Effectiveness of structured planned post discharge support to patients with chronic obstructive pulmonary disease for reducing readmission rates: a systematic review

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease, characterized by airflow limitation. The disease has a significant impact on the lives of patients and is a challenge for the health care due to readmissions to hospitals. OBJECTIVES: This review aimed to identify, appraise and synthesize the best available evidence on the effectiveness of discharge interventions that can reduce readmission of patients with COPD. TYPES OF PARTICIPANTS: Hospitalized patients, aged 18 years or over, who had been diagnosed with COPD and were admitted to hospital due to acute exacerbation. TYPES OF INTERVENTIONS: Studies that evaluated discharge interventions that supported patients managing symptoms of COPD. TYPES OF STUDIES: Randomized controlled trials, non-randomized controlled trials, quasi-experimental or cohort studies. OUTCOMES: Readmission, defined as hospitalization to the same or different hospital for any reason within the following year after discharge. SEARCH STRATEGY: Multiple databases (PubMed, Embase, CINAHL, the Cochrane Library, Pedro, Web of Science, Turning Research Into Practice [Trip] and Scopus) were searched from 1990 to June 2015. Studies published in English or Scandinavian. METHODOLOGICAL QUALITY: Two independent reviewers used the standard critical appraisal tool from the Joanna Briggs Institute to assess the methodological quality of studies. All studies were of good methodological quality. DATA EXTRACTION: The process of data extraction was undertaken independently by two reviewers using tools from the Joanna Briggs Institute. DATA SYNTHESIS: A narrative description of each study was performed. Outcomes were reported as the event rate (ER) in the intervention and control groups. Based on the ER relative risk reduction (RRR), absolute risk reduction (ARR), the number needed to treat (NNT), and relative risk (RR) with 95% confidence intervals were calculated. Continuous data were reported in natural units. RESULTS: This review includes ten studies all testing a mix of interventions. A meta-analysis included six studies, four at 30 days follow-up with RR 0.67 (0.45 to 0.98) and 180 days follow-up with RR 0.74 (0.51 to 1.08). The analysis could not identify a single set of interventions that could be recommended. CONCLUSIONS: Post discharge support and interventions in patients with COPD significantly reduce the readmission rate within 30 days after discharge from hospital and the interventions may significantly reduce readmission up to 180 days after initial discharge. This is a significant finding from the clinical and practical perspective.