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 1 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 2008À31 Mar 2009) and compared for the same patients and same period 12 months earlier (1 Nov 2007À31 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 (0.07À0.076; p ¼ 0.83). The number of general practice visits per patient dropped from 4.9 to 3.8 (p ¼ 0.001), with drop in average number of visits to patients by out-of-hours services from 0.52À0.14 (p ¼ 0.013). The average number of home consultations provided by general practice increased from 0.05 to 0.92 (p ¼ 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.

Health effects of milder winters: a review of evidence from the United Kingdom

“…Specific cardiovascular diseases shown to be associated with cold include myocardial infarction [ 14 ] and stroke [ 32 ]. Among respiratory categories, chronic obstructive pulmonary disease (COPD) is strongly linked with wintertime weather and has been the outcome of intervention studies conducted within the home [ 33 ] and of preventative care informed by a health forecasting and alert system [ 34 ]. Many infectious diseases, including influenza, are seasonally distributed, but the contribution of weather factors to such outcomes is not clear.…”

Forecasting asthma-related hospital admissions in London using negative binomial models

“…The reduced 7-day average model had an AIC of 3245, that is, an improvement in AIC with a reduction in the number of predictors. The reduced 7-day average model included: season, air temperature, vapour pressure, carbon monoxide, sulphur dioxide, nitrogen oxide and PM 10 . Figure 2 shows the plot of the seasonal model and the reduced 7-day average model for the hold-in and hold-out (forecast) periods.…”

Linking e-health records, patient-reported symptoms and environmental exposure data to characterise and model COPD exacerbations: protocol for the COPE study

“…Several studies have attempted to identify relationships between environmental factors and COPD exacerbations. 25 26 However, limitations of the methodological design of previous studies have made it difficult to identify clear links between exposure and health outcomes.…”