PURPOSE:Nurse educators are commonly utilized in the management of patients with chronic obstructive pulmonary disease (COPD), but data on their effectiveness is conflicting. We hypothesized that a single inpatient encounter with a nurse educator would change health care utilization rates amongst patients with COPD.
METHODS:A retrospective review of all patients admitted with COPD in the Calgary Health Region from January 1, 2004 to December 31, 2007 was conducted. Those seen by educators between January 1, 2006 and January 31, 2007 were considered the case group, whilst the remainder served as a control group. Admission rates to hospital and length of stays were collected for each patient. These were analyzed for a priori defined differences between cases and controls, and pre and post-education in the case group.
RESULTS:Of 204 patients who received education, 185 were analyzed. There were 1932 control patients. Compared to the post-education group, controls had fewer admissions to hospital (0.998 admissions/1000 patient days versus 1.511/1000 patient days; p=0.003), fewer ICU admissions (0.057/1000 patient days versus 0.173/1000 patient days; p=0.016) and less admissions to subspecialists (24.42% versus 35.67%; p<0.01). There were no differences pre and post-education in the number of COPD admissions (mean change -0.29/1000 patient days; p=0.09) or ICU admissions (-0.54/1000 patient days; p=0.08). There was a significant reduction in hospital length of stay (mean change -6.24 days/stay; p<0.01), but no change in length of ICU stay (-3.05 days/ICU admission; p=0.12). Likewise, compared to controls, the post-education group had shorter total lengths of stay (mean 9.45 days versus 7.41 days; p=0.04), but no difference in ICU lengths of stay (4.24 days versus 4.25 days; p=0.99).
CONCLUSION:The lower rates of admission to hospital, ICU, and subspecialists indicate less acuity in the control arm. Despite this, total length of hospital stays were significantly improved when a nurse educator was involved in COPD care.
CLINICAL IMPLICATIONS:COPD education seems to be an effective adjunct to in-patient care. Prospective studies are needed to evaluate the magnitude of this benefit.
DISCLOSURE:Mitesh Thakrar, No Financial Disclosure Information; No Product/Research Disclosure Information