Impact of a COPD discharge care bundle on readmissions following admission with acute exacerbation: interrupted time series analysis

PLoS One. 2015 Feb 13;10(2):e0116187. doi: 10.1371/journal.pone.0116187. eCollection 2015.

Abstract

Objectives: We evaluated the impact of a COPD discharge care bundle on readmission rates following hospitalisation with an acute exacerbation.

Design: Interrupted time series analysis, comparing readmission rates for COPD exacerbations at nine trusts that introduced the bundle, to two comparison groups; (1) other NHS trusts in London and (2) all other NHS trusts in England. Care bundles were implemented at different times for different NHS trusts, ranging from October 2009 to April 2011.

Setting: Nine NHS acute trusts in the London, England.

Participants: Patients aged 45 years and older admitted to an NHS acute hospital in England for acute exacerbation of COPD. Data come from Hospital Episode Statistics, April 2002 to March 2012.

Main outcome measures: Annual trend readmission rates (and in total bed days) within 7, 28 and 90 days, before and after implementation.

Results: In hospitals introducing the bundle readmission rates were rising before implementation and falling afterwards (e.g. readmissions within 28 days +2.13% per annum (pa) pre and -5.32% pa post (p for difference in trends = 0.012)). Following implementation, readmission rates within 7 and 28 day were falling faster than among other trusts in London, although this was not statistically significant (e.g. readmissions within 28 days -4.6% pa vs. -3.2% pa, p = 0.44). Comparisons with a national control group were similar.

Conclusions: The COPD discharge care bundle appeared to be associated with a reduction in readmission rate among hospitals using it. The significance of this is unclear because of changes to background trends in London and nationally.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Disease Progression*
  • Hospitals / statistics & numerical data
  • Humans
  • Interrupted Time Series Analysis*
  • Length of Stay / statistics & numerical data
  • London / epidemiology
  • Middle Aged
  • National Health Programs
  • Patient Admission*
  • Patient Care Bundles*
  • Patient Discharge / statistics & numerical data*
  • Patient Readmission / statistics & numerical data*
  • Pulmonary Disease, Chronic Obstructive / epidemiology*
  • Pulmonary Disease, Chronic Obstructive / therapy
  • Retrospective Studies

Grant support

This article presents independent research commissioned by the National Institute for Health Research (NIHR) under the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) programme for North West London. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Additional support was received from Imperial Centre for Patient Safety and Service Quality and the NIHR Biomedical Research Centre scheme. The funders had no role in the study design, interpretation, or the decision to publish.