An Outcome on COPD Readmission in Secondary Care Hospitals Participating the Rational Drug Use Hospital Project

Abstract

Patients with chronic obstructive pulmonary disease (COPD) tend to be admitted repeatedly to hospitals. Hospitals participating in the Rational Drug Use (RDU) Hospital Project since inception in 2014 have never been evaluated for clinical outcomes. This research assessed the RDU Project on ability to reduce hospital readmission with COPD among patients under the Universal Coverage Scheme (UCS). Materials and methods: This was a quasi-experimental study of patients aged 15 years or over who were admitted to secondary care hospitals during 2009-2016. Data were obtained from the National Health Security Office. The analysis was conducted, using an interrupted time-series analysis by Prais-Winsten regression. Results: During 2009-2016, hospitals in the RDU Project had a higher readmission with COPD than those not in the Project. Both groups had a decreasing trend in the readmission before the Project. Since 2014, readmission in the RDU group reduced from 26.51% in 2014 to 25.64% in 2015, then rose to 27.05% in 2016. Over the same years, readmission in the non-RDU group reduced from 25.49 to 24.60 and 24.51%. Results from the interrupted time-series analysis revealed that readmission rate in the RDU group reduced by 0.47 percentage points (P<0.05) per year before the Project, then increased by 0.16% points (P=0.449) thereafter. In the non-RDU group, the readmission reduced by 0.51% points (P<0.01) per year before the Project and maintained a decreasing trend with a reduction of 0.21% points (P=0.136) after the Project. Conclusion: For patients with COPD under UCS, the RDU hospitals did not show a lower 28-day readmission than the non-RDU hospitals.