A national multidimensional integrated approach to care improves COPD-related healthcare utilisation

Background: Chronic Obstructive Pulmonary Disease (COPD) is the most common chronic respiratory condition, associated with multi-morbidity and high healthcare utilisation. In 2022, a new integrated model of COPD care was implemented in Ireland which included the establishment of specialist community care hubs linked to acute hospitals. The model supports the delivery of COPD care across 7 core domains: GP-led chronic disease management, community specialist nursing and physiotherapy care, community specialist consultant care, COPD outreach supported discharge, pulmonary rehabilitation, direct GP-access diagnostics, and specialist acute COPD care.

 

Approach: We examined the impact of the provision of the complete multi-domain COPD model of care (MOC) on COPD outcomes. Limitations in the recruitment and funding has led to variation in MOC delivery nationwide. Changes in COPD hospitalisation and 90-day readmission between 2024 and 2018 (pre-COVID) were compared between the 12 sites delivering the complete MOC and 15 sites delivering a partial MOC. Data from the national Hospital In-Patient Enquiry database was examined, and included all hospital admissions in this period coded as primary diagnosis of COPD in adults.

 

Results: COPD hospitalisation rate in 2018 was comparable across both groups, however in 2024 COPD hospitalisation rate was lower in complete MOC sites (147/100 000 population) vs partial MOC sites (167 per 100 000 population). Complete MOC sites had a median reduction in COPD hospitalisations between 2024 and 2018 of 11% vs. increase of 8% at partial MOC sites, p<0.05. An estimated 1064 hospital admissions have been avoided in 2024 at complete MOC sites.

COPD readmission in 90-days reduced by 3.5% in complete MOC sites vs increase of 2% in partial MOC sites, p<0.05.

 

Further analysis identified the presence of integrated consultant leadership, GP access to diagnostics, and a supported discharge COPD outreach service, as discriminatory factors driving improvements in COPD-related healthcare use. In particular expansion of COPD outreach services has doubled same-day admission avoidance activity. Sites with a fully resourced COPD outreach service have experienced an 11% reduction in COPD hospitalisation vs 10-20% increase at sites with partial or no COPD outreach service, p<0.05. An 8% difference in 90-day readmission rate was seen between sites offering COPD Outreach (-3%) vs. those who do not have access to COPD Outreach (+5.5%), p<0.05.

 

Implication; An integrated approach to COPD care improves COPD-related hospitalisation and readmission rates. Improvements are greater where dedicated integrated clinical leadership, GP access diagnostics, and adequately staffed home support services are available. Improving chronic disease care requires a multidimensional, multidisciplinary approach which covers the spectrum of disease across acute, primary care and community interfaces.