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Title: Effectiveness of a chronic obstructive pulmonary disease integrated care pathway in a regional health system : a propensity score matched cohort study
Authors: Wu, Christine Xia
Hwang, Chi Hong
Tan, Woan Shin
Tai, Kai Pik
Kwek, Lynette Siang Lim
Chee, Thong Gan
Choo, Yee Mun
Phng, Francis Wei Loong
Chua, Gerald Seng Wee
Keywords: Chronic Obstructive Pulmonary Disease
Issue Date: 2018
Source: Wu, C. X., Hwang, C. H., Tan, W. S., Tai, K. P., Kwek, L. S. L., Chee, T. G., . . . Chua, G. S. W. (2018). Effectiveness of a chronic obstructive pulmonary disease integrated care pathway in a regional health system : a propensity score matched cohort study. BMJ Open, 8(3), e019425-. doi:10.1136/bmjopen-2017-019425
Series/Report no.: BMJ Open
Abstract: Objective: The chronic obstructive pulmonary disease (COPD) integrated care pathway (ICP) programme was designed and implemented to ensure that the care for patients with COPD is comprehensive and integrated across different care settings from primary care to acute hospital and home. We evaluated the effectiveness of the ICP programme for patients with COPD. Design, setting and participants: A retrospective propensity score matched cohort study was conducted comparing differences between programme enrolees and propensity-matched non-enrolees in a Regional Health System in Singapore. Data on patients diagnosed with COPD who enrolled in the programme (n=95) and patients who did not enrol (n=6330) were extracted from the COPD registry and hospital administrative databases. Enrolees and non-enrolees were propensity score matched. Outcome measures: The risk of COPD hospitalisations and COPD hospital bed days savings were compared between the groups using a difference-in-difference strategy and generalised estimating equation approach. Adherence with recommended care elements for the COPD-ICP group was measured quarterly at baseline and during a 2-year follow-up period. Results: Compared with non-enrolees, COPD hospitalisation risk for ICP programme enrolees was significantly lower in year 2 (incidence rate ratio (IRR): 0.73; 95% CI 0.54 to 1.00). Similarly, COPD hospital bed days was significantly lower for enrolees in year 2 (IRR: 0.78; 95% CI 0.64 to 0.95). ICP programme patients had sustained improvements in compliance with all recommended care elements for patients with COPD. The overall all-or-none care bundle compliance rate had improved from 28% to 54%. Conclusion: The study concluded that the COPD-ICP programme was associated with reductions in COPD hospitalisation risk and COPD health utilisation in a 2-year follow-up period.
DOI: 10.1136/bmjopen-2017-019425
Rights: © 2018 Article author(s) (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Fulltext Permission: open
Fulltext Availability: With Fulltext
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