The effect of COPD health forecasting on hospitalisation and health care utilisation in patients with mild-to-moderate COPD

Abstract

Exacerbations are a major cause of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD) as well as having a large impact on health care utilisation (HCU). They are more frequent during periods of cold weather with a corresponding increase in hospital admissions. It has been hypothesised that COPD exacerbations and admissions can be reduced by predicting periods of cold weather coupled with patients’ alerts and education. Healthy Outlook^® service provided by the Meteorological Office, UK, was used in patients with mild-to-moderate COPD who consented to participate from three primary care practices. Outcome measures included data relating to hospital admissions for acute exacerbations as well as HCU for these patients during the intervention period (1 Nov 2008-31 Mar 2009) and compared for the same patients and same period 12 months earlier (1 Nov 2007-31 Mar 2008). A cost analysis comparing treatment cost per patient for the two periods was also conducted. A total of 157 (34% of target COPD population) patients took part in the project, with five weather alerts generated (first alert reached 150 patients; second reached 146; third reached 138 patients; fourth reached 137 patients; and the fifth reached 125 patients) during the intervention period. There was a non-statistically-significant increase in hospital admissions per patient (0.07-0.076; p = 0.83). The number of general practice visits per patient dropped from 4.9 to 3.8 (p = 0.001), with drop in average number of visits to patients by out-of-hours services from 0.52-0.14 (p = 0.013). The average number of home consultations provided by general practice increased from 0.05 to 0.92 (p = 0.001). Cost per patient increased by an average of £142 (95% CI -£128 to £412). This anticipatory care model was not associated with reduction in admissions from COPD exacerbations. Further research is required to fully understand its role in the management of patients with COPD.

Keywords

COPD exacerbation health forecast healthy outlook met office cost

References

Rabe KF , Hurd S. , Anzueto A. , Barnes PJ , Buist SA , Calverley P. , et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007; 176(6): 532-555.

Groenewegen KH , Schols AM , Wouters EF Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest 2003; 124(2): 459-467.

McGhan R. , Radcliff T. , Fish R. , Sutherland ER , Welsh C. , Make B. Predictors of rehospitalization and death after a severe exacerbation of COPD. Chest 2007; 132(6): 1748-1755.

Andersson F. , Borg S. , Jansson SA , Jonsson AC , Ericsson A. , Prutz C. , et al. The costs of exacerbations in chronic obstructive pulmonary disease (COPD). Respir Med 2002; 96(9): 700-708.

Mann M. , Patel K. , Reardon JZ , Goldstein M. , Godar TJ , ZuWallack RL The influence of spring and summer New England meteorologic conditions on the respiratory status of patients with chronic lung disease. Chest 1993; 103(5): 1369-1374.

Donaldson GC , Seemungal T. , Jeffries DJ , Wedzicha JA Effect of temperature on lung function and symptoms in chronic obstructive pulmonary disease. Eur Respir J 1999; 13(4): 844-849.

Nichol KL , Baken L. , Nelson A. Relation between influenza vaccination and outpatient visits, hospitalization, and mortality in elderly persons with chronic lung disease. Ann Intern Med. 1999; 130(5): 397-403.

Burge PS Prevention of exacerbations: how are we doing and can we do better? Proc Am Thorac Soc 2006; 3(3): 257-261.

Marno P. , Bryden C. , Bird W. , Watkin HA How different measures of cold weather affect chronic obstructive pulmonary disease (COPD) hospital admissions in London. Eur Resp Rev 2006; 15(101): 185-186.

10.

http://www.metoffice.gov.uk/health/professionals/healthyoutlook/about.html (accessed February 2010).

11.

Hemming D. , Colman A. , James P. , Kaye N. , Marno P. , McNeall D. , et al. Framework for COPD forecasting in the UK using weather and climate change predictions. IOP Conference Series: Earth and Environmental Science. 2009; 6: 142021.

12.

Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax 2004; 59 Suppl1: 1-232.

13.

NHS 2007-08 reference costs. Wetherby, UK : Department of Health, 2009.

14.

Curtis L. Unit costs of health and social care 2008: Personal Social Services Research Unit, University of Kent; 2008.

15.

Efron B. TR. An introduction to the bootstrap. San Francisco, CA: Chapman and Hall, 1994.

16.

Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. The Eurowinter Group. Lancet 1997; 349(9062): 1341-1346.

17.

Wedzicha JA , Seemungal TA COPD exacerbations: defining their cause and prevention. Lancet 2007; 370(9589): 786-796.

18.

http://www.metoffice.gov.uk/climate/uk/stationdata/bradforddata.txt (accessed February 2010).

19.

http://www.metoffice.gov.uk/climate/uk/datasets/.MetOffice (accessed August 2010).

20.

Maheswaran R. , Pearson T. , Hoysal N. , Campbell MJ Evaluation of the impact of a health forecast alert service on admissions for chronic obstructive pulmonary disease in Bradford and Airedale. J Public Health (Oxf) 2010; 32(1): 97-102.

21.

Halpin D. , Laing-Morton T. , Levy M. , Marno P. Effect of an innovative automated interactive health forecast alert system on rate of exacerbations of COPD. Thorax 2009 ; 64(Suppl4): A114-A118.