title: Integrated multidisciplinary community service for chronic obstructive pulmonary disease reduces hospitalisations.
abstract: BACKGROUND
  Hospitalisations for chronic obstructive pulmonary disease (COPD) exacerbation affect patient outcomes and healthcare costs. The long-term impact of an integrated COPD disease-management approach on hospitalisation remains controversial.
  
  
  OBJECTIVE
  The aim of this study was to evaluate whether a multidisciplinary community service reduces respiratory hospitalisations for COPD patients.
  
  
  METHODS
  A total of 346 patients was followed for a mean duration of 27.3 months. The number of admissions, total bed days for respiratory (COPD exacerbation or pneumonia) or general medical causes and length of stay (LOS) per respiratory admission was compared before and after referral with the service. A secondary multivariate analysis examined which clinical parameters best predict benefit from such service.
  
  
  RESULTS
  The total respiratory admission and hospital bed days after referral were reduced by 31% (288 vs 417, P < 0.001) and 40.4% (1637 vs 2746, P < 0.0001) respectively, compared with the equivalent duration prior. The average LOS for each respiratory admission was also significantly reduced after referral (6.61 vs 5.70, P = 0.02). Overall, 55% patients experienced a reduction in admission frequency and hospital days. The impact on admission frequency and hospital days was the greatest in those with an at least moderate disease (GOLD ≥2, odds ratio (OR): 3.2, 95% confidence interval (CI): 1.2, 8.9; P = 0.019) and those who completed pulmonary rehabilitation (PR) (OR: 1.7, 95% CI: 1.1, 2.8; P = 0.04). In contrast, general medical admissions increased, one-third attributable to a cardiovascular cause both before and after referral.
  
  
  CONCLUSIONS
  The implementation of COPD multidisciplinary community service was associated with reduced respiratory hospitalisations in the long term. Patients with moderate or severe disease and who are able to complete PR are much more likely to benefit.
authors.affiliation: Department of Respiratory and Sleep Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: L P
authors.initials: LP
authors.lastname: Chung
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.|School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: F
authors.initials: F
authors.lastname: Lake
authors.affiliation: Department of Respiratory and Sleep Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Hyde
authors.affiliation: Department of Physiotherapy, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: C
authors.initials: C
authors.lastname: McCamley
authors.affiliation: Department of Respiratory and Sleep Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Phuangmalai
authors.affiliation: Department of Respiratory and Sleep Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Lim
authors.affiliation: Department of Respiratory and Sleep Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Medicine and Pharmacology, Royal Perth Hospital, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Waterer
authors.affiliation: Department of Respiratory and Sleep Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Q
authors.initials: Q
authors.lastname: Summers
authors.affiliation: Department of Respiratory and Sleep Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Medicine and Pharmacology, Royal Perth Hospital, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Y
authors.initials: Y
authors.lastname: Moodley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods / Q000639:trends; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000628:therapy*; D012946:Social Welfare / Q000639:trends*
keywords: COPD; community; exacerbations; hospitalisations; multidisciplinary; pneumonia