Telehealth Interventions for COPD Management: An Umbrella Review (Preprint)

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a growing epidemic, with a heavy associated economic burden. Education, physical activity, and pulmonary rehabilitation programs are important aspects of the management of COPD. These interventions are commonly delivered remotely as part of telemedicine interventions. Several systematic reviews and meta-analyses have been conducted to assess the effectiveness of these interventions. However, these reviews often have conflicting conclusions. OBJECTIVE We thus sought to conduct an umbrella review to critically appraise and summarise the available evidence on telemedicine interventions for the management of COPD. METHODS Medline, Embase, Scopus, Web of Science, PsycINFO and Cochrane databases were searched for articles relating to telemedicine interventions for the management of COPD. We included systematic reviews and meta-analyses of randomised controlled trials which compared telemedicine interventions to usual care. A narrative synthesis was performed. RESULTS We identified 10 systematic reviews which met the inclusion criteria. Telemedicine interventions used in these reviews were tele treatment, telemonitoring and tele support. Tele support interventions significantly reduced the number of inpatient days and quality of life. Tele monitoring interventions were associated with significant reductions in respiratory exacerbations and hospitalisation rate. Tele treatment showed significant effectiveness in reducing respiratory exacerbations, respiratory exacerbations, hospitalisation rate, compliance (acceptance and dropout rate) and physical activity. Among studies which used integrated telemedicine interventions, there was a significant improvement in physical activity. CONCLUSIONS Telemedicine interventions showed non-inferiority or superiority over standard of care for the management of COPD. Telemedicine interventions should be considered as a supplement to usual methods of care for the outpatient management of COPD, with the aim of reducing the burden on healthcare systems.

Temporal trends of COVID-19 mortality and hospitalisation rates: an observational cohort study from the US Department of Veterans Affairs

ObjectivesTo investigate the temporal trends of 30-day mortality and hospitalisation in US Veterans with COVID-19 and 30-day mortality in hospitalised veterans with COVID-19 and to decompose the contribution of changes in the underlying characteristics of affected populations to these temporal changes.DesignObservational cohort study.SettingUS Department of Veterans Affairs.Participants49 238 US veterans with a positive COVID-19 test between 20 March 2020 and 19 September 2020; and 9428 US veterans hospitalised with a positive COVID-19 test during the same period.Outcome measures30-day mortality rate and hospitalisation rate.ResultsBetween 20 March 2020 and 19 September 2020 and in COVID-19 positive individuals, 30-day mortality rate dropped by 9.2% from 13.6% to 4.4%; hospitalisation rate dropped by 16.8% from 33.8% to 17.0%. In hospitalised COVID-19 individuals, 30-day mortality rate dropped by 12.7% from 23.5% to 10.8%. Among COVID-19 positive individuals, decomposition analyses suggested that changes in demographic, health and contextual characteristics, COVID-19 testing capacity, and hospital occupancy rates accounted for 40.2% and 33.3% of the decline in 30-day mortality and hospitalisation, respectively. Changes in the underlying characteristics of hospitalised COVID-19 individuals accounted for 29.9% of the decline in 30-day mortality.ConclusionBetween March and September 2020, changes in demographic and health characteristics of people infected with COVID-19 contributed measurably to the substantial decline in 30-day mortality and hospitalisation.

Re-hospitalisation Rate of Patients Hospitalised with a Diagnosis Of COVID-19: A Training And Research Hospital Example

Background/aim: COVID-19 cases originated in Wuhan and it has become a global problem. The purpose of study to examine the rate of re-hospitalisation within 30 days after the completion of medical treatments for patients suffering from COVID-19. Materials and methods: In this study, the results of COVID-19 patients who were re-admitted to the hospital within 30 days were examined. The general and clinical characteristics of the patients and laboratory results were evaluated using parametric and nonparametric tests. Results: Included in this study were 22 patients, comprising 14 males and 8 females, with re-hospitalisation rate within 30 days and a diagnosis of COVID-19 that was 0.6%. The mean age of the patients who were re-hospitalised was 56.45 years. The major clinical symptoms of the patients who were re-hospitalised, respectively, were cough, shortness of breath, fever. When the levels from the first hospitalisation and the second hospitalisation were compared, an increase in the LYM count and N/L ratio was detected and the difference was statistically significant. Conclusion: A holistic patient assessment and care approach should be adopted by evaluating the symptomatic complaints as well as the comorbidities of the patients, so as to reduce the number of re-hospitalisations.

