Where are we now?COPD predicted to rise from 12th to 5th most burdensome global disease from 1990 to 2020 Total UK COPD expenditure (1996/97) £817.5 million Inpatient cost of exacerbations £243.4 million Cost of one admission £3000
Relevance of HaH to national strategiesChronic disease management Acute medical admissions (trolley waits) Community care
StakeholdersCOPD patients GPs Liaison nurses/physiotherapists A&E departments
Type of serviceAdmission avoidance (AA), high staffing levels, suitable for busy inner city hospital Early supported discharge (ESD), lower staffing level, suitable for moderate-sized DGH Combined AA and ESD best model but expensive Direct referral from primary care not recommended because of excess inappropriate referrals
Predicted activity (work load)30–35% of COPD patients who present for hospital admission
Effect on bed daysReduction in length of stay from 7 to 4 days (2nd UK COPD audit)
Team composition (5 day service):large DGHLead – consultant respiratory physician Trainee middle-grade doctors (rotating) Liaison nurses/physiotherapists 2.5 WTE (increasing to 3.5 WTE for 7 day service)
Start-up (non-recurring) costs (catchment area of 300 000)Computers, printers, database software, office equipment: £5000 Portable oximeters: £2500 Electronic sphygmomanometers: £750 Electronic thermometers: £1000 Handheld spirometers: £1500
Recurring costsSalaries Pharmacy Uniforms Travel expenses, petrol/car leasing Mobile phone line rental Audit Training courses Data collection