Impact of integrated respiratory services on chronic obstructive pulmonary disease hospital admissions: An interrupted time series analysis

Objective
To investigate the effects of an admission avoidance (AA) pathway within a new integrated respiratory service on the number of COPD-related hospital admissions in England.

Methods
We used interrupted time series analysis to estimate the effects of the AA pathway on COPD hospital admissions, length of stay, and 30-day readmissions. We included all unplanned admissions with COPD as primary diagnosis using Hospital Episode Statistics, comparing the intervention region with a demographically similar control region in the two years before and one year after the implementation of the new service.

Results
Unplanned hospital admissions for COPD exacerbations followed a clear seasonal pattern, peaking in early winter. We found no evidence that the AA pathway influenced the rate of hospital admissions or 30-day readmissions. We found weak evidence of a trend change in length of stay following the launch of the AA pathway.

Conclusion
Our study adds to the growing body of evidence that suggests that additional AA capacity alone does not lead to a measurable reduction in admissions or length of stay. Further investigation is required to understand the reasons why. A longer follow-up may be required to see some of the potential benefits.