Factors associated with 28-day readmission among patients with chronic obstructive pulmonary disease, Cha-uat Hospital, Nakhon Si Thammarat Province

Abstract

This retrospective analytical study aimed to examine factors associated with 28-day readmission among patients with chronic obstructive pulmonary disease (COPD), Cha-uat Hospital, Nakhon Si Thammarat Province. The population consisted of patients treated for COPD, who were divided into two groups: 73 patients who were not readmitted and 189 patients who were readmitted within 28 days. The research instrument was data from medical records. Content validity was assessed by three experts with an Item-Objective Congruence (IOC) index of 1.00 for all items. Data were analyzed using descriptive statistics and multivariable logistic regression.

The results showed that factors associated with 28-day readmission among COPD patients included the following: female patients had a higher likelihood of readmission compared with male patients (adj.OR = 175.70, 95% CI = 15.71–1,964.57). Patients aged 60–69 years and 70–79 years had a lower likelihood of readmission compared with those aged ≤59 years (adj.OR = 0.001, 95% CI = 0.01–0.10 and adj.OR = 0.001, 95% CI = 0.01–0.05, respectively). Patients with general labor occupations had a lower likelihood of readmission (adj.OR = 0.02, 95% CI = 0.01–0.40), whereas those who were traders or homemakers had a higher likelihood of readmission compared with those engaged in agriculture (adj.OR = 61.45, 95% CI = 2.64–1,430.13 and adj.OR = 77.62, 95% CI = 3.56–1,692.45, respectively). Patients with an education level higher than primary school had a lower likelihood of readmission compared with those with primary education (adj.OR = 0.06, 95% CI = 0.01–0.66). Patients with insufficient income relative to expenses had a higher likelihood of readmission compared with those whose income was sufficient (adj.OR = 22.02, 95% CI = 2.89–167.57). Smokers had a significantly higher likelihood of readmission compared with non-smokers (adj.OR = 26,553.57, 95% CI = 501.25–1,406,663.59). Patients with severe disease classified as GOLD C–D had a higher likelihood of readmission compared with those classified as GOLD A–B (adj.OR = 131.59, 95% CI = 10.44–1,658.05). In addition, patients with a hospital length of stay of ≥8 days had a higher likelihood of readmission compared with those with a length of stay of 1–7 days (adj.OR = 753.53, 95% CI = 9.98–56,904.06).

Therefore, professional nurses should develop behavior modification programs targeting risk factors associated with COPD exacerbation and readmission. Such programs should emphasize increased involvement of family members to enhance awareness of the severity of COPD exacerbations and to support patients in preventing recurrent episodes.