Pilot study evaluating frailty-focused care for hospitalised patients with chronic obstructive pulmonary disease
Bibliographic record
Abstract
BACKGROUND: Frailty is associated with morbidity and mortality among people with chronic obstructive pulmonary disease (COPD), yet there are no established care pathways to manage frail patients with COPD. To address this gap, we developed, implemented and assessed the feasibility of a new frailty-focused care model for patients hospitalised with exacerbations of COPD. METHODS: We conducted a prospective cohort study among hospitalised patients with acute exacerbations of COPD in an academic hospital in Canada over 18 months. We developed and implemented a frailty-focused care model using the degree of frailty to guide personalised assessments, education, and care interventions during and after hospital discharge. We assessed the feasibility of using frailty-focused care in a real-world setting with prespecified targets for recruitment rate, care model completion and collection of patient-reported outcomes including symptom burden, health confidence, health status and self-management scores. Patients were followed up at 3 months after hospitalisation to reassess patient-reported outcomes. RESULTS: 87 patients used the frailty-focused care model during hospitalisation, 58 consented to participate in this study and 45 (78%) completed 3-month postdischarge follow-up. 47% (n=21) were at least mildly frail at baseline, with 35% (n=20) at risk of frailty. Target recruitment of 50 patients was achieved, and all participants completed core elements of frailty-focused care, including frailty assessment, personalised education and discharge planning. Patient-reported outcomes were measured in all participants in hospital, and in 78% (n=45) patients at 3-month follow-up. 23% (n=13) of patients initially reported feeling confident to manage their health condition. This improved to 62% (n=28) at 3-month follow-up. CONCLUSIONS: This study provides a foundation to build innovative care models for frail individuals with COPD and shows it is feasible to use frailty-focused care in a real-world hospital setting. Future work requires strong patient engagement to better align frailty-focused care with patient-centred goals.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".