Decreasing Hospital Readmissions Utilizing an Evidence-Based COPD Care Bundle.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a chronic condition that leads to significant morbidity and mortality. Management of COPD hospitalizations utilizing an evidence-based care bundle can provide consistent quality of care and may reduce readmissions. METHODS: This single-center retrospective cohort study evaluated readmission rates in patients hospitalized with a COPD exacerbation. Patients in the pre-intervention cohort received usual care, while patients in the post-intervention cohort received an innovative inpatient COPD care bundle. The bundle focused on optimizing care in five areas: consults, inpatient interventions, education, transitions of care, and after discharge care. RESULTS: In this study, 149 subjects were included in the pre-intervention cohort and 214 subjects were included in the post-intervention cohort. Thirty-day readmission rates were lower in the post-intervention cohort compared to the pre-intervention cohort, 22.4% vs. 38.3% (p = 0.001). A reduction in 60-day and 90-day readmission rates was also observed, 13.7% vs. 40.3% (p < 0.001) and 10.1% vs. 32.2% (p < 0.001), respectively. CONCLUSION: Bundled care is an effective and inexpensive method for institutions to provide consistent and quality care. The findings of this study demonstrate that the implementation of a COPD care bundle is an effective strategy to decrease hospital readmissions.

Flashback to 2002: a retesting and reanalysis suggests an important role of DSA.

In 2002, Lee et al. published the first paper describing the effect of HLA antibodies on graft failure in kidney transplant patients, yet remained skeptical as to why some patient grafts were surviving years longer than others while testing positive for HLA antibodies. Through a retesting and reanalysis of these patient samples, we confirm the effect that HLA antibodies had on graft failure. Furthermore, our data suggests an explanation for the discrepancy in patient graft survival lasting significant periods of time with HLA antibodies. Through use of updated technology by Luminex testing, as opposed to the ELISA-based HLA screening used in 2002, we confirm that although patient grafts are surviving significant periods of time with HLA antibodies, these antibodiesare not DSA. Thus, grafts with non-DSA HLA antibodies are able to survive longer than grafts with DSA. The data also proposes that lower DSA MFI values are less detrimental to graft survival as well. Moreover, the recent data also suggests that Class I DSA leads to an even shorter graft survival than Class II only DSA.