Mapping inpatient care pathways for patients with COPD: an observational study using routinely collected electronic hospital record data

Felicity Evison; Rachel Cooper; Suzy Gallier; Paolo Missier; Avan A Sayer; Elizabeth Sapey; Miles D. Witham

doi:10.1183/23120541.00110-2023

Mapping inpatient care pathways for patients with COPD: an observational study using routinely collected electronic hospital record data

Felicity Evison, Rachel Cooper, Suzy Gallier, Paolo Missier, Avan A Sayer, Elizabeth Sapey, Miles D. Witham^*

^*Corresponding author for this work

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Abstract

INTRODUCTION: Respiratory specialist ward care is associated with better outcomes for patients with COPD exacerbations. We assessed patient pathways and associated factors for people admitted to hospital with COPD exacerbations.

METHODS: We analysed routinely collected electronic health data for patients admitted with COPD exacerbation in 2018 to Queen Elizabeth Hospital, Birmingham, UK. We extracted data on demographics, deprivation index, Elixhauser comorbidities, ward moves, length of stay, and in-hospital and 1-year mortality. We compared care pathways with recommended care pathways (transition from initial assessment area to respiratory wards or discharge). We used Markov state transition models to derive probabilities of following recommended pathways for patient subgroups.

RESULTS: Of 42 555 patients with unplanned admissions during 2018, 571 patients were admitted at least once with an exacerbation of COPD. The mean±sd age was 51±11 years; 313 (55%) were women, 337 (59%) lived in the most deprived neighbourhoods and 45 (9%) were from non-white ethnic backgrounds. 428 (75.0%) had ≥4 comorbidities. Age >70 years was associated with higher in-hospital and 1-year mortality, more places of care (wards) and longer length of stay; having ≥4 comorbidities was associated with higher mortality and longer length of stay. Older age was associated with a significantly lower probability of following a recommended pathway (>70 years: 0.514, 95% CI 0.458-0.571; ≤70 years: 0.636, 95% CI 0.572-0.696; p=0.004).

CONCLUSIONS: Only older age was associated with a lower chance of following recommended hospital pathways of care. Such analyses could help refine appropriate care pathways for patients with COPD exacerbations.

Original language	English
Article number	00110-2023
Number of pages	10
Journal	ERJ Open Research
Volume	9
Issue number	5
DOIs	https://doi.org/10.1183/23120541.00110-2023
Publication status	Published - 16 Oct 2023

Bibliographical note

Acknowledgments:
This work used data provided by patients and collected by the NHS as part of their care and support. M.D. Witham, R. Cooper and A.A. Sayer acknowledge support from the National Institute for Health and Care Research Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. E. Sapey acknowledges funding from the UK Medical Research Council and Health Data Research UK to support the PIONEER programme.

Copyright:
©The authors 2023.

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Cite this

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title = "Mapping inpatient care pathways for patients with COPD: an observational study using routinely collected electronic hospital record data",

abstract = "INTRODUCTION: Respiratory specialist ward care is associated with better outcomes for patients with COPD exacerbations. We assessed patient pathways and associated factors for people admitted to hospital with COPD exacerbations.METHODS: We analysed routinely collected electronic health data for patients admitted with COPD exacerbation in 2018 to Queen Elizabeth Hospital, Birmingham, UK. We extracted data on demographics, deprivation index, Elixhauser comorbidities, ward moves, length of stay, and in-hospital and 1-year mortality. We compared care pathways with recommended care pathways (transition from initial assessment area to respiratory wards or discharge). We used Markov state transition models to derive probabilities of following recommended pathways for patient subgroups.RESULTS: Of 42 555 patients with unplanned admissions during 2018, 571 patients were admitted at least once with an exacerbation of COPD. The mean±sd age was 51±11 years; 313 (55%) were women, 337 (59%) lived in the most deprived neighbourhoods and 45 (9%) were from non-white ethnic backgrounds. 428 (75.0%) had ≥4 comorbidities. Age >70 years was associated with higher in-hospital and 1-year mortality, more places of care (wards) and longer length of stay; having ≥4 comorbidities was associated with higher mortality and longer length of stay. Older age was associated with a significantly lower probability of following a recommended pathway (>70 years: 0.514, 95% CI 0.458-0.571; ≤70 years: 0.636, 95% CI 0.572-0.696; p=0.004).CONCLUSIONS: Only older age was associated with a lower chance of following recommended hospital pathways of care. Such analyses could help refine appropriate care pathways for patients with COPD exacerbations.",

author = "Felicity Evison and Rachel Cooper and Suzy Gallier and Paolo Missier and Sayer, {Avan A} and Elizabeth Sapey and Witham, {Miles D.}",

note = "Acknowledgments: This work used data provided by patients and collected by the NHS as part of their care and support. M.D. Witham, R. Cooper and A.A. Sayer acknowledge support from the National Institute for Health and Care Research Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. E. Sapey acknowledges funding from the UK Medical Research Council and Health Data Research UK to support the PIONEER programme. Copyright: {\textcopyright}The authors 2023.",

year = "2023",

month = oct,

day = "16",

doi = "10.1183/23120541.00110-2023",

language = "English",

volume = "9",

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T1 - Mapping inpatient care pathways for patients with COPD

T2 - an observational study using routinely collected electronic hospital record data

AU - Evison, Felicity

AU - Cooper, Rachel

AU - Gallier, Suzy

AU - Missier, Paolo

AU - Sayer, Avan A

AU - Sapey, Elizabeth

AU - Witham, Miles D.

N1 - Acknowledgments: This work used data provided by patients and collected by the NHS as part of their care and support. M.D. Witham, R. Cooper and A.A. Sayer acknowledge support from the National Institute for Health and Care Research Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. E. Sapey acknowledges funding from the UK Medical Research Council and Health Data Research UK to support the PIONEER programme. Copyright: ©The authors 2023.

PY - 2023/10/16

Y1 - 2023/10/16

N2 - INTRODUCTION: Respiratory specialist ward care is associated with better outcomes for patients with COPD exacerbations. We assessed patient pathways and associated factors for people admitted to hospital with COPD exacerbations.METHODS: We analysed routinely collected electronic health data for patients admitted with COPD exacerbation in 2018 to Queen Elizabeth Hospital, Birmingham, UK. We extracted data on demographics, deprivation index, Elixhauser comorbidities, ward moves, length of stay, and in-hospital and 1-year mortality. We compared care pathways with recommended care pathways (transition from initial assessment area to respiratory wards or discharge). We used Markov state transition models to derive probabilities of following recommended pathways for patient subgroups.RESULTS: Of 42 555 patients with unplanned admissions during 2018, 571 patients were admitted at least once with an exacerbation of COPD. The mean±sd age was 51±11 years; 313 (55%) were women, 337 (59%) lived in the most deprived neighbourhoods and 45 (9%) were from non-white ethnic backgrounds. 428 (75.0%) had ≥4 comorbidities. Age >70 years was associated with higher in-hospital and 1-year mortality, more places of care (wards) and longer length of stay; having ≥4 comorbidities was associated with higher mortality and longer length of stay. Older age was associated with a significantly lower probability of following a recommended pathway (>70 years: 0.514, 95% CI 0.458-0.571; ≤70 years: 0.636, 95% CI 0.572-0.696; p=0.004).CONCLUSIONS: Only older age was associated with a lower chance of following recommended hospital pathways of care. Such analyses could help refine appropriate care pathways for patients with COPD exacerbations.

AB - INTRODUCTION: Respiratory specialist ward care is associated with better outcomes for patients with COPD exacerbations. We assessed patient pathways and associated factors for people admitted to hospital with COPD exacerbations.METHODS: We analysed routinely collected electronic health data for patients admitted with COPD exacerbation in 2018 to Queen Elizabeth Hospital, Birmingham, UK. We extracted data on demographics, deprivation index, Elixhauser comorbidities, ward moves, length of stay, and in-hospital and 1-year mortality. We compared care pathways with recommended care pathways (transition from initial assessment area to respiratory wards or discharge). We used Markov state transition models to derive probabilities of following recommended pathways for patient subgroups.RESULTS: Of 42 555 patients with unplanned admissions during 2018, 571 patients were admitted at least once with an exacerbation of COPD. The mean±sd age was 51±11 years; 313 (55%) were women, 337 (59%) lived in the most deprived neighbourhoods and 45 (9%) were from non-white ethnic backgrounds. 428 (75.0%) had ≥4 comorbidities. Age >70 years was associated with higher in-hospital and 1-year mortality, more places of care (wards) and longer length of stay; having ≥4 comorbidities was associated with higher mortality and longer length of stay. Older age was associated with a significantly lower probability of following a recommended pathway (>70 years: 0.514, 95% CI 0.458-0.571; ≤70 years: 0.636, 95% CI 0.572-0.696; p=0.004).CONCLUSIONS: Only older age was associated with a lower chance of following recommended hospital pathways of care. Such analyses could help refine appropriate care pathways for patients with COPD exacerbations.

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DO - 10.1183/23120541.00110-2023

M3 - Article

C2 - 37850214

SN - 2312-0541

VL - 9

JO - ERJ Open Research

JF - ERJ Open Research

IS - 5

M1 - 00110-2023

ER -

Mapping inpatient care pathways for patients with COPD: an observational study using routinely collected electronic hospital record data

Abstract

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