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dc.contributor.authorTsai, Chu-Lin
dc.contributor.authorGinde, Adit A.
dc.contributor.authorBlanc, Phillip G.
dc.contributor.authorCamargo, Carlos Arturo
dc.date.accessioned2011-05-19T19:53:23Z
dc.date.issued2009
dc.identifier.citationTsai, Chu-Lin, Adit A. Ginde, Phillip G. Blanc, and Carlos A. Camargo. 2009. Improved care of acute exacerbation of chronic obstructive pulmonary disease in two academic emergency departments. International Journal of Emergency Medicine 2(2): 111-116.en_US
dc.identifier.issn1865-1372en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:4892353
dc.description.abstractBackground: Although several chronic obstructive pulmonary disease (COPD) practice guidelines have been published, there is sparse data on the actual emergency department (ED) management of acute exacerbation of COPD (AECOPD). Aims: Our objectives were to examine concordance of ED care of AECOPD in older patients with guideline recommendations and to evaluate whether concordance has improved over time in two academic EDs. Methods: Data were obtained from two cohort studies on AECOPD performed in two academic EDs during two different time periods, 2000 and 2005–2006. Both studies included ED patients, aged 55 and older, who presented with AECOPD, and cases were confirmed by emergency physicians. Data on ED management and disposition were obtained from chart review for both cohorts. Results: The analysis included 272 patients: 72 in the 2000 database and 200 in the 2005–2006 database. The mean age of the patients was 72 years; 50% were women and 80% white. In 2005–2006, overall concordance with guideline recommendations was high (for chest radiography, pulse oximetry, bronchodilators, all ≥ 90%), except for arterial blood gas testing (7% among the admitted) and discharge medication with systemic corticosteroids (42%). Compared to the 2000 data, the use of systemic corticosteroids in the ED improved from 53 to 77% [absolute improvement: 24%, 95% confidence interval (CI): 11–37%], and the use of antibiotics among the patients with respiratory infection symptoms improved from 56 to 78% (absolute improvement: 22%, 95% CI: 6–38%). Conclusions: Overall concordance with guideline-recommended care for AECOPD was high in two academic EDs, and some emergency treatments have improved over time.en_US
dc.language.isoen_USen_US
dc.publisherSpringer-Verlagen_US
dc.relation.isversionofdoi:10.1007/s12245-009-0089-8en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700228/pdf/en_US
dash.licenseLAA
dc.subjectchronic obstructive pulmonary diseaseen_US
dc.subjectexacerbationen_US
dc.subjectguidelinesen_US
dc.subjectquality of careen_US
dc.titleImproved care of acute exacerbation of chronic obstructive pulmonary disease in two academic emergency departmentsen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalInternational Journal of Emergency Medicineen_US
dash.depositing.authorCamargo, Carlos Arturo
dc.date.available2011-05-19T19:53:23Z
dash.affiliation.otherSPH^Epidemiologyen_US
dash.affiliation.otherHMS^Medicine-Massachusetts General Hospitalen_US
dc.identifier.doi10.1007/s12245-009-0089-8*
dash.contributor.affiliatedCamargo, Carlos


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