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...

by GPs and hospitals. <50% took action when concordance reports showed variance (under or over use) from prescribed treatment. 2. Lack of ability to detect hypoxic patients with >20% community healthcare sites not having access to an oximeter. 3. Fire safety officers are rarely advised about the persistent smoker (only 16%) despite the potential risk to patients, their families and the general public. Local guidance on appropriate steps to take is rare (35%). 3 HOS units denied LTOT for smokers and one assessed this by exhaled carbon monoxide measurement. 4. A variety of methods for protecting patients from excessive oxygen are favoured but use appears limited. When asked what policy respondents favoured, universal precaution (as promoted by ambulance guidelines) was most popular (60%) while 20% favoured oxygen cards and 20% patient specific protocols (PSP). 5. A specific local policy for removing oxygen when no longer indicated or used is rare (<25%). This, coupled with inadequate follow-up of patients started on oxygen during hospital admission, suggests significant waste with the current oxygen provision. 6. Respondents indicated guidance on oxygen removal, contract monitoring, assessment for ambulatory oxygen and training in arterial or capillary blood gases as being required.Conclusions Problems in healthcare coordination, public and patient safety and in removing oxygen once ordered were common. There is a need to integrate hospital and community teams and to prepare for safe mobilisation and contract management so that a quality home oxygen service can be provided in the future.

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.