Measuring the impact of a Chronic Obstructive Pulmonary Disease Community Respiratory Programme on emergency admissions to hospital: A controlled interrupted time series analysis

Abstract

Background: A community respiratory service was implemented in the North West of Glasgow (NW) in January 2013, as part of the Reshaping Care for Older People programme (RCOP). This study aimed to measure the impact of the service on older people's emergency admissions (EAs) to hospital. Methods: EAs to hospital with a primary diagnosis of COPD (COPD EAs) per 1,000 population aged 65 years+ in NW were compared before and after onset of the service with a 6-month phase-in period, using segmented linear regression. South and North East Glasgow (S + NE) was the control-an area with no such service in place. The model adjusted for the rate of all-cause EAs to control for the impact of other localised RCOPP initiatives. Autoregressive terms and a Fourier term to adjust for seasonality were included in the model. Results: Prior to implementation of the respiratory service, increases in COPD EAs over time were evident in NW. Adjusting for changes in COPD EAs in NE + S, an additional reduction of-0.04 (-0.03,-0.05) per 1,000 population per month was observed in NW following the phase-in, so that by March 2015, the predicted reduction due to the respiratory service was-0.85 COPD EAs per 1,000 population, a relative reduction of 34.3%. No significant changes in admissions with COPD as a secondary diagnosis (COPD5 EAs) were observed, suggesting that the intervention had no impact on these. Conclusions: The community respiratory service was associated with a significant reduction in the rate of COPD EAs among older people and no change in COPD5 EAs.