Reducing the Number of Hospitalization Days for COPD: Setting up a Transmural-Care Pathway

Int J Chron Obstruct Pulmon Dis. 2020 Sep 30:15:2367-2377. doi: 10.2147/COPD.S242914. eCollection 2020.

Abstract

Background: Many patients with chronic obstructive pulmonary disease (COPD) experience exacerbations of symptoms, leading to a large burden on patients and the health system and costs to society. To address this burden, a 25% reduction in number of hospitalization days for COPD exacerbations was recently declared a national goal in the Netherlands, to be achieved in 5 years.

Methods: A national care pathway was designed following an established managed clinical pathway setup, which involved prior national surveys and the identification of ten key elements. The concept was discussed, made locally applicable, and finally tested in eight regions containing eleven hospitals and surrounding primary-care groups in a prospective cohort study. All patients were followed for 1 year, starting at hospitalization.

Results: In total, 752 patients gave informed consent and participated (mean age 70 years, 58% female). Of these, 120 (16%) died within a year. The median length of index hospitalization was 5 days, and 43% had at least one rehospitalization within 1 year (range 0-8). There was a 19.4% reduction in number of total hospitalization days, without a decrease in health-related quality of life or perceived quality of care. Elements that contributed significantly to the reduction were contact in the first week after hospitalization, and during the year of follow-up pharmacological and nonpharmacological smoking-cessation guidance, checks on inhalation technique, and discussion of lung-attack plan.

Discussion: With concerted action between patients and health workers in the hospital and in the community, a large reduction in number of hospitalization days can be achieved. The program was quite demanding for both patients and health workers. In our subsequent national implementation plan after this pilot study, we have named the major contributors to success and advocate the stepwise introduction of the elements in light of feasibility.

Keywords: COPD; National Action Program; hospitalization; managed-care pathway.

MeSH terms

  • Aged
  • Female
  • Hospitalization
  • Humans
  • Male
  • Netherlands
  • Pilot Projects
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive* / diagnosis
  • Pulmonary Disease, Chronic Obstructive* / therapy
  • Quality of Life*

Grants and funding

Partial funding for this study was received from the Dutch Innovation Funds (Innovatie Fonds), Dutch Ministry of Health, Welfare, and Sport, Lung Alliance Netherlands Support Fund, and Dutch Lung Fund. Additional funding in kind and/or cash was received from the participating hospitals and regional general practitioner organisations: Slotervaart Hospital and& Regionale Organisatie Huisartsen Amsterdam, Amsterdam; Rijnstate Hospital and Onze Huisartsen, Arnhem; Haaglanden Medical Center, Hagaziekenhuis and Hadoks, Arts en Zorg, SHG, the Hague; Maastricht University Medical Center and Zorg in Ontwikkeling, Maastricht; Ommelanden Zorg Groep Hospital and Stichting Eerstelijnszorg Appingedam and Groninger Huisartsen Coöperatie, Scheemda, Groningen; Franciscus Gasthuis and Integrale Zorggroep Eerstelijn Rijnmond, Rotterdam; Bravis Hospital and Zorggroep West-Brabant, Roosendaal and Bergen op Zoom; and Dijklander Hospital, Purmerend, Zaans Medical Center, Zaandam, all located in the Netherlands.