The effect of COPD health forecasting on hospitalisation and health care utilisation in patients with mild-to-moderate COPD.

Exacerbations are a major cause of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD) as well as having a large impact on health care utilisation (HCU). They are more frequent during periods of cold weather with a corresponding increase in hospital admissions. It has been hypothesised that COPD exacerbations and admissions can be reduced by predicting periods of cold weather coupled with patients' alerts and education. Healthy Outlook(®) service provided by the Meteorological Office, UK, was used in patients with mild-to-moderate COPD who consented to participate from three primary care practices. Outcome measures included data relating to hospital admissions for acute exacerbations as well as HCU for these patients during the intervention period (1 Nov 2008-31 Mar 2009) and compared for the same patients and same period 12 months earlier (1 Nov 2007-31 Mar 2008). A cost analysis comparing treatment cost per patient for the two periods was also conducted. A total of 157 (34% of target COPD population) patients took part in the project, with five weather alerts generated (first alert reached 150 patients; second reached 146; third reached 138 patients; fourth reached 137 patients; and the fifth reached 125 patients) during the intervention period. There was a non-statistically-significant increase in hospital admissions per patient (0.07-0.076; p = 0.83). The number of general practice visits per patient dropped from 4.9 to 3.8 (p = 0.001), with drop in average number of visits to patients by out-of-hours services from 0.52-0.14 (p = 0.013). The average number of home consultations provided by general practice increased from 0.05 to 0.92 (p = 0.001). Cost per patient increased by an average of £142 (95% CI -£128 to £412). This anticipatory care model was not associated with reduction in admissions from COPD exacerbations. Further research is required to fully understand its role in the management of patients with COPD.

Development of an integrated chronic obstructive pulmonary disease service model in an inner-city region in the UK: initial findings and 12-month results.

AIMS: To improve the management of chronic obstructive pulmonary disease (COPD) in Salford, UK, and to evaluate the impact of an integrated service model after one year. METHODS: A health needs analysis and benchmarking exercise was undertaken in 2007. These activities were used to develop an integrated service model in order to improve the diagnosis and management of COPD and reduce unscheduled hospital admissions and length of stay. RESULTS: Following implementation of the model, 811 further patients were diagnosed. Unscheduled hospital admissions for COPD fell from 935 to 840, length of stay was reduced from 8.3 to 7.7 days, and associated costs fell from £1,772, 865 to £1,528,080. The number of patients who completed pulmonary rehabilitation increased from 84 to 143. CONCLUSIONS: An integrated COPD service model was successful in increasing diagnosis, reducing hospital admissions and reducing length of hospital stay - in line with the proposed National Strategy for COPD Services in England. It also promoted management according to National Institute of Health and Clinical Excellence (NICE) guidelines.