title: Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates.
abstract: BACKGROUND
  COPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing.
  
  
  OBJECTIVE
  The aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD.
  
  
  METHODS
  We retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90 days. We compared numbers, rates, and intervals of readmission and LOS during 2 years of active program delivery compared to 1 year prior to program implementation.
  
  
  RESULTS
  A total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3 years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all causes showed a significant decline, with hazard ratios (HRs) of 0.55 (year 1) and 0.51 (year 2) of intervention (P<0.001). In addition, patients' mean LOS (days) for COPD-related admissions declined significantly from 10.8 to 6.8 (P<0.05).
  
  
  CONCLUSIONS
  A comprehensive disease management program for COPD patients, including education, case management, and follow-up, was associated with significant reduction in hospital admissions and LOS.
authors.affiliation: Department of Experimental Medicine, University of British Columbia.
authors.forename: Abdulmajeed
authors.initials: A
authors.lastname: Alshabanat
authors.affiliation: British Columbia Centre for Disease Control; School of Population and Public Health.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Otterstatter
authors.affiliation: Department of Medicine, Centre for Heart Lung Innovation, St Paul's Hospital; Division of Respirology, Department of Medicine.
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.affiliation: Division of Respirology, Department of Medicine; Department of Medicine, Faculty of Medicine, Institute for Heart and Lung Health, University of British Columbia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Road
authors.affiliation: Department of Medicine, Faculty of Medicine, Institute for Heart and Lung Health, University of British Columbia.
authors.forename: Carmen
authors.initials: C
authors.lastname: Rempel
authors.affiliation: Department of Medicine, Faculty of Medicine, Institute for Heart and Lung Health, University of British Columbia.
authors.forename: Jane
authors.initials: J
authors.lastname: Burns
authors.affiliation: Department of Medicine, Centre for Heart Lung Innovation, St Paul's Hospital; Division of Respirology, Department of Medicine.
authors.forename: Stephan F
authors.initials: SF
authors.lastname: van Eeden
authors.affiliation: Division of Respirology, Department of Medicine; Department of Medicine, Faculty of Medicine, Institute for Heart and Lung Health, University of British Columbia; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, BC, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: FitzGerald
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning / Q000458:organization & administration*; D010359:Patient Readmission; D015397:Program Evaluation; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: CCP; COPD; admission; length of stay; readmission