Prevalence and predictors of scar contracture-associated re-hospitalisation among burn inpatients in China

Scar contracture, a common destructive complication causing increased re-hospitalisation rate of burn survivors and aggravated burden on the medical system, may be more seriously in Chinese population because of their higher susceptibility to scar formation. This study aims to evaluate the prevalence and predictors of scar contracture-associated re-hospitalisation among Chinese burn inpatients. This cross-sectional study screened burn inpatients hospitalised during 2013 to 2018 through the Hospital Quality Monitoring System database, among whom re-hospitalised for scar contracture were identified. Variables including sex, age, occupations, burn area, burn site and surgical treatment were analysed. Potential predictors of scar contracture-associated re-hospitalisation among burn inpatients were determined by univariate regression analyses. Of the 220,642 burn inpatients, 2146 (0.97%) were re-hospitalised for scar contracture. The re-hospitalised inpatients were predominantly men and blue-collar workers, showing younger median age at the time of burns, larger burn sizes, and higher percentage of surgical treatment compared other burn inpatients. Significant univariate predictors of scar contracture-associated re-hospitalisation included male sex, age < 50 years, blue-collar work, ≥ 40% total body superficial area burned, inhalation injured, and surgical treatment. Scar contracture is an intractable complication and a significant factor to increase re-hospitalisation rate among Chinese burn inpatients.

Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009–2018

BackgroundEvidence on the effect of pay-for-performance (P4P) schemes on provider performance is mixed in low-income and middle-income countries. Brazil introduced its first national-level P4P scheme in 2011 (PMAQ-Brazilian National Programme for Improving Primary Care Access and Quality). PMAQ is likely one of the largest P4P schemes in the world. We estimate the association between PMAQ and hospitalisations for ambulatory care sensitive conditions (ACSCs) based on a panel of 5564 municipalities.MethodsWe conducted a fixed effect panel data analysis over the period of 2009–2018, controlling for coverage of primary healthcare, hospital beds per 10 000 population, education, real gross domestic product per capita and population density. The outcome is the hospitalisation rate for ACSCs among people aged 64 years and under per 10 000 population. Our exposure variable is defined as the percentage of family health teams participating in PMAQ, which captures the roll-out of PMAQ over time. We also provided several sensitivity analyses, by using alternative measures of the exposure and outcome variables, and a placebo test using transport accident hospitalisations instead of ACSCs.ResultsThe results show a negative and statistically significant association between the rollout of PMAQ and ACSC rates for all age groups. An increase in PMAQ participating of one percentage point decreased the hospitalisation rate for ACSC by 0.0356 (SE 0.0123, p=0.004) per 10 000 population (aged 0–64 years). This corresponds to a reduction of approximately 60 829 hospitalisations in 2018. The impact is stronger for children under 5 years (−0.0940, SE 0.0375, p=0.012), representing a reduction of around 11 936 hospitalisations. Our placebo test shows that the association of PMAQ on the hospitalisation rate for transport accidents is not statistically significant, as expected.ConclusionWe find that PMAQ was associated with a modest reduction in hospitalisation for ACSCs.

