Impact of an Integrated Medical-Nursing Clinical Pathway on 30-Day Readmission and Long-Term Prognosis in Patients with Acute Exacerbation of COPD: A Retrospective Cohort Study Using Real-World Data.

Abstract

Background: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is associated with high rates of hospital readmission and mortality. Traditional fragmented care often fails to address the complex needs of these patients. This study aimed to evaluate the impact of an Integrated Medical-Nursing Management (IMNM) model on readmission rates, mortality, and patient-centered outcomes in AECOPD patients.

Methods: A retrospective cohort study was conducted at the First Hospital of Hebei Medical University involving AECOPD patients admitted between January 2022 and January 2025. Patients were divided into a Control Group (standard care, Jan 2022-Jun 2023) and an Intervention Group (IMNM model, Aug 2023-Jan 2025). The IMNM model featured interdisciplinary rounds, joint discharge planning, and structured follow-up. Propensity Score Matching (PSM) was used to balance baseline covariates (1:1 matching). The primary outcome was hospital readmission rates at 30, 90, 180, and 365 days. Secondary outcomes included all-cause mortality, CAT scores, and treatment adherence.

Results: A total of 120 patients (60 per group) were included after PSM. The Intervention Group showed significantly lower readmission rates at 30 days (15.0% vs. 28.3%, P=0.046) and 365 days (26.7% vs. 51.7%, P<0.001). The hazard ratio for readmission-free survival favored the intervention (HR 0.38, 95% CI 0.21-0.70). All-cause mortality at 1 year was significantly lower in the Intervention Group (5.0% vs. 13.3%, P=0.041). Patients in the IMNM group also demonstrated improved CAT scores (MD -5.4, P<0.001) and higher medication adherence (80.0% vs. 53.3%, P=0.004).

Conclusion: In conclusion, the Integrated Medical-Nursing Management model is associated with reduced hospital readmissions and mortality, as well as improved patient quality of life and treatment adherence in AECOPD patients. These findings provide actionable evidence for healthcare systems to adopt collaborative clinical pathways, thereby standardizing routine clinical practice to mitigate the burden of AECOPD.