Use of a chronic disease management programme in COPD to reduce hospital admissions

Abstract

Chronic obstructive pulmonary disease (COPD) accounts for a large number of hospital admissions and numerous interventions have attempted to reduce exacerbations requiring hospitalization. This paper describes the implementation of a community based COPD management programme led by a respiratory physiotherapist to improve home management of COPD and its effect on reducing readmissions and/or length of stay in hospital. One-hundred and twenty-five patients (median age 73) referred with COPD exacerbations met the criteria for the service; 95 received the intervention and data were available for 80. Median FEV1 was 0.86 L. Admission data, length of stay and total hospitalization days with COPD were compared for one year before and after the intervention. Overall there was no reduction in length of stay, admission frequency, or adjusted total hospitalization days with COPD, but median time interval to next exacerbation increased by 29%. In those who had had previous admissions (mean FEV1 0.58 L) total hospitalization days fell by 27%, length of stay fell by 58% despite an increase in admission frequency from one to two per year, and there was no change in median time interval to next hospitalized exacerbation. In our patients implementation of a Chronic Disease Management programme increased the time to next hospitalized exacerbation. Benefit was seen in the more severe patients however, with a significant reduction in both length of stay and total hospitalization days.

Role of the Management Pathway in the Care of Advanced COPD Patients in Their Own Homes

“…Our study is short term compared to the long-term study conducted by Pearson et al (2006) and included only patients with advanced COPD. Pushparajah, McClellan, Henry, and Kuitert (2006) showed a signifi cant reduction in both length of stay and total hospitalization in more severely ill patients by implementation of a chronic disease management program similar to ours. A self-management program as part of an overall supported package of care has been shown to reduce readmission rates (Gadoury et al, 2005).…”

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

“…Strong clinical leadership within collaborative quality improvement programmes 275 and individual specialist provision of care, 271 both improved process outcomes in these before-and-after studies, but neither study provided evidence of clinical effectiveness.…”

“…248,257,260,262,273,276 l Technological solutions (such as cCBT programmes, automated telephone calls) are being explored and show some promise. 225,238,265,267,269,271 l The only study which specifically explored duration of intervention and effect found evidence of benefit as much as 5 years after a one-off intensive insulin training course. 243 Intensive courses in diabetes and LBP seem to be more effective than less intensive programmes.…”

“…Pushparajah et al 271 report a physiotherapy-led service which provided home visits within 5 days of a hospital discharge with an exacerbation of COPD with the aim of supporting self-management to reduce future admissions. The process evaluation identified referrals and medication errors corrected as a result of the visit, but there was no change in frequency or duration of admissions.…”

“…We included two studies, 271,275 both delivered in the community, but one led by primary care physicians in rural USA, 275 and the other led from secondary care immediately after an admission (see Table 122 for details). 271 …”