MO702DIFFERENCES IN HOSPITALISATION BETWEEN PERITONEAL DIALYSIS AND IN-CENTRE HAEMODIALYSIS PATIENTS

Background and Aims End stage kidney disease (ESKD) and dialysis treatment are associated with high morbidity, frequently resulting in hospitalisation. However, studies comparing hospitalisation between different dialysis modalities report conflicting results. Some studies report an equal number and length of hospital admissions, while others conclude that peritoneal dialysis (PD) patients are more likely to be hospitalised. In addition, most studies only analyse data of patients that remain on their initial dialysis modality. However, a transition from one dialysis modality to another, e.g. from PD to in-centre haemodialysis (ICHD), certainly occurs in current dialysis practice. Therefore, the aim of this study was to compare hospitalisations between PD and ICHD patients, taking into account transfers between dialysis modalities. Method The retrospective Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO) collected hospitalisation data of ESKD patients who started dialysis treatment between 2012 and 2017. Eligible patients had a minimum dialysis duration of 3 months. For baseline comparison, groups were defined based on the dialysis modality (i.e. PD or ICHD) 3 months after dialysis initiation. Primary outcome was hospitalisation rate, which was analysed with a multi-state model that attributed each hospitalisation to the dialysis modality the patient was treated with at that the time. Secondary outcomes were time to first hospitalisation, number of hospitalisations and length of hospitalisation. Time to first hospitalisation was analysed with Cox regression analysis, with dialysis modality as a time-varying covariate. Number of hospitalisations was analysed with negative binomial regression, and length of stay with Poisson regression. All analyses were adjusted for potential confounders. Results In total, 252 PD and 443 ICHD patients from 31 Dutch dialysis centres were included. Baseline characteristics of the groups were comparable, apart from a lower dialysis vintage and a slightly lower comorbidity score in the PD group. Patients transferred more often from PD to ICHD (33%), than from ICHD to PD (11%) during a median follow-up period of 22.0 months [IQR 11.1-36.4]. The crude hospitalisation rate for PD was 2.3 (±5.0) and for ICHD 1.4 (±3.2) hospitalisations per patient-year. Using a multistate model, the adjusted hazard ratio (HR) for hospitalisation rate was 1.1 (95%CI 1.02-1.3) for PD compared to ICHD patients. Cox regression analysis showed a significant difference in time to first hospitalisation with an adjusted HR of 1.3 (95%CI 1.1 - 1.6) for PD compared to ICHD patients in the first year after dialysis initiation. After the first year, the time to first hospitalisation had an adjusted HR of 1.9 (95%CI 1.4–2.5) for PD compared to ICHD patients. The number of hospitalisations was significantly higher, while the length of stay was non-significantly higher for PD patients. In PD patients, the most common cause of all hospitalisations was peritonitis (23%). In ICHD patients, the most common cause was access-related (33%). Conclusion PD was associated with a higher hospitalisation rate, a shorter time to first hospitalisation and more hospitalisations compared to ICHD. One explanation might be that the threshold for admission to hospital is lower for PD patients compared to ICHD patients.

Detection of SARS-CoV-2 lineage P.1 in patients from a region with exponentially increasing hospitalisation rate, February 2021, Rio Grande do Sul, Southern Brazil

The emergence of SARS-CoV-2 P.1 lineage coincided with a surge in hospitalisations in the North region of Brazil. In the South region’s Rio Grande do Sul state, severe COVID-19 case numbers rose 3.8 fold in February 2021. During that month, at a COVID-19 referral hospital in this state, whole-genome sequencing of a subset of cases’ specimens (n = 27) revealed P.1 lineage SARS-CoV-2 in most (n = 24). Findings raise concerns regarding a possible association between lineage P.1 and rapid case and hospitalisation increases.

Spatiotemporal variations of asthma admission rates and their relationship with environmental factors in Guangxi, China

ObjectiveThe study aimed to determine if and how environmental factors correlated with asthma admission rates in geographically different parts of Guangxi province in China.SettingGuangxi, China.ParticipantsThis study was done among 7804 asthma patients.Primary and secondary outcome measuresSpearman correlation coefficient was used to estimate correlation between environmental factors and asthma hospitalisation rates in multiple regions. Generalised additive model (GAM) with Poisson regression was used to estimate effects of environmental factors on asthma hospitalisation rates in 14 regions of Guangxi.ResultsThe strongest effect of carbon monoxide (CO) was found on lag1 in Hechi, and every 10 µg/m3 increase of CO caused an increase of 25.6% in asthma hospitalisation rate (RR 1.26, 95% CI 1.02 to 1.55). According to the correlation analysis, asthma hospitalisations were related to the daily temperature, daily range of temperature, CO, nitrogen dioxide (NO2) and particulate matter (PM2.5) in multiple regions. According to the result of GAM, the adjusted R2 was high in Beihai and Nanning, with values of 0.29 and 0.21, which means that environmental factors are powerful in explaining changes of asthma hospitalisation rates in Beihai and Nanning.ConclusionAsthma hospitalisation rate was significantly and more strongly associated with CO than with NO2, SO2 or PM2.5 in Guangxi. The risk factors of asthma exacerbations were not consistent in different regions, indicating that targeted measures should differ between regions.