volume: 13

Issue: 4

Pages: 523-533

Online publication date: 08/02/2016

Acceptance date: 28/06/2015

ISSN (print): 1541-2555

ISSN (electronic): 1541-2563

Publisher: Taylor and Francis

URL: http://dx.doi.org/10.3109/15412555.2015.1067885

DOI: 10.3109/15412555.2015.1067885

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