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Impact of clinical pathway on clinical outcomes in the management of COPD exacerbation

机译:临床途径对COPD急性加重治疗的临床结果的影响

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Background Exacerbations, a leading cause of hospitalization in patients with chronic obstructive pulmonary disease (COPD), affect the quality of life and prognosis. Treatment recommendations as provided in the evidence-based guidelines are not consistently followed, partly due to absence of simplified task-oriented approach to care. In this study, we describe the development and implementation of a clinical pathway (CP) and evaluate its effectiveness in the management of COPD exacerbation. Methods We developed a CP and evaluated its effectiveness in a non-randomized prospective study with historical controls on patients admitted for exacerbation of COPD to Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Consecutive patients who were admitted between June 2009 and December 2010 were prospectively recruited into the CP group. Non-CP historical controls were obtained from case records of patients admitted between January 2008 and January 2009. Clinical outcomes were evaluated by comparing the length of stay (LOS), complication rates, readmissions, and mortality rates. Results Ninety-five patients were recruited in the CP group and 98 patients were included in the non-CP historical group. Both groups were comparable with no significant differences in age, sex and severity of COPD (p?=?0.641). For clinical outcome measures, patients in the CP group had shorter length of stay than the non-CP group (median (IQR): 5 (4–7) days versus 7 (7–9) days, p?p? Conclusion The implementation of CP –reduced the length of stay and complication rates of patients hospitalized for acute exacerbation of COPD.
机译:背景恶化是慢性阻塞性肺疾病(COPD)患者住院的主要原因,它会影响生活质量和预后。未始终遵循循证指南中提供的治疗建议,部分原因是缺乏简化的面向任务的护理方法。在这项研究中,我们描述了临床途径(CP)的开发和实施,并评估了其在治疗COPD急性发作中的有效性。方法我们开发了CP并在一项非历史性前瞻性研究中评估了其有效性,该研究采用历史对照方法,对马来西亚科邦萨大学医学中心(UKMMC)入院的COPD恶化患者进行了研究。在2009年6月至2010年12月期间入院的连续患者前瞻性纳入CP组。从2008年1月至2009年1月期间收治的患者病例记录中获得非CP的历史对照。通过比较住院时间(LOS),并发症发生率,再入院率和死亡率来评估临床结局。结果CP组招募了95例患者,非CP历史组包括了98例患者。两组均具有可比性,COPD的年龄,性别和严重程度无显着差异(p = 0.641)。对于临床结局指标,CP组患者的住院时间短于非CP组(中位(IQR):5(4–7)天,而7(7–9)天,p?p?结论CP的减少–减少了因COPD急性加重而住院的患者的住院时间和并发症发生率。

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