Discharge Care Bundle for Patients with Acute Exacerbations of COPD: Benefit more likely to be seen beyond 30 Days

Background: COPD is associated with significant morbidity, mortality, and hospital costs.The implementation of COPD "discharge care bundles" has been proposed as having an impact on readmissions.We developed and implemented a discharge care bundle and the aim of this study was to evaluate its effects on utilization of hospital services in a real life setting. Methods:We conducted a retrospective chart review study from 2007-2013 to evaluate utilization of hospital services over three time periods (30, 90 days, and one year) post discharge care bundle implementation in two patient cohorts.The first cohort included patients who had utilized any hospital service in the previous year for respiratory complaints and the second included only those who had been admitted.These cohorts were analyzed to evaluate differences in readmissions pre and post discharge care bundle implementation.Results: In the first cohort (210 patients), the 90-day hospital service utilisation rate after implementation was 23.3% versus 35.7% for one hospital service (p=0.049) and at one year it was 22.4% versus 50.0%(p<0.001).In the second cohort (118 patients), the 90 days readmission rate after implementation was 18.6% versus 32.2% for one readmission (p=0.017) and at one year it was 30.5% versus 61.9% (p=0.038).At one year the readmission rate for two readmissions was 14.4% versus 24.6% (p=0.049). Conclusion:The implementation of a COPD discharge care bundle successfully decreases hospital health service utilization and hospital readmissions, with the benefit more likely to be seen on a longer period of follow up beyond 30 days. Methods Designing the COPD Discharge Care BundleMapping the patient pathway: Before designing the discharge