title: Study protocol for an evaluation of the effectiveness of 'care bundles' as a means of improving hospital care and reducing hospital readmission for patients with chronic obstructive pulmonary disease (COPD).
abstract: BACKGROUND
  Chronic Obstructive Pulmonary Disease is one of the commonest respiratory diseases in the United Kingdom, accounting for 10% of unplanned hospital admissions each year. Nearly a third of these admitted patients are re-admitted to hospital within 28 days of discharge. Whilst there is a move within the NHS to ensure that people with long-term conditions receive more co-ordinated care, there is little research evidence to support an optimum approach to this in COPD. This study aims to evaluate the effectiveness of introducing standardised packages of care i.e. care bundles, for patients with acute exacerbations of COPD as a means of improving hospital care and reducing re-admissions.
  
  
  METHODS
  This mixed-methods evaluation will use a controlled before-and-after design to examine the effect of, and costs associated with, implementing care bundles for patients admitted to hospital with an acute exacerbation of COPD, compared with usual care. It will quantitatively measure a range of patient and organisational outcomes for two groups of hospitals - those who deliver care using COPD care bundles, and those who deliver care without the use of COPD care bundles. These care bundles may be provided for patients with COPD following admission, prior to discharge or at both points in the care pathway. The primary outcome will be re-admission to hospital within 28 days of discharge, although the study will additionally investigate a number of secondary outcomes including length of stay, total bed days, in-hospital mortality, costs of care and patient / carer experience. A series of nested qualitative case studies will explore in detail the context and process of care as well as the impact of COPD bundles on staff, patients and carers.
  
  
  CONCLUSIONS
  The results of the study will provide information about the effectiveness of care bundles as a way of managing in-hospital care for patients with an acute exacerbation of COPD. Given the number of unplanned hospital admissions for this patient group and their rate of subsequent re-admission, it is hoped that this evaluation will make a timely contribution to the evidence on care provision, to the benefit of patients, clinicians, managers and policy-makers.
  
  
  BACKGROUND
  International Standard Randomised Controlled Trials - ISRCTN13022442 - 11 February 2015.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. melanie.chalder@bristol.ac.uk.
authors.forename: M J E
authors.initials: MJ
authors.lastname: Chalder
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. caroline.wright@bristol.ac.uk.
authors.forename: C L
authors.initials: CL
authors.lastname: Wright
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. k.morton@bristol.ac.uk.
authors.forename: K J P
authors.initials: KJ
authors.lastname: Morton
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. padraig.dixon@bristol.ac.uk.
authors.forename: P
authors.initials: P
authors.lastname: Dixon
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. anne.daykin@bristol.ac.uk.
authors.forename: A R
authors.initials: AR
authors.lastname: Daykin
authors.affiliation: Sue Jenkins Consulting, Taunton, UK. sue@suejenkins.biz.
authors.forename: S
authors.initials: S
authors.lastname: Jenkins
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK. jonathan.benger@uwe.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: Benger
authors.affiliation: Southmead Hospital, North Bristol NHS Trust, Bristol, UK. james.calvert@nbt.nhs.uk.
authors.forename: J
authors.initials: J
authors.lastname: Calvert
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. ali.heawood@bristol.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Shaw
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. chris.metcalfe@bristol.ac.uk.|Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK. chris.metcalfe@bristol.ac.uk.
authors.forename: C
authors.initials: C
authors.lastname: Metcalfe
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. william.hollingworth@bristol.ac.uk.
authors.forename: W
authors.initials: W
authors.lastname: Hollingworth
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. sarah.purdy@bristol.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Purdy
mesh_terms: D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D019468:Disease Management; D004739:England; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D064872:Patient Care Bundles / Q000191:economics / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D036301:Qualitative Research; D058996:Quality Improvement; D013222:State Medicine; D016896:Treatment Outcome; D014852:Wales