• Chantal E Atwood, Mohit Bhutani, Maria B Ospina, Brian H Rowe, Richard Leigh, Lesly Deuchar, Peter Faris, Marta Michas, Kelly J Mrklas, Jim Graham, Raymond Aceron, Ron Damant, Lee Green, Naushad Hirani, Kelly Longard, Virginia Meyer, Patrick Mitchell, Willis Tsai, Brandie Walker, and Michael K Stickland.
• Alberta Health Services, Calgary, AB, Canada.
• Chest. 2022 Aug 1; 162 (2): 321-330.

BackgroundAcute exacerbations of COPD (AECOPD) are associated with high morbidity and mortality and frequent readmissions.Research QuestionWhat is the effectiveness of a COPD transition bundle, with and without a care coordinator, on rehospitalizations and ED revisits?Study Design And MethodsTwo patient cohorts were selected: (1) the group exposed to the transition bundle and (2) the group not exposed to the transition bundle (usual care group). Patients exposed subsequently were randomized to a care coordinator. An AECOPD transition bundle was implemented in the hospital; patients randomized to the care coordinator were contacted ≤ 72 h after discharge. Six hundred four patients (320 to the care coordinator and 284 to routine care) who met eligibility criteria from five hospitals across three cities in Alberta, Canada, were exposed to the transition bundle, whereas 3,106 patients discharged from the same hospitals received the usual care. Primary outcomes were 7-day, 30-day, and 90-day readmissions, median length of stay (LOS), and 30-day ED revisits.ResultsThe transition bundle cohort were 83% (relative risk [RR], 0.17; 95% CI, 0.07-0.35) less likely to be readmitted within 7 days and 26% (RR, 0.74; 95% CI, 0.60-0.91) less likely to be readmitted within 30 days of discharge. Ninety-day readmissions were unchanged (RR, 1.05; 95% CI, 0.93-1.18). The transition bundle was associated with a 7.3% (RR, 1.07; 95% CI, 1.0-1.15) relative increase in LOS and a 76% (RR, 1.76; 95% CI, 1.53-2.02) greater risk of a 30-day ED revisit. The care coordinator did not influence readmission or ED revisits.InterpretationThe COPD transition bundle reduced 7- and 30-day hospital readmissions while increasing LOS and ED revisits. The care coordinator did not improve outcomes.Trial RegistryClinicalTrials.gov; No.: NCT03358771; URL: www.Clinicaltrialsgov.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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