Letter to the Editor
Care Mechanisms to Avoid Readmission of Patients With Chronic Obstructive Pulmonar Disease
Acerca de los mecanismos asistenciales para evitar el reingreso de los pacientes con enfermedad pulmonar obstructiva crónica
Òscar Miró
Área de Urgencias, Hospital Clínic, Barcelona, Spain
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Syndrome and Sleep Apnea" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "364" "paginaFinal" => "365" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Apert y apnea de sueño" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1877 "Ancho" => 2500 "Tamanyo" => 516536 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Characteristic facies of Apert syndrome with facial hypoplasia. (C) Syndactyly and sclerodactyly. (D) Patient's baseline polysomnography showing predominance of obstructive apneas and recording from autoCPAP connected to the polygraph flow channels.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Landete, Patricia Pérez-Ferrer, Eusebi Chiner" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Landete" ] 1 => array:2 [ "nombre" => "Patricia" "apellidos" => "Pérez-Ferrer" ] 2 => array:2 [ "nombre" => "Eusebi" "apellidos" => "Chiner" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289613000240" "doi" => "10.1016/j.arbres.2013.01.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289613000240?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212913001079?idApp=UINPBA00003Z" "url" => "/15792129/0000004900000008/v1_201307270144/S1579212913001079/v1_201307270144/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Care Mechanisms to Avoid Readmission of Patients With Chronic Obstructive Pulmonar Disease" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "365" "paginaFinal" => "366" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Òscar Miró" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Òscar" "apellidos" => "Miró" "email" => array:1 [ 0 => "omiro@clinic.cat" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Área de Urgencias, Hospital Clínic, Barcelona, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acerca de los mecanismos asistenciales para evitar el reingreso de los pacientes con enfermedad pulmonar obstructiva crónica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read with interest the article by Jurado Gámez et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in which the authors suggest that early home monitoring does not decrease the readmission rate during the first month of patients discharged from hospital after COPD exacerbation. These results may be very discouraging, since this is a highly prevalent disease that uses up a large proportion of hospital resources.</p><p id="par0010" class="elsevierStylePara elsevierViewall">However, I would like to highlight that the small size of the sample analyzed by the authors does not rule out a beta error, i.e. stating that are no differences between the groups when in reality there are. Thus, according to the data provided by the authors, the difference between a readmission rate of 16% in the intervention group and 20% in the control group gives an odds ratio (OR) for readmission in patients with intervention of 0.74, although the 95% confidence interval (0.21–2.62) is too wide to be considered statistically significant. In addition, the multivariate model developed by the authors to determine the profile of patients with a greater risk of readmission cannot be considered consistent, since 12 events (hospitalizations) are clearly insufficient for making an approximation with this model. In any case, taking into account these observations and the severity of the patients included (over 50% with GOLD stages 3 and 4 and a mean pO<span class="elsevierStyleInf">2</span> of 51<span class="elsevierStyleHsp" style=""></span>mmHg on discharge), this is an avenue that must not be considered closed based on the results of this study.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this respect, I think it would be very interesting to explore ways of avoiding not only hospital admission in these patients, but also emergency room visits. This is an aspect which is not examined in the report by Jurado Gámez et al. The emergency departments in Spain are frequently overstretched,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and patients who come in are faced with long waits, both before being seen and before being given a hospital bed, if needed. All this unquestionably raises issues regarding clinical safety.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> In this situation, decisions taken in the emergency room, especially if they are to discharge patients, are not always correct and involve risks that should be avoided. It would clearly be of interest to study whether post-emergency room discharge monitoring programs, similar to the post-hospital discharge programs studied by the authors, could add value to emergency care, while minimizing the risk of emergency department revisits and/or hospital admission, both recognized quality markers in the care of patients with COPD<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and in dispensing urgent medical care.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Miró Ò. Acerca de los mecanismos asistenciales para evitar el reingreso de los pacientes con enfermedad pulmonar obstructiva crónica. Arch Bronconeumol. 2013;49:365–6.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intervención domiciliaria y variables predictoras para reingreso hospitalario en la enfermedad pulmonar obstructiva crónica agudizada" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Jurado Gámez" 1 => "K. Lady" 2 => "C. Williams" 3 => "N. Feu Collado" 4 => "W. Hansen" 5 => "J.C. Jurado García" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2012.08.003" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "10" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23089685" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La saturación de los servicios de urgencias: una llamada a la unidad" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.R. Flores" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2011" "volumen" => "23" "paginaInicial" => "59" "paginaFinal" => "64" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La seguridad del paciente en urgencias y emergencias: balance de cuatro años del Programa SEMES-seguridad Paciente" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Tomás Vecina" 1 => "M.R. Chanovas Borràs" 2 => "F. Roqueta" 3 => "T. Toranzo Cepeda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2012" "volumen" => "24" "paginaInicial" => "225" "paginaFinal" => "233" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cultura de seguridad del paciente en los servicios de urgencias: resultados de su evaluación en 30 hospitales del Sistema Nacional de Salud español" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Roqueta Egea" 1 => "S. Tomás Vecina" 2 => "M.R. Chanovas Borràs" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2011" "volumen" => "23" "paginaInicial" => "356" "paginaFinal" => "364" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía de práctica clínica para el diagnóstico y tratamiento de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) – Guía Española de la EPOC (GesEPOC)" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Grupo de Trabajo de GesEPOC" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0300-2896(12)70044-3" "Revista" => array:7 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2012" "volumen" => "48" "numero" => "Suppl 1" "paginaInicial" => "2" "paginaFinal" => "58" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23116901" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000004900000008/v1_201307270144/S1579212913001110/v1_201307270144/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000004900000008/v1_201307270144/S1579212913001110/v1_201307270144/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212913001110?idApp=UINPBA00003Z" ]
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