Impact of community-based chronic obstructive pulmonary disease service, a multidisciplinary intervention in an area of high deprivation: a longitudinal matched controlled study

Abstract

Objective To examine the effects of a consultant-led, community-based chronic obstructive pulmonary disease (COPD) service, based in a highly deprived area on emergency hospital admissions. Design A longitudinal matched controlled study using difference-in-differences analysis to compare the change in outcomes in the intervention population to a matched comparison population, 5 years before and after implementation. Setting A deprived district in the North West of England between 2005 and 2016. Intervention A community-based, consultant-led COPD service providing diagnostics, treatment and rehabilitation from 2011 to 2016. Main outcome measures Emergency hospital admissions, length of stay per emergency admission and emergency readmissions for COPD. Results The intervention was associated with 24 fewer emergency COPD admissions per 100 000 population per year (95% CI −10.6 to 58.8, p=0.17) in the postintervention period, relative to the control group. There were significantly fewer emergency admissions in populations with medium levels of deprivation (64 per 100 000 per year; 95% CI 1.8 to 126.9) and among men (60 per 100 000 per year; 95% CI 12.3 to 107.3). Conclusion We found limited evidence that the service reduced emergency hospital admissions, after an initial decline the effect was not sustained. The service, however, may have been more effective in some subgroups.