Commissioning for COPD care: a new, recordable metric that supports the patient interest.
Healthcare metrics have been used to drive improvement in outcome and delivery in UK hospital stroke and cardiac care. This model is attractive for chronic obstructive pulmonary disease (COPD) care because of disease frequency and the burden it places on primary, secondary and integrated care services.



Using 'hospital episode statistics' (UK 'coding'), we examined hospital 'bed days/1000 population' in 150 UK Primary Care Trusts (PCTs) during 2006-07 and 2007-08. Data were adjusted for COPD prevalence. We looked at year-on-year consistency and factors which influenced variation.



There were 248 996 COPD admissions during 2006-08. 'Bed days/1000 PCT population' was consistent between years (r = 0.87; P < 0.001). There was a >2-fold difference in bed days between the best and worst performing PCTs which was primarily a consequence of variation in emergency admission rate (P < 0.001) and proportion of emergency admissions due to COPD (P < 0.001) and to only a lesser extent length of hospital stay (P < 0.001).



Bed days/1000 population appears a useful annual metric of COPD care quality. Good COPD care keeps patients active and out of hospital and requires co-ordinated action from both hospital and community services, with an important role for integrated care. This metric demonstrates that current care is highly variable and offers a measurable target to commission against.
Aintree Health Outcomes Partnership, University of Liverpool, University Hospital Aintree, Clinical Science Building, Lower Lane, Liverpool L9 7AL, UK.
Paul Phillip
PP
Walker
Aintree Health Outcomes Partnership, University of Liverpool, University Hospital Aintree, Clinical Science Building, Lower Lane, Liverpool L9 7AL, UK.
E
E
Thompson
Department of Health, Wellington House, Waterloo Road, London, UK.
S L
SL
Hill
Department of Health, Wellington House, Waterloo Road, London, UK.
K
K
Holton
Aintree Health Outcomes Partnership, University of Liverpool, University Hospital Aintree, Clinical Science Building, Lower Lane, Liverpool L9 7AL, UK.
K
K
Bodger
Aintree Health Outcomes Partnership, University of Liverpool, University Hospital Aintree, Clinical Science Building, Lower Lane, Liverpool L9 7AL, UK.
M G
MG
Pearson
D000368:Aged; D000704:Analysis of Variance; D005260:Female; D054625:Healthcare Disparities; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000628:therapy*; D011787:Quality of Health Care; D013222:State Medicine; D006113:United Kingdom / Q000453:epidemiology
emergency care; health services; respiratory disorders