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Background: COPD is associated with significant morbidity, mortality, and hospital costs. The implementation of COPD “discharge care bundles” has been proposed as having an impact on readmissions. We developed and implemented a discharge care bundle and the aim of this study was to evaluate its effects on utilization of hospital services in a real life setting. Methods: We conducted a retrospective chart review study from 2007-2013 to evaluate utilization of hospital services over three time periods (30, 90 days, and one year) post discharge care bundle implementation in two patient cohorts. The first cohort included patients who had utilized any hospital service in the previous year for respiratory complaints and the second included only those who had been admitted. These cohorts were analyzed to evaluate differences in readmissions pre and post discharge care bundle implementation. Results: In the first cohort (210 patients), the 90-day hospital service utilisation rate after implementation was 23.3% versus 35.7% for one hospital service (p=0.049) and at one year it was 22.4% versus 50.0% (p<0.001). In the second cohort (118 patients), the 90 days readmission rate after implementation was 18.6% versus 32.2% for one readmission (p=0.017) and at one year it was 30.5% versus 61.9% (p=0.038). At one year the readmission rate for two readmissions was 14.4% versus 24.6% (p=0.049). Conclusion: The implementation of a COPD discharge care bundle successfully decreases hospital health service utilization and hospital readmissions, with the benefit more likely to be seen on a longer period of follow up beyond 30 days. of COPD and 17.3% for any diagnosis of COPD [5]. It is imperative that COPD exacerbations are not only managed as an acute episode, but prior to hospital discharge steps are taken to fulfill care gaps that would assist in improving quality outcomes. The development and implementation of COPD “discharge care bundles” has been suggested as a practice that could bridge these care gaps and potentially have a positive impact on hospital readmissions and related morbidity and mortality [6-8]. To date however, there have been only a few studies on discharge care bundles for COPD. The typical components common to these discharge care bundles include a medicine reconciliation, review of inhaler technique prior to discharge, referral to health care services after discharge, and smoking cessation counselling. These preliminary studies have shown that the implementation of a discharge care bundle may have the potential to decrease 30-day hospital readmissions [6,7]. However, readmission rates after 30 days, individual components of the care bundle, and whether the discharge care bundle benefits all COPD patients are not known [6,7]. Since 2007, the McGill University Health Centre (MUHC), an academic institution, has undertaken an organizational knowledge transfer initiative, the RECAP project (Rehabilitation, Education for COPD, and Added-value to the medical Practice), to document and overcome care gaps. To help fix these care gaps, a discharge care bundle tool was developed, implemented and data were collected as part of regular practice. We performed a chart review study to evaluate the implementation of this Discharge Care Bundle over a six-year time period to determine if there was a decrease in hospital readmission and emergency department visit rates over a short period, e.g., 30 days, a long period, e.g., 90 days, and one year post hospital discharge. We also evaluated whether the benefits of the discharge care bundle were indistinguishable to all COPD patients and if its benefits were related to specific components rather than the entirety of care.

Discharge Care Bundle for Patients with Acute Exacerbations of COPD: Benefit more likely to be seen beyond 30 Days