In response to high mortality rates, high numbers of COPD admissions, poor quality of care and a lack of integration of services for people with COPD, City and Hackney Primary Care Trust tendered the provision of an acute- and community-based COPD service from Homerton University Hospital in 2009 (the Acute COPD Early Response Service: ACERS).
We studied the impact of ACERS on outcomes for COPD patients in City and Hackney including patient CAT scores, healthcare usage (admissions, length of stay and bed days) and place of death, from 2010 to 2015.
We found a decrease in COPD admissions (from 1.38 admissions per 1000 population to 1.24 per 1000 population) following the establishment of the ACERS service (compared to an increase seen nationally over this time) and a significant reduction in the number of bed days for COPD patients – from 1,817 per year to 1,200 per year (Mann Whitney U test Z-Score 3.6607, p < 0.05). This was alongside a significant increase in patients staying less than 2 days in hospital – from 27% to 34% (significant at p < 0.0001) reflecting the effect of the service on early discharge. We also found a significant increase in the number of patients dying outside of hospital (a proxy for quality of end of life care as most patients express wishes to be cared for and die in their own home or a hospice). The percentage of City and Hackney COPD patients dying outside of hospital increased from 24% to 42% following introduction of ACERS (p = 0.00015). Patient satisfaction with the service was high and patients saw a clinically significant improvement in CAT scores (from 24 to 20, n = 69) following intervention by the ACERS team.
This data was used in a locally developed economic model to determine the economic benefits of the ACERS team and whether therefore, when comparing to the cost of the service, this service was cost-saving overall. The model found that the impact on place of death and healthcare usage meant that ACERS had net monetary benefits to commissioners.
We conclude that an exemplar integrated COPD service can provide financial and other benefits to commissioners which equate to a cost saving service with high return on initial investment. ACERS has been expanded from its original remit to now include management of patients with asthma and bronchiectasis.
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