Predischarge Bundle for Patients With Acute Exacerbations of COPD to Reduce Readmissions and ED Visits
Abstract
Background Hospital readmissions for acute exacerbations of COPD (AECOPDs) pose burdens to the health-care system and patients. A current gap in knowledge is whether a predischarge screening and educational tool administered to patients with COPD reduces readmissions and ED visits.Methods A single-center, randomized trial of admitted patients with AECOPDs was conducted at Henry Ford Hospital between February 2010 and April 2013. One hundred seventy-two patients were randomized to either the control (standard care) or the bundle group in which patients received smoking cessation counseling, screening for gastroesophageal reflux disease and depression or anxiety, standardized inhaler education, and a 48-h postdischarge telephone call. The primary end point was the difference in the composite risk of hospitalizations or ED visits for AECOPD between the two groups in the 30 days following discharge. A secondary end point was 90-day readmission rate.Results Of the 172 patients, 18 of 79 in the control group (22.78%) and 18 of 93 in the bundle group (19.35%) were readmitted within 30 days. The risk of ED visits or hospitalizations within 30 days was not different between the groups (risk difference, -3.43%; 95% CI, -15.68% to 8.82%; P = .58). Overall, the time to readmission in 30 and 90 days was similar between groups (log-rank test P = .71 and .88, respectively).Conclusions A predischarge bundle intervention in AECOPD is not sufficient to reduce the 30-day risk of hospitalizations or ED visits. More resources may be needed to generate a measurable effect on readmission rates.Trial registry ClinicalTrials.gov; No.: NCT02135744; URL: www.clinicaltrials.gov.
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The only other randomized study done in the United States to test an intervention to decrease 1- and 3-month rehospitalizations proposed the same sample size.
“The only other randomized study done in the United States to test an intervention to decrease 1- and 3-month rehospitalizations proposed the same sample size (32)”
From Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization: A Randomized Study (2016) · cites this paper as [32]
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A quality improvement initiative for COPD patients: A cost analysis
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“Previous work has suggested that the impact of respiratory therapist-led or specialist-led home intervention is unclear [31].”
BackgroundHospital Readmissions for COPD: We Can Meet the Challenge
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“A single-center randomized controlled trial targeting smoking cessation, inhaler education, screening for gastroesophageal reflux disease and anxiety, and a postdischarge follow-up call failed to show a reduction in readmission.(23) The Global initiative for chronic Obstructive Lung”
di Chiara, C., Sartori, G., Fantin, A., Castaldo, N., & Crisafulli, E. (2025) · Medicina · doi:10.3390/medicina61010097 · Cited by 12 · see citing works
“• Identify patients at risk for readmission by patient-related or health-system-related factors;”
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Cost Savings from Reduced Hospitalizations with Use of Home Noninvasive Ventilation for COPD
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Sharpe, I., Bowman, M., Kim, A., Srivastava, S., Jalink, M., & Wijeratne, D. T. (2021) · COPD · doi:10.1080/15412555.2021.1955338 · Cited by 13 · see citing works
“The Cochrane Risk of Bias tool [16] was used to assess the RCTs, where a score of eight or higher was considered low risk of bias and a score below eight was considered high risk of bias.”
BackgroundResultInfluential[Integral approach to the acute exacerbation of chronic obstructive pulmonary disease].
del Castillo, J. M. G., Candel, F. J., de la Fuente, J., Gordo, F., Martín‐Sánchez, F. J., Menéndez, R., Mujal, A., & Barberán, J. (2018) · PubMed · Cited by 11 · see citing works
How to reduce hospital readmissions in chronic obstructive pulmonary disease?
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Noort, B. A. C., van der Vaart, T., & Ahaus, K. (2021) · PLoS ONE · doi:10.1371/journal.pone.0258337 · Cited by 8 · see citing works
Impact of a COPD care bundle on hospital readmission rates
Kendra, M., Kakwani, A., Uppala, A., Mansukhani, R. P., Pigott, D. K., Soubra, M., Jacobson, J., Cerrone, F., Farrell, M., Chiu, S. H., et al. (2022) · Journal of the American Pharmacists Association · doi:10.1016/j.japh.2022.10.002 · Cited by 7 · see citing works
Enhancing Postdischarge Asthma Care by Using Pharmacy Claims and Telephone Follow-up
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Ruiz, C. A. J., Buljubasich, D., Miranda, J. A. R., Acuña, A., Orive, J. I. D. G., Chatkin, J. M., Zabert, G. E., Benavides, A. G., Espinel, N. P., Noé-Díaz, V., et al. (2017) · Archivos de Bronconeumología · doi:10.1016/j.arbres.2017.04.012 · Cited by 6 · see citing works
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“Methodological design of the articles and levels of evidence Code of the interventions performed Significant reduction in readmission* IRR DP EHH EHD MR CHS OFD PCD PHV Other Randomized Clinical Trial (LE 02) Altfeld et al. (2013) x x x x No Balaban et al. (2015) x x x x No Bell et al. (2016) x x X x x No Benzo et al.…”
BackgroundUsing PICO Methodology to Answer Questions About Smoking in COPD Patients
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“Patients should receive education regarding the disease’s nature and severity, exacerbation recognition and early pursue of medical care, and the importance of pharmacological and non-pharmacological interventions and preventive measures to avoid exacerbations [73].”
BackgroundInterventions and Strategies to Reduce 30-day Readmission Rates
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“Tremendous financial responsibility exists for both patients and the health care system due to the high consumption of resources (Jennings et al., 2015).”
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Cigarette Smoking and Psychiatric Illness Among Individuals with COPD: a Systematic Review
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Risks May Not Be Reasons for COPD Readmissions
Ohar, J. A. (2015) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201507-444ed · Cited by 3 · see citing works
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“Studies evaluating comprehensive programmes that provide multidisciplinary care from hospital to home have shown mixed results [35,36].”
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“Conversely, some studies have reported no significant change in readmission or mortality rates after implementing discharge care bundles [21,22].”
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Discharge from Hospital to Home Care
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COPD Bundle to Prevent Hospital Readmissions and ED Visits
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Using Clinical Pathways to Assess Interventions to Prevent COPD Readmissions
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Discharge Care Bundle to Reduce COPD 30-Day Readmission Rates in a Hospital Acute Care Unit
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“…30-day readmission rate was the preferred outcome measure used to determine healthcare organizations’ performance and quality of care efficiency (Gentene et al., 2021; Jennings et al., 2015; Laverty et al., 2015; Matthews et al., 2013; Ohar et al., 2018; Shorofsky et al., 2015; Zafar et al., 2017).”
BackgroundMethodResultInfluentialNowalk, N. C., Rojas, J. C., Parker, W. F., Smith-Nunez, A., Gray, S. E., Sood, R., Lewis, D. O., Chia, S., Krishnamurthy, R., & Press, V. G. (2025) · CHEST Pulmonary · doi:10.1016/j.chpulm.2025.100219
“16,32 Patients actively using cigarettes were significantly more likely to receive tobacco cessation therapy if seen by our inpatient program with reduced odds of 30-day all-cause readmissions when tobacco cessation therapy was prescribed.”
Benetti, A., Fiorelli, E., Grassi, D., & Montano, N. (2026) · International Journal of COPD · doi:10.2147/copd.s571480
Implementing acute exacerbations of COPD care bundles: evidence, effectiveness and future directions
Wang, J., Shi, C. X., & Lin, Y. (2026) · European Respiratory Review · doi:10.1183/16000617.0032-2026
- Authors
- Jennings, J. H., Thavarajah, K., Mendez, M. P., Eichenhorn, M., Kvale, P., & Yessayan, L.
- Affiliations
- Henry Ford Health (US)
- Corresponding author
- Jennings, Jeffrey H.
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 147
- Issue
- 5
- Pages
- 1227-1234
- ISSN
- 0012-3692 (ISSN-L)
- OpenAlex
- W1560264663
- Cited by
- 89
- References
- 40
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 5 · 2022: 5 · 2021: 5 · 2020: 4 · 2019: 7 · 2018: 10 · 2017: 21 · 2016: 13 · 2015: 7 · 2014: 1
- FWCI
- 11.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CHEST Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Inhalation and Respiratory Drug Delivery
- Keywords
- COPD exacerbations, hospital readmission, emergency department visits, smoking cessation counseling, inhaler education, COPD education
- MeSH terms
- Acute Disease, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Patient Discharge, Patient Readmission, Disease Progression, Pulmonary Disease, Chronic Obstructive, Patient Care Bundles
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