Cost analysis of integrated care model in management of acute
exacerbations of chronic obstructive pulmonary disease
Carol Davies, Nawar Diar-Bakerly1, Matthew Dyer2, Paul Dhillon1
1UHCW,
Background
Clifford Bridge Road, Coventry CV2 2DX 2Brunel University, Uxbridge, Middlesex UB8 3PH
Printing a copy to check for errors
Chronic Obstructive Pulmonary Disease (COPD) affects
900,000 individuals in the UK & the economic burden is
increasing (NCCCC 2004) An estimated NHS direct
health care cost is > £800 million, over half due to inpatient hospital stay (DoH 2005).
Early supported discharge models have been popular in
the UK to reduce length of hospital stay& costs and, to
some extent, reducing total number of acute admissions
of COPD (Cotton 2000, Quatril 2007) Early supported
discharge is safe & can be achieved in ~25% of patients
(Ram 2004). However, there are many varied service
delivery models in the UK.
The national COPD audit in 2003 (Price 2006) revealed
t44% of participating acute trusts had some form of early
supported discharge with a three month readmission rate
of 31.4% similar to previous studies (Swarska 2000,
Hernandez 2003).
However, there was little evidence of the financial impact
of these schemes & whether they provide cheaper
alternatives to hospital admission. This research study
includes cost & resource use data.
Poster Basics – Poster Layout
COPD
team
Aim
To compare two models of care for COPD, early discharge supported home
nursing care vs hospital admission
Objectives
To compare resource use and cost of prospective Acute COPD Assessment
Service (ACAS) supported care with retrospective cohort of hospital only
treatment
Methods
A prospective cohort study in Coventry August 2007 - July 2008
Prospective cohort
Offered ACAS home support or ACAS supported hospital admission
ACAS: 3 full time specialist respiratory nurses (7 days/week 9am-5pm))
1 dedicated middle grade physician (0.4 whole time equivalent)
ACAS inclusion criteria:
COPD diagnosis & acute exacerbation per the BTS COPD guidelines 1997
Decision to admit Hospital Modified Early Warning Score (MEWS) <3
Patients with previous COPD admissions directly/GP referred
Exclusion criteria:
Unable to socially sustain discharge
If patient fit for home management without support of ACAS.
If ACAS referral after day 10 of hospital stay
Acidotic exacerbation COPD requiring NIV / ITU
MEWSr=> 3
Retrospective cohort
Matched for age, gender, and post code from previous 12 months admissions to hospital.
Costs
Cost minimisation analysis - National Health Service (NHS) 2007 perspective
HRG tariff
Results
Results
Differences between prospective & retrospective
groups
No significant differences ethnicity, FEV1, O2
presentation saturation, admissions 2 months before &
after index episode, number of current smoker slightly
higher in the retrospective group
Average length of stay & number of visits
ACAS 3.3 days (SD3.9) vs hospital 10.4 days (SD7.7)
Average number ACAS visits per patient 3.08 (SD=0.95;
95% CI= 2.9- 3.2)
Cost per patient
ACAS £1,653 (95% CI; £1,521 to £1,802)
Hospital £2,256 (95% CI; £2,126 to £2,407)
Recruitment
Total screened n= 546
Excluded/ no consent n=416 (76%) Consent n=130 (24%)
Prospective integrated care model
Received ACAS support at home n=107/130 (82%)
[55 identified 1st assessment & 52 identified later]
Received ACAS support in hospital n=23/130 (18%)
Early re-admission from home to hospital with ACAS n=6/107 (6%)
2 months hospital readmission n=28/130 (22%)
Out-patient f/u @10 weeks n=104/130 (80%)
15/130 (12%) in hospital, 2/130 (1%) lost to follow up & 9/130 (7%) deceased
Retrospective hospital cohort (n=95)
2 months readmission 28/95 (29%)
Cost saving Approx. £600 per patient (p<0.001)
Reference N Diar Bakerly, CL Davies, M Dyer, DP Dhillon submitted Chronic Respiratory Disease
Journal October 2008 Cost analysis of an integrated care model in the management of acute
exacerbations of chronic obstructive pulmonary disease (COPD)
POSTER TEMPL ATE BY:
Contact details Carol.Davies@warwick.ac.uk WMS
www.PosterPresentations.co
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