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Supported discharge shortens hospital stay in patients hospitalized because of an exacerbation of COPD

Hospital Universitari Son Dureta, Palma de Mallorca, Spain

CORRESPONDENCE: A. Agustí, Servei Respiratori, Hospital Universitari Son Dureta, Andrea Doria 55, 07014, Palma Mallorca, Spain. Fax: 34 971175228

Keywords: chronic bronchitis, chronic obstructive pulmonary disease, emphysema, health-care costs, managed care

Received: July 27, 2000
Accepted January 31, 2001

This study was supported, in part, by FIS (00/1011) and ABEMAR

This prospective, controlled, but not formally randomized study investigates the feasibility and efficiency of an alternative to standard hospitalization for patients with exacerbated chronic obstructive pulmonary disease (COPD), based upon supported discharge with nurse supervision at home.

Over a 12-month period, emergency physicians, not directly involved in the study, admitted 205 patients with exacerbated COPD to the authors' respiratory unit. Patients were included in the supported discharge group (n=105) if they voluntarily chose to participate in the programme and lived in the city of Palma de Mallorca (where adequate home support could be provided). Patients not fulfilling these criteria (mainly residents outside the city) served as controls (n=100). Inpatient treatment was standardized in all patients and included oxygen therapy, bronchodilators, antibiotics and steroids.

Both groups were comparable in terms of age (mean±sd: 70±10 versus 65±11 yr for supported discharge and control group, respectively), severity of airflow obstruction (forced expiratory volume in one second 45±18% reference versus 46±19% ref.), comorbidity and socioeconomic status. Length of hospital stay (LOS) in the supported discharge group was shorter (5.9±2.8 versus 8.0±5.1 days, p<0.001). After discharge, a respiratory nurse visited supported discharge patients at home during 7.3±3.8 days. Only one patient (1%) required hospital readmission during this period of time. The reduced LOS resulted in a lower utilization of hospital beds at any given point in time throughout the study period.

Within the framework and potential limitations of this study, the results indicate that the supported discharge programme in Spain: 1) allows a significant reduction in the length of hospital stay of patients hospitalized because of an exacerbation of chronic obstructive pulmonary disease; 2) does not result in an inappropriately increased rate of hospital readmissions; and 3) reduces the utilization of hospital resources.

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