OBJECTIVES:

Effectiveness of peri-discharge interventions for reducing 30-day hospital readmissions among COPD patients has been synthesized in previous network meta-analyses (NMAs). However, as the benefits of interventions may vary across health system contexts, these interventions should be adapted before implementation. Guided by the GRADE Evidence to Decision(EtD) framework, we aimed to translate evidence-based peri-discharge interventions into stakeholder consensus-based intervention options for reducing 30-day hospital readmissions among COPD patients in Hong Kong.

METHODS:

A total of 18 local stakeholders were recruited to perform a two-step process in this study. In Step 1, stakeholders were invited to prioritize NMA-supported peri-discharge interventions and suggest essential intervention combinations. In Step 2, based on the priority list from Step 1, stakeholders were asked to conduct a two-round Delphi study to determine whether these interventions should be implemented in the local context. GRADE EtD framework was used to guide the decision-making process considering benefits and harms, values and preferences, equity, acceptability, and feasibility.

RESULTS:

Six out of ten peri-discharge interventions reached positive consensus and were endorsed by stakeholders for reducing 30-day avoidable hospital readmissions among COPD patients in Hong Kong. The percentage agreement ratings for these six endorsed interventions ranged from 70.6% to 94.1%. After considering all the criteria mentioned above, over 60% of local stakeholders agreed that the desirable consequences of implementing these six endorsed interventions probably or clearly outweigh the undesirable effects. Preliminary implementation issues are in the areas of financing, governance and leadership, health workforce development, service access and readiness, and empowerment of patients and caregivers.

CONCLUSIONS:

A list of stakeholders-endorsed evidence-based peri-discharge interventions was established for reducing 30-day hospital readmissions among COPD patients in Hong Kong. Before scaling up the implementation of these interventions, future studies should be conducted to improve intervention-context fit and to further assess real-world implementation effectiveness.