Dataset Information

Impact of a COPD discharge care bundle on readmissions following admission with acute exacerbation: interrupted time series analysis.

ABSTRACT:

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.

SUBMITTER: Laverty AA

PROVIDER: S-EPMC4332682 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Publications

Impact of a COPD discharge care bundle on readmissions following admission with acute exacerbation: interrupted time series analysis.

Laverty Anthony A AA Elkin Sarah L SL Watt Hilary C HC Millett Christopher C Restrick Louise J LJ Williams Sian S Bell Derek D Hopkinson Nicholas S NS

PloS one 20150213 2

<h4>Objectives</h4>We evaluated the impact of a COPD discharge care bundle on readmission rates following hospitalisation with an acute exacerbation.<h4>Design</h4>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 ...[more]

PMID: 25679218

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Project description:ObjectivePatient handovers are often delayed, patients are hardly involved in their discharge process and hospital-wide standardised discharge procedures are lacking. The aim of this study was to implement a structured discharge bundle and to test the effect on timeliness of medical and nursing handovers, length of hospital stay (LOS) and unplanned readmissions.DesignInterrupted time series with six preintervention and six postintervention data collection points (September 2015 to June 2017).SettingInternal medicine and surgical wards PARTICIPANTS: Patients (≥18 years) admitted for more than 48 hours to surgical or internal medicine wards.InterventionThe Transfer Intervention Procedure (TIP), containing four elements: planning the discharge date within 48 hours postadmission; arrangements for postdischarge care; preparing handovers and personalised patient discharge letter; and a discharge conversation 12-24 hours before discharge.Outcome measuresThe number of medical and nursing handovers sent within 24 hours. Secondary outcomes were median time between discharge and medical handovers, LOS and unplanned readmissions.ResultsPreintervention 1039 and postintervention 1052 patient records were reviewed. No significant change was observed in the number of medical and nursing handovers sent within 24 hours. The median (IQR) time between discharge and medical handovers decreased from 6.15 (0.96-15.96) to 4.08 (0.33-13.67) days, but no significant difference was found. No intervention effect was observed for LOS and readmission. In subgroup analyses, a reduction of 5.6 days in the median time between discharge and medical handovers was observed in hospitals with high protocol adherence and much attention for implementation.ConclusionImplementation of a structured discharge bundle did not lead to improved timeliness of patient handovers. However, large interhospital variation was observed and an intervention effect on the median time between discharge and medical handovers was seen in hospitals with high protocol adherence. Future interventions should continue to create awareness of the importance of timely handovers.Trial registration numberNTR5951; Results.

Project description:BackgroundHospital readmission rates decreased for myocardial infarction (AMI), heart failure (CHF), and pneumonia with implementation of the first phase of the Hospital Readmissions Reduction Program (HRRP). It is not established whether readmissions fell for chronic obstructive pulmonary disease (COPD), an HRRP condition added in 2014.ObjectiveWe sought to determine whether HRRP penalties influenced COPD readmissions among Medicare, Medicaid, or privately insured patients.DesignWe analyzed a retrospective cohort, evaluating readmissions across implementation periods for HRRP penalties ("pre-HRRP" January 2010-April 2011, "implementation" May 2011-September 2012, "partial penalty" October 2012-September 2014, and "full penalty" October 2014-December 2016).PatientsWe assessed discharged patients ≥ 40 years old with COPD versus those with HRRP Phase 1 conditions (AMI, CHF, and pneumonia) or non-HRRP residual diagnoses in the Nationwide Readmissions Database.InterventionsHRRP was announced and implemented during this period, forming a natural experiment.MeasurementsWe calculated differences-in-differences (DID) for 30-day COPD versus HRRP Phase 1 and non-HRRP readmissions.Key resultsCOPD discharges for 1.2 million Medicare enrollees were compared with 22 million non-HRRP and 3.4 million HRRP Phase 1 discharges. COPD readmissions decreased from 19 to 17% over the study. This reduction was significantly greater than non-HRRP conditions (DID - 0.41%), but not HRRP Phase 1 (DID + 0.02%). A parallel trend was observed in the privately insured, with significant reduction compared with non-HRRP (DID - 0.83%), but not HRRP Phase 1 conditions (DID - 0.45%). Non-significant reductions occurred in Medicaid (DID - 0.52% vs. non-HRRP and - 0.21% vs. Phase 1 conditions).ConclusionsIn Medicare, HRRP implementation was associated with reductions in COPD readmissions compared with non-HRRP controls but not versus other HRRP conditions. Parallel findings were observed in commercial insurance, but not in Medicaid. Condition-specific penalties may not reduce readmissions further than existing HRRP trends.

Dataset Information

Impact of a COPD discharge care bundle on readmissions following admission with acute exacerbation: interrupted time series analysis.

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

Impact of a COPD discharge care bundle on readmissions following admission with acute exacerbation: interrupted time series analysis.

Similar Datasets

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