Reducing hospital admissions and improving the diagnosis of COPD in Southampton City: methods and results of a 12-month service improvement project

Tom Wilkinson, Mal North, Simon C Bourne, Tom Wilkinson, Mal North, Simon C Bourne

Abstract

Background: The British Lung Foundation highlighted Southampton City as a hotspot for patients at future risk of chronic obstructive pulmonary disease (COPD) exacerbations due to severe deprivation levels and a high undiagnosed level of disease based on health economic modelling. We developed a strategy spanning primary and secondary care to reduce emergency admissions of patients with acute exacerbations of COPD and increase the diagnosed prevalence of COPD on general practitioner (GP) registers closer to that predicted from local modelling.

Methods: A comprehensive 3-year audit of admissions was performed. Patients who had been admitted with an exacerbation to University Hospital Southampton three or more times in the previous 12 months were cohorted and cared for in a consultant-led, but community based, COPD service. Within primary care, a programme of education and case-based finding was delivered to most practices within the city.

Results: Thirty-four patients were found to be responsible for 176 admissions (22% of total COPD admissions) to the hospital. These 34 patients required 185 active interventions during the 12-month period but only 39 hospital admissions. The 30-day readmission rate dropped from 13.4 to 1.9% (P<0.01), confirming the contribution the cohort made to readmissions. Prior to the project, the registered Quality Outcomes Framework prevalence of COPD within the city was 1.5; after just 1 year of the project, the prevalence increased from 1.5 to 2.27%.

Conclusions: The use of medical intelligence to investigate the underlying processes of COPD hospital admissions led to an effective intervention delivered in a consultant-led model.

Figures

Figure 1
Figure 1
Three-year audit of COPD admissions to the University Hospital Southampton during the period before the initiation of the project.
Figure 2
Figure 2
Number of admissions per patient to the University Hospital Southampton in the year prior to project initiation. Thirty-four patients accounted for 176 admissions.
Figure 3
Figure 3
Quarterly COPD prevalence in Southampton City December 2010–2011 according to local Quality Outcomes Framework statistics.
Figure 4
Figure 4
COPD admission to the University Hospital Southampton according to route of referral in the 3-year period prior to the initiation of the project.
Figure 5
Figure 5
(a) Admission rate in the cohort of 34 patients in the year immediately preceding the project and the following year. (b) Total 30-day COPD patient readmission rate over the same period.

References

    1. Invisible Lives—Chronic Obstructive Pulmonary Disease (COPD)—finding the missing millions. British Lung Foundation. November 2007. Available at: .
    1. Report of The National Chronic Obstructive Pulmonary Disease Audit 2008: Resources and Organisation of care in Acute NHS units across the UK, September 2008 Royal College of Physicians, British Lung Foundation and British Thoracic Society. Available at: .
    1. British Thoracic Society Burden of Lung Disease BTS, London, UK; 2006 . Available at: .
    1. UK National Statistics.
    1. Alrajab S, Smith TR, Owens M, Areno JP, Caldito G. A home telemonitoring program reduced exacerbation and healthcare utilization rates in COPD patients with frequent exacerbations. Telemed J E Health. 2012;18:772–776.
    1. Bucknall CE, Miller G, Lloyd SM, Cleland J, McCluskey S, Cotton M. Glasgow supported self-management trial (GSuST) for patients with moderate to severe COPD: randomised controlled trial. BMJ. 2012;344:e1060.
    1. Rice KL, Dewan N, Bloomfield HE, Grill J, Schult TM, Nelson DB. Disease Management Program for chronic obstructive pulmonary disease: a randomized controlled trial. Am J Respir Crit Care Med. 2010;182:890–896.
    1. Bischoff EW, Hamd DH, Sedeno M, Benedetti A, Schermer TR, Bernard S. Effects of written action plan adherence on COPD exacerbation recovery. Thorax. 2011;66:26–31.
    1. Fan V, Gaziano J, Lew R, Bourbeau J, Adams SG, Leatherman S. A comprehensive care management program to prevent chronic obstructive pulmonary disease hospitalizations: a randomized, controlled trial. Ann Intern Med. 2012;156:673–683.
    1. Shahab L, Jarvis MJ, Britton J, West R. Prevalence, diagnosis and relation to tobacco dependence of chronic obstructive pulmonary disease in a nationally representative population sample. Thorax. 2006;61:1043–1047.
    1. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A. Standardisation of spirometry. Eur Respir J. 2005;26:319–338.
    1. CG101 Chronic Obstructive Pulmonary Disease (updated). National Institute for Health and Clinical Excellence. June 2010. Available at: .
    1. Godtfredsen NS, Vestbo J, Osler M, Prescott E. Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population study. Thorax. 2002;57:967–972.
    1. Fletcher CM, Peto R, Tinker C, Speizer F. The Natural History of Chronic Bronchitis and Emphysema. Oxford University Press: Oxford, UK; 1976.
    1. Vestbo J, Anderson JA, Calverley PM, Celli B, Ferguson GT, Jenkins C. Adherence to inhaled therapy, mortality and hospital admission in COPD. Thorax. 2009;64:939–943.
    1. Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006;61:772–778.
    1. Boland J, Owen J, Ainscough R, Mahdi H. Developing a service for patients with very severe chronic obstructive pulmonary disease (COPD) within resources. BMJ Support Palliat Care. 2014;4:196–201.
    1. Kruis AL, Smidt N, Assendelft WJ, Gussekloo J, Boland MR, Rutten-van Mölken M. Integrated disease management interventions for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013;10:CD009437.

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