Early Supported Discharge and Enhanced Homecare After Emergency Department Admission for Acute Exacerbation of COPD

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).