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S131 USE OF PROPORTION OF PATIENTS WITH COPD ADMITTED UNDER A RESPIRATORY SPECIALIST AS A MARKER OF COPD CARE
E. Thompson, P. P. Walker, G. Tack, H. Crone, G. Flatt, M. G. Pearson. Aintree Health Outcomes Partnership, University of Liverpool, Liverpool, UK
Patients with a chronic obstructive pulmonary disease (COPD) exacerbation are more likely to have blood gases recorded, receive corticosteroids and/or non-invasive ventilation (NIV), and access early discharge schemes if managed by specialists rather than generalists (Connolly, Thorax 2006). The 2008 National UK COPD Audit shows patients prefer to be cared for by a specialist. Hence, delivery of acute COPD care by a respiratory specialist presents a potentially important, measurable proxy of outcome.
Hospital Episode Statistics (HES) data detail every COPD hospital admission and record a variety of related outcomes. Separately we have created a database of GMC numbers of 821 respiratory specialists (missing only 5 from the BTS workforce book) and matched this to HES. From this we calculated the percentage of admissions under respiratory specialist care for 149 English Trusts during 2006–7 and 2007–8. We went on to examine the potential of this to represent an indicator of quality of care.
In 2006–7, 51 107 out of 128 184 (40%) COPD admissions were discharged from respiratory specialists. The total for 2007–8 was 49 114/126 695 (39%). Comparing Trusts, there existed a wide variation in the percentage of patients admitted under a respiratory specialist—2006–7 median 38.6% (interquartile range (IQR) 28.8–49%); 2007–8 median 37.2% (IQR 29.5–48.4%)—allowing considerable room for improvement. This percentage for each Trust varied little between years (r = 0.84; p<0.001)—shown in fig 1—probably reflecting the organisation of the acute “take”. However, there was no relationship between specialist care and either annual number of admissions per Trust, mean length of stay or 30-day mortality, these …