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Comparative Study
. 2017 Mar 21:12:961-971.
doi: 10.2147/COPD.S124385. eCollection 2017.

Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates

Abdulmajeed Alshabanat  1 , Michael C Otterstatter  2 , Don D Sin  3 , Jeremy Road  4 , Carmen Rempel  5 , Jane Burns  5 , Stephan F van Eeden  3 , J M FitzGerald  6
Affiliations
Comparative Study

Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates

Abdulmajeed Alshabanat et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: COPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing.

Aim: The aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD.

Materials and methodology: We retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90 days. We compared numbers, rates, and intervals of readmission and LOS during 2 years of active program delivery compared to 1 year prior to program implementation.

Results: A total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3 years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all causes showed a significant decline, with hazard ratios (HRs) of 0.55 (year 1) and 0.51 (year 2) of intervention (P<0.001). In addition, patients' mean LOS (days) for COPD-related admissions declined significantly from 10.8 to 6.8 (P<0.05).

Conclusion: A comprehensive disease management program for COPD patients, including education, case management, and follow-up, was associated with significant reduction in hospital admissions and LOS.

Keywords: CCP; COPD; admission; length of stay; readmission.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Distribution of numbers of readmissions (all causes and COPD only) within 90 days for patients with an index COPD admission prior to, or during years 1 and 2, of the program.
Figure 2
Figure 2
Mean cumulative number of all-cause readmissions relative to days since index COPD admission (inpatients only), based on Cox regression model. Notes: Solid lines represent cohort means and colored bands represent 95% confidence intervals. Red = preprogram; green = program year 1; blue = program year 2.
Figure 3
Figure 3
Mean cumulative number of readmissions with primary diagnosis of COPD relative to days since index COPD admission (inpatients only), based on Cox regression model. Notes: Solid lines represent cohort means and colored bands represent 95% confidence intervals. Red = preprogram; green = program year 1; blue = program year 2.
See this image and copyright information in PMC

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MeSH terms