Early Supported Discharge and Enhanced Homecare After Emergency Department Admission for Acute Exacerbation of COPD
Early Supported Discharge and Enhanced Homecare After Emergency Department Admission for Acute Exacerbation of COPD
The prevalence of chronic obstructive pulmonary disease (COPD) is between 8 and 15% of the
 adult population in 2010. This prevalence is expected to increase over the coming decades as
 the population ages and exposure to the risk factors for the disease continues. The evolution
 of COPD is marked by the occurrence of exacerbations of varying severity responsible for 1%
 of emergency department admission. Thus,95% of COPD patients admitted to emergency department
 for exacerbation are hospitalized.

 Several recent studies seem to show that an early discharge from hospital with home care can
 reduce the rate of rehospitalisation and mortality of COPD patients. These preliminary data
 on low numbers need to be confirmed. In addition, it seems necessary to identify the
 phenotypes of patients who benefit most from these early exits.

 Exadom project (supported by Rhône-Alpes-Auvergne Regional Health Authorities (ARS),
 AstraZeneca and Grenoble Alpes University Hospital) aims to establish a safe and effective
 way of discharging patients by providing enhanced home-based care for AECOPD.
Exadom project (supported by Rhône-Alpes-Auvergne Regional Health Authorities (ARS) ,
 Grenoble Alpes University Hospital) aims to establish a safe and effective way of discharging
 COPD patients from emergency department by providing enhanced home care.

 This program implements ambulatory care immediately after leaving the emergency department
 with a main goal of reducing hospital readmission during the first month. The home-based
 support includes daily visits at home conducted by the home care provider's nurses from day 1
 to day 7, telephone calls at days 14 and 21 and a final home visit one month after discharge
 from the emergency department. Blood samples will be collected at inclusion, day 7 and one
 month during home visit and urine samples at inclusion, day 2, day 4 and one month during
 home visit .Telephone follow-up at 3, 6 months and one year.
Inclusion Criteria:

 -  Age ≥ 40 years

 -  Current or former smoker, with at least 10 pack-years

 -  previous history of COPD with concordant spirometry results

 -  Admission to the emergency department for an exacerbation defined as an acute event
 which is characterized by a degradation of respiratory symptoms greater than the usual
 daily variations and requiring a change in therapeutic management

 -  Patient with mild exacerbation characterized by a DECAF score at 0 or 1. (DECAF score:
 Dyspnea, Eosinopenia, Consolidation on chest x-ray, Acidaemia, and atrial
 Fibrillation. One point for each criterion. Mortality at one month is less than 3% if
 the DECAF score is 0 or 1).

 -  Residence within 30km of Grenoble Alps University Hospital

 -  Patient legally able to give consent

 -  Person affiliated to a medical insurance

 Exclusion Criteria:

 -  Dementia or non-communicating patient in French language

 -  Patient unable to call the emergency department at any time in case of sudden
 worsening

 -  Pregnancy or breastfeeding woman

 -  patient under administrative or judicial supervision

 -  DECAF Score > 1. Patient's with DECAF score > 1 are considered at too high risk of
 mortality to be managed at home (they are usually hospitalized).