Background: An increasing prevalence of obesity in the UK has also seen a rise in the diagnosis of co-morbidities. Obstructive sleep apnoea (OSA) has previously been associated with body mass index (BMI) but has not been fully explored in a UK population.

Introduction/Objectives Previous integrated care models for COPD have reduced length of stay slightly 1 or improved patient quality of life. In this study a pathfinder consortium of 20 practices and the local acute hospital, implemented a collaborative project with a partner from the pharmaceutical industry to improve COPD outcomes. The aims were to reduce hospital admissions, re-admissions and length of stay by integrating care via a patient focussed pathway. Methods A care pathway was developed, involving patients, that crossed primary and secondary care boundaries and led to improved access to community respiratory services. In each practice patients with COPD were stratified by risk and reviewed by trained nurses, in a structured format. Practice Nurse educational needs were assessed and a mentorship programme put in place. A Consultant Respiratory Physician from the local hospital visited the practices to discuss COPD management and the care pathway, and now runs on-going education and support. National medicine management guidelines were adhered to and reinforced with all healthcare professionals. The links between primary care and the community respiratory team were enhanced and clear referral guidelines were disseminated. The local patient support group (Breathe Easy) was re-launched. Results Patients were satisfied with the structured nurse-led COPD reviews, 463/487 said they were "very satisfied", and 433/487 said they were "totally aware" of their self-management plan. There was a 21% reduction in COPD hospital bed days and the average length of stay fell from 6.8 days to 5.0 days. At the end of 2010 the 30 day re-admission rate had fallen below the Strategic Health Authority average. Over the 12 months of the project the 90 day re-admission rate fell from 43% to 31%, a 12% reduction not shown previously elsewhere 1 dsee Abstract P97 figure 1. Abstract P97 Figure 1Conclusions By engaging with all aspects of COPD care, an integrated multidisciplinary team improved service delivery and patient care, reducing COPD hospital bed days and re-admission rates. If the current proposed NHS reforms offer an opportunity for better integrated healthcare then they may deliver improved outcomes. Introduction Chronic Obstructive Pulmonary Disease (COPD) represents an increasing burden for the NHS. National data indicate significant variation in the quality and consistency of diagnosis and management of COPD, with low recorded prevalence and increasing admissions. Early, accurate diagnosis and proactive management can modify disease progression to improve quality of life and use of health care resources. This national improvement programme aims to reduce variation and optimise diagnosis, treatment and use of healthcare resources through implementation of chronic disease management approaches. Methods 16 project sites from primary and secondary care adopted a systematic approach using improvement methodology to analyse existing patient pathways for COPD diagnosis and management, test changes and evaluate impact. Prima...

ObjectivesEngagement in guideline-recommended sexually transmitted infection (STI) care is fundamental to ending the STI epidemic in the USA. However, the US 2021–2025 STI National Strategic Plan and STI surveillance reports do not include a framework to measure quality STI care delivery. This study developed and applied an STI Care Continuum that can be used across settings to improve STI care quality, assess adherence to guideline-recommended care and standardise the measurement of progress towards National Strategic goals.MethodsReview of the Centers for Disease Control and Prevention STI Treatment guidelines identified seven distinct steps of STI care for gonorrhoea, chlamydia and syphilis: (1) STI testing indication, (2) STI test completion, (3) HIV testing, (4) STI diagnosis, (5) partner services, (6) STI treatment and (7) STI retesting. Steps 1–4, 6 and 7 for gonorrhoea and/or chlamydia (GC/CT) were measured among females aged 16–17 years with a clinic visit at an academic paediatric primary care network in 2019. We used Youth Risk Behavior Surveillance Survey data to estimate step 1, and electronic health record data for steps 2, 3, 4, 6 and 7.ResultsAmong 5484 female patients aged 16–17 years, an estimated 44% had an STI testing indication. Among those patients, 17% were tested for HIV, of whom none tested positive, and 43% were tested for GC/CT, 19% of whom were diagnosed with GC/CT. Of these patients, 91% received treatment within 2 weeks and 67% were retested within 6 weeks to 1 year after diagnosis. On retesting, 40% were diagnosed with recurrent GC/CT.ConclusionsLocal application of an STI Care Continuum identified STI testing, retesting and HIV testing as areas for improvement. The development of an STI Care Continuum identified novel measures for monitoring progress towards National Strategic indicators. Similar methods can be applied across jurisdictions to target resources, standardise data collection and reporting and improve STI care quality.

Introduction Respiratory disease presents a significant financial burden to the UK. 40% of the cost of managing respiratory disease is spent on hospital admissions. Admissions for respiratory disease account for 12% of all medical admissions and 94 000 are for exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Between 1991 and 2001 admissions for COPD rose by 50% and data suggest the admissions trend continues to increase, representing an increasing burden to the NHS. The aims of this programme of work were to reduce admissions, readmissions at 30 days, length of stay (LOS) for exacerbation of COPD and to improve the quality of patient care and the patient's experience. Methods Twelve project sites from primary care, secondary care and community services took part in an improvement workstream. They were supported by a national programme of information sharing and peer support. Service improvement methodology was used including a series of diagnostic tools. Secondary care data were used to demonstrate areas of duplication, bottlenecks and gaps within services. The Plan Do Study Act (PDSA) cycle was used to implement changes to services and to evaluate the impact of service redesign. Results Data from five sites demonstrate £202k savings/cost avoidance through reductions in LOS and hospital admissions. Several important key learning points emerged from the programme of work:< Cohorts of frequent attenders via the Emergency Department can be identified. One site identified 34 patients who accounted for 157 admissions in a 12-month period. Coordinated case management in this cohort may be effective in reducing admissions; data are not yet available to support this. < Early access to specialist respiratory care is effective in reducing LOS. One site demonstrated a mean reduction in LOS of 0.4 days and another site a reduction of 1.5 days by instigating early specialist review. < Improving communication and service integration is effective in reducing admissions. One site prevented 33 admissions through closer working between GP and Hospital at Home services.Conclusion Effective service redesign can deliver improvements in the quality of respiratory services for patients with COPD and simultaneously deliver productivity gains and cost savings.