Chronic obstructive pulmonary disease (COPD) is second only to heart failure as a cause of hospital readmissions. Most hospitalists know a COPD exacerbation when they see one, but spotting and treating the underlying chronic disease don't always get the attention they should, according to pulmonary experts. Part of the problem is that many hospitals lack a systematic approach to diagnosing and managing COPD patients, both their in-hospital treatment and their transition to outpatient care. Our cover story looks at what a few enterprising hospitals are doing to ensure this population is properly diagnosed, treated and educated—as well as supported at discharge so they don't wind up back in the hospital the following month. The results of these efforts are encouraging: A COPD protocol at one hospital cut 30-day readmissions for the disease nearly in half over the course of a year.
Hospitals and hospitalists also need a plan for using dabigatran, recently approved by the Food and Drug Administration. The anticoagulant has several advantages over warfarin, including a need for less monitoring and a lower stroke and bleeding risk profile. It isn't the best choice for all patients, however. Our story explains which patients are and are not suited for the drug, and advises on the types of “what if” scenarios to consider when using this new pharmaceutical on the block.
Efforts to create more seamless disease management through better discharge processes and patient education often run into a barrier: lack of clinician time for new initiatives. As a result, some hospitals are turning to computerized patient education programs, which are easy to use and can be brought to a patient's bedside. Early results of such a program at Boston Medical Center indicate reduced readmissions and emergency department visits in patients with low health literacy. Learn more about how computers can help improve patient care efficiently.
Other clinical articles in this issue include a Coding Corner column on chronic respiratory failure, and a MKSAP quiz on COPD. If you're looking for some music to accompany your reading, turn to Jamie Newman's column for a suggested playlist of songs that chronicle a day in the life of a hospitalist.
Got a favorite song about medicine or a coding question you'd like to share? Email us.
Editor, ACP Hospitalist