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...

Poster sessionsThorax 2012;67(Suppl 2):A1-A204 A77Conclusions Pilot results show that there was no correlation between COPD severity and PAM Scores. Differences in PAM scores were found between those in current PR, as well as those with more hospitalisations. Further work is needed to evaluate the PAM as a tool for multiple points in an individual's journey such as at diagnosis, after a first or repeat admission and as part of PR programmes.Abstract P32 Building on learning from initial test sites, selected practises in three CCG areas were supported to analyse primary care data for patients on the COPD disease register and optimise care for these patients. Practises process mapped their current system for managing COPD patients to identify potential improvements. Different methods for data extraction were used to audit diagnosis, disease severity and treatment in relation to NICE guidance. Patients identified as potentially sub optimally treated were called in for review with support of local nurse specialists. Data was collected on respiratory chapter prescribing costs per month per practize, patients reviewed, reasons and outcome. At CCG level, appropriate tools, training and support were developed to help sustain and spread improvement.Early findings from data analysis and patient review identified up to 20% of patients with scope for optimisation of treatment, for reasons including inaccurate diagnosis, poor interpretation of spirometry, and over-or under-treatment in relation to assessment of disease severity. Detailed analysis of patient records required significant input of time and skills, but data extraction tools allowed groups of patients to be targeted more quickly. Review of patients is ongoing. Conclusions Data analysis and practical support at practise level can identify and address existing problems of misdiagnosis and sub optimal treatment, but are labour intensive and reactive. It is essential to develop a reliable pathway to ensure accurate and timely diagnosis and treatment are maintained for the future. Tools, guidelines, and ongoing education and support can help sustain this.NHS Improvement acknowledges the contribution of project teams from Mansfield and Ashfield CCG, Godiva CCG and University Hospitals Coventry & Warwickshire, & NHS Isle of Wight in this work. P33patients to reach diagnosis and treatment however because of multiple referral sources, non 2 week [N2WW] patients follow a different journey. Our aim was to find out whether there is significant difference in patient outcome in these two groups in a multisite NHS Trust. ConclusionThe data suggests there is a significant difference between patient journey and outcome between two groups despite no significant difference in staging. Poor documentation and use of upgrading to 2WW made it difficult to find out why so many were under N2WW. Physicians are encouraged to review and alter patient pathway for N2WW group to ensure equal access to health care and appropriate outcome for all patients with LC diagnosis. DOES DISEASE SEVERI...

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This paper examines the notion of the original water industry, presenting the argument that there was in fact an original water industry of which Indigenous Australians were the custodians.The second finding is that this original water industry existed across all sectors including the way water was managed and used for drinking, how water was interacted with to harvest plants and animals sustainably, and the way in which waterways and the water cycle more broadly were integrated with the Indigenous lifestyle.The paper then highlights the value of this industry and puts forth that this knowledge has contemporary application, particularly in a commercial setting.The authors found that Indigenous Australians face many of the same issues the water industry faces more broadly, such as water quality and water scarcity, however these key water issues affect Indigenous Australians at a disproportionate rate.

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.