在南安普顿市降低住院率和改善 COPD 诊断：为期 12 个月的服务改进项目的方法和结果。
Reducing hospital admissions and improving the diagnosis of COPD in Southampton City: methods and results of a 12-month service improvement project.
机构信息
1] University Hospital Southampton, Southampton, UK [2] Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK.
University Hospital Southampton, Southampton, UK.
出版信息
NPJ Prim Care Respir Med. 2014 Aug 21;24(0):14035. doi: 10.1038/npjpcrm.2014.35.
BACKGROUND
The British Lung Foundation highlighted Southampton City as a hotspot for patients at future risk of chronic obstructive pulmonary disease (COPD) exacerbations due to severe deprivation levels and a high undiagnosed level of disease based on health economic modelling. We developed a strategy spanning primary and secondary care to reduce emergency admissions of patients with acute exacerbations of COPD and increase the diagnosed prevalence of COPD on general practitioner (GP) registers closer to that predicted from local modelling.
METHODS
A comprehensive 3-year audit of admissions was performed. Patients who had been admitted with an exacerbation to University Hospital Southampton three or more times in the previous 12 months were cohorted and cared for in a consultant-led, but community based, COPD service. Within primary care, a programme of education and case-based finding was delivered to most practices within the city.
RESULTS
Thirty-four patients were found to be responsible for 176 admissions (22% of total COPD admissions) to the hospital. These 34 patients required 185 active interventions during the 12-month period but only 39 hospital admissions. The 30-day readmission rate dropped from 13.4 to 1.9% (P<0.01), confirming the contribution the cohort made to readmissions. Prior to the project, the registered Quality Outcomes Framework prevalence of COPD within the city was 1.5; after just 1 year of the project, the prevalence increased from 1.5 to 2.27%.
CONCLUSIONS
The use of medical intelligence to investigate the underlying processes of COPD hospital admissions led to an effective intervention delivered in a consultant-led model.
背景
英国肺脏基金会强调南安普顿市是未来慢性阻塞性肺疾病（COPD）加重患者的热点地区，这是基于健康经济模型，由于严重的贫困水平和高未确诊疾病水平所致。我们制定了一项跨越初级和二级保健的策略，以减少 COPD 急性加重患者的急诊入院次数，并增加全科医生（GP）登记处 COPD 的确诊患病率，使其更接近当地模型预测的水平。
方法
对入院进行了为期 3 年的全面审计。在过去 12 个月中，有 3 次或以上因 COPD 加重而在南安普顿大学医院入院的患者被分组，并在顾问主导但以社区为基础的 COPD 服务中进行护理。在初级保健中，在全市大多数实践中开展了教育和基于病例的发现计划。
结果
发现 34 名患者导致了 176 名（22%的 COPD 总入院人数）医院入院。这 34 名患者在 12 个月期间需要 185 次主动干预，但只需要 39 次住院。30 天再入院率从 13.4%降至 1.9%（P<0.01），证实了该队列对再入院的贡献。在该项目之前，该市的注册质量结果框架 COPD 患病率为 1.5；在该项目实施仅 1 年后，患病率从 1.5 增加到 2.27%。
结论
利用医学情报调查 COPD 住院的潜在过程，导致采用顾问主导模式实施了有效的干预措施。
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