Impact of a COPD Discharge Care Bundle on Readmissions Following Admission with Acute Exacerbation: Interrupted Time Series Analysis

